Faculty Profiles - NISHIO Naoki

Anxiety, depression and quality of life in patients with head and neck cancer undergoing laryngectomy: A long-term prospective evaluation. Reviewed International journal

Nobuaki Mukoyama, Naoki Nishio, Hiroyuki Kimura, Tatsuya Tokura, Shinichi Kishi, Kazuyoshi Ogasawara, Hidenori Tsuzuki, Sayaka Yokoi, Akihisa Wada, Mayu Shigeyama, Norio Ozaki, Yasushi Fujimoto, Michihiko Sone

International journal of language & communication disorders Vol. 59 ( 5 ) page： 1865 - 1877 2024.9

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: This study aimed to assess anxiety, depression and quality of life (QoL) in patients with head and neck cancer undergoing laryngectomy using comprehensive self-reported questionnaires for a period of up to 5 years. METHODS: This prospective observational study enrolled 150 consecutive patients with locally advanced head and neck cancer who underwent laryngectomy at Nagoya University Hospital between 2007 and 2020. Anxiety, depression and QoL were assessed at baseline (preoperative) and at 3, 6, 12, 24, 36, 48 and 60 months after surgery using two brief self-reported questionnaires, such as the eight-item Short Form Health Survey (SF-8) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: The surgical procedures were total laryngectomy, pharyngo-laryngectomy and pharyngo-laryngo-oesophagectomy in 97 (65%), 41 (27%) and 12 (8%) patients, respectively. All eight items of the SF-8 were significantly worse than those of the normal population at baseline and at 3 months after surgery. However, general health, vitality, mental health and bodily pain improved to normal levels within 1 year after surgery and were maintained for 5 years. In this study, 35% of patients were categorised as potential cases of depression, and 35% were potential cases of anxiety. During the follow-up period, the proportion of patients with anxiety gradually decreased after surgery. Further analysis revealed that the SF-8 and HADS scores and trends in 89 patients without tumour recurrence were similar to those in the total enrolled 150 patients. CONCLUSION: Anxiety, depression and QoL in laryngectomised patients improved at 1 year after surgery and were maintained for up to 5 years. WHAT THIS PAPER ADDS: What is already known on the subject Laryngectomy is associated with prolonged functional and psychological effects and has a major impact on patient quality of life (QoL). Several prospective studies evaluating the QoL in laryngectomised patients have been reported, in which significant deterioration in social functioning was found even 1 year after surgery. What this paper adds to existing knowledge One year is not a sufficient period for laryngectomised patients to return to normal life and spend their time in a social community. A recent review showed that most studies on QoL in laryngectomised patients were conducted under 1 year after the procedure, and there were not enough studies of sufficient quality. This is the first long-term prospective observational study of Japanese patients with head and neck cancer who underwent laryngectomy up to 5 years after surgery. What are the potential or actual clinical implications of this work? Our long-term observational study showed that the scores for anxiety, depression and QoL in laryngectomised patients improved at 1 year after surgery and were maintained for up to 5 years. Clinicians should recognize the importance of psychosocial risk factors in their QoL and multidisciplinary management, including social and psychological support, is essential for long-term laryngectomised survivors.

DOI： 10.1111/1460-6984.13036

Effect of acute kidney injury and overall survival in patients with postoperative head and neck cancer who received chemoradiotherapy with cisplatin: A supplementary analysis of the phase II/III trial of JCOG1008. Reviewed International journal Open Access

Yoshinori Imamura, Naomi Kiyota, Makoto Tahara, Takeshi Kodaira, Ryuichi Hayashi, Hiroshi Nishino, Yukinori Asada, Hiroki Mitani, Shigemichi Iwae, Naoki Nishio, Yusuke Onozawa, Nobuhiro Hanai, Akira Ohkoshi, Hiroki Hara, Nobuya Monden, Masato Nagaoka, Shujiro Minami, Ryo Kitabayashi, Keita Sasaki, Akihiro Homma

Cancer medicine Vol. 13 ( 18 ) page： e70235 2024.9

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: In a randomized phase II/III trial (JCOG1008), weekly cisplatin (40 mg/m2) was non-inferior to 3-weekly cisplatin (100 mg/m2) for postoperative high-risk head and neck cancer. We investigated how acute kidney injury (AKI), a major dose-limiting toxicity effect of cisplatin, affects overall survival (OS). METHODS: We analyzed 251 patients from JCOG1008 receiving chemoradiotherapy. AKI was defined based on AKI Network criteria (serum creatinine increase of ≥0.3 mg/dL or ≥1.5-fold [≥ stage I]) within 30 days after completing chemoradiotherapy. OS in the two arms was compared according to AKI development using the log-rank test. RESULTS: The total incidence of AKI was lower in the weekly arm than in the 3-weekly arm (38/122 [31.1%] vs. 56/129 [43.4%]). Additionally, stage II/III AKI occurred less frequently in the weekly arm than in the 3-weekly arm (8/122 [6.6%] vs. 19/129 [14.7%]). Cisplatin doses were similar in the weekly arm for patients with and without AKI (median, 238.6 mg/m2 vs. 239.2 mg/m2; p = 0.94), but lower in the 3-weekly arm for those who developed AKI (median, 276.3 mg/m2 vs. 297.4 mg/m2; p = 0.007). In the weekly arm, there was no difference in OS between patients with and without AKI (hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.53 to 2.10). However, in the 3-weekly arm, patients with AKI had poorer OS than those without AKI (HR, 1.83; 95% CI, 1.04 to 3.21). CONCLUSIONS: In this supplementary analysis of JCOG1008 data, AKI impacted the OS of patients with head and neck cancer undergoing postoperative chemoradiotherapy in the 3-weekly arm but not in the weekly arm. Our results further endorse the utilization of weekly cisplatin at 40 mg/m2 in this setting.

DOI： 10.1002/cam4.70235

Development of a plant-based surgical training model for fluorescence-guided cancer surgery. Reviewed International coauthorship International journal Open Access

Mayu Shigeyama, Naoki Nishio, Akihisa Wada, Sohei Mitani, Gaku Morimoto, Sayaka Yokoi, Nobuaki Mukoyama, Mai Yokoi, Stan van Keulen, Eben Rosenthal, Michihiko Sone

Head & neck Vol. 46 ( 9 ) page： 2274 - 2283 2024.9

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Fluorescence-guided surgery (FGS) can help surgeons to discriminate tumor tissue from adjacent normal tissues using fluorescent tracers. METHODS: We developed a surgical training model, manufactured using sustainable vegetable organic material with indocyanine green (ICG)-containing "tumor." Surgeons evaluated the model with both the closed-field and endoscopic fluorescence imaging devices and assessed its efficacy to identify residual tumor after enucleation using electrocautery. RESULTS: Strong correlations of fluorescence were obtained at all working distance (3, 5, 7, and 10 cm), showing the robustness of fluorescence signal for the closed-field and endoscopic fluorescence imaging devices. The higher fluorescence signals were obtained in the wound bed in the closed-field fluorescence imaging device and the residual tumor could be clearly identified by fluorescence endoscopy. CONCLUSIONS: Our FGS training model may provide experience for surgeons unfamiliar with optical surgery and subsequent tissue interactions. The model seemed particularly helpful in teaching surgeons the principles of FGS.

DOI： 10.1002/hed.27835

Risk prediction model for cisplatin-induced acute kidney injury in patients with head and neck cancer receiving chemoradiotherapy: A re-analysis of a phase II/III JCOG1008 trial. Reviewed International journal

Oral oncology Vol. 154 page： 106868 - 106868 2024.7

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: Acute kidney injury (AKI) represents a major toxicity associated with cisplatin. We developed a risk prediction model for cisplatin-induced AKI in patients with postoperative high-risk head and neck cancer who received chemoradiotherapy during a randomized phase II/III trial, JCOG1008. MATERIALS AND METHODS: Two hundred and fifty-one patients received radiotherapy with weekly cisplatin at 40 mg/m2 (weekly arm) or 3-weekly cisplatin at 100 mg/m2 (3-weekly arm). AKI was defined using the AKI Network classification/staging system as increased serum creatinine of ≥0.3 mg/dL or a ≥1.5-fold increase from baseline 30 days after completing chemoradiotherapy. The Akaike information criterion was used to explore the optimal model by combining explanatory variables at registration. RESULTS: Among the 251 patients (210 men and 41 women (median age; 62 years)), 94 (37.5 %) developed cisplatin-induced AKI. The optimal cisplatin-induced AKI risk prediction model comprised four factors, including a primary site of hypopharynx/larynx (vs. oral cavity/oropharynx), 3-weekly arm (vs. weekly arm), serum albumin of ≤3.5 g/dL (vs. >3.5 g/dL) and creatinine clearance (CCr) of <90 mL/min (vs. ≥90 mL/min). The incidence of cisplatin-induced AKI rose with cumulative count of the four factors. When the cumulative count was ≥2, the positive predictive value for cisplatin-induced AKI was 50.3 %. CONCLUSIONS: We developed a risk prediction model for cisplatin-induced AKI in patients with head and neck cancer who received postoperative chemoradiotherapy using primary site, cisplatin administration method, serum albumin, and CCr. Patients with risk factors unrelated to the cisplatin administration method should adopt a weekly cisplatin regimen.

DOI： 10.1016/j.oraloncology.2024.106868

Combined use of tyrosine kinase inhibitors with PD-(L)1 blockade increased the risk of thyroid dysfunction in PD-(L)1 blockade: a prospective study. Reviewed International journal Open Access

Tomoko Kobayashi, Shintaro Iwama, Ayana Yamagami, Tetsushi Izuchi, Koji Suzuki, Koki Otake, Yoshinori Yasuda, Masahiko Ando, Takeshi Onoue, Takashi Miyata, Mariko Sugiyama, Daisuke Hagiwara, Hidetaka Suga, Ryoichi Banno, Tetsunari Hase, Naoki Nishio, Shoichiro Mori, Tomoya Shimokata, Tomoyasu Sano, Kaoru Niimi, Nobuhisa Yoshikawa, Shusuke Akamatsu, Yuichi Ando, Masashi Akiyama, Michihiko Sone, Makoto Ishii, Hiroshi Arima

Cancer immunology, immunotherapy : CII Vol. 73 ( 8 ) page： 146 - 146 2024.6

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Anti-programmed cell death-1 (ligand-1) antibody [PD-(L)1-Ab] can cause destructive thyroiditis and/or hypothyroidism. In addition, tyrosine kinase inhibitors (TKIs) frequently induce hypothyroidism. The aim of this prospective study is to examine the incidence and clinical characteristics of thyroid dysfunction induced by combination therapy of a PD-(L)1-Ab and TKI [PD-(L)1-Ab/TKI]. METHODS: A total of 757 patients treated with PD-(L)1-Ab or PD-(L)1-Ab/TKI were evaluated for anti-thyroid antibodies (ATAs) at baseline and for thyroid function for 48 weeks after treatment initiation and then observed until the last visit. RESULTS: The cumulative incidences of destructive thyroiditis [4/23 (17.4%) vs. 45/734 (6.1%) patients, p < 0.001], isolated hypothyroidism [10/23 (43.5%) vs. 29/734 (4.0%) patients, p < 0.001], and all thyroid dysfunction [14/23 (60.9%) vs. 74/734 (10.1%) patients, p < 0.001] were significantly higher in the PD-(L)1-Ab/TKI group than PD-(L)1-Ab group, respectively. All patients positive for ATAs at baseline developed thyroid dysfunction after PD-(L)1-Ab/TKI treatment, a significantly higher incidence than that in those negative for ATAs at baseline [4/4 (100%) vs. 10/19 (52.6%) patients, p = 0.026]. CONCLUSIONS: The addition of TKIs increased the risk of thyroid dysfunction induced by PD-(L)1-Ab, with the risk being higher in patients positive for baseline ATAs.

DOI： 10.1007/s00262-024-03733-2

アンドロゲン受容体(AR)陽性唾液腺癌に対するAR阻害薬Darolutamide(ODM-201)の第II相試験:単剤パート

大塚倫之, 岡野晋, 今村善宣, 瓜生英興, 大越明, 佐野大佑, 塚原清彰, 大野十央, 花澤豊行, 加納里志, 西尾直樹, 長岡真人, 長尾俊孝, 久野博文, 尾尻博也, 齋藤尚子, 篠田覚, 三角俊裕, 清田尚臣, 田原信

頭頸部癌 Vol. 50 ( 2 ) page： 138 - 138 2024.5

Identification of Optimal Tissue-Marking Dye Color for Pathological Evaluation in Fluorescence Imaging Using IRDye800CW. Reviewed International coauthorship International journal

Takahito Kondo, Naoki Nishio, Jason S Park, Lucas D Mani, Abdullah Naveed, Hidenori Tanaka, James S Lewis Jr, Eben L Rosenthal, Marisa E Hom

Molecular imaging and biology Vol. 26 ( 1 ) page： 162 - 172 2024.2

Language：English Publishing type：Research paper (scientific journal)

PURPOSE: Fluorescence-guided surgery using a tumor-specific antibody-dye conjugate is useful in various cancer types. Fluorescence imaging is a valuable tool both intraoperatively and postoperatively for ex vivo imaging. The color of inks used for tumor specimens during ex vivo specimen processing in pathology is an important consideration for fluorescence imaging since the absorption/emission of the dyes may interfere with the fluorescent dye. This study assesses suitable ink colors for use specifically with IRDye800CW fluorescence imaging. PROCEDURES: Eight tissue-marking inks or dyes (TMDs) commonly used for pathological evaluation were assessed. Agarose tissue-mimicking phantoms containing Panitumumab-IRDye800CW were used as an initial model. Mean fluorescence intensity was measured at 800 nm using both Pearl Trilogy as a closed-field fluorescence imaging system and pde-neo II as an open-field fluorescence imaging system before and after TMD application. An in vivo mouse xenograft model using the human head and neck squamous cell carcinoma FaDu cell line was then used in conjunction with TMDs. RESULTS: The retained IRDye800CW fluorescence on Pearl Trilogy was as follows: yellow at 91.0 ± 4.5%, red at 90.6 ± 2.7%, orange at 88.2 ± 2.2%, violet at 56.6 ± 1.1%, lime at 40.9 ± 1.8%, green at 19.3 ± 2.8%, black at 13.3 ± 0.6%, and blue at 8.1 ± 0.2%. The retained IRDye800CW fluorescence on pde-neo II was as follows: yellow at 86.5 ± 6.4%, red at 77.0 ± 6.2%, orange at 76.9 ± 2.8%, lime at 72.5 ± 9.5%, violet at 59.7 ± 0.4%, green at 30.1 ± 6.9%, black at 17.0 ± 2.7%, and blue at 6.7 ± 1.7%. The retained IRDye800CW fluorescence in yellow and blue TMDs was 42.1 ± 14.9% and 0.2 ± 0.2%, respectively in the mouse experiment (p = 0.039). CONCLUSION: Yellow, red, and orange TMDs should be used, and blue and black TMDs should be avoided for evaluating tumor specimens through fluorescence imaging using IRDye800CW.

DOI： 10.1007/s11307-023-01882-x

Extent of thyroidectomy and paratracheal lymph node dissection in total pharyngolaryngectomy for pyriform sinus cancer, and recurrence, survival, and postoperative hypoparathyroidism: A multicenter retrospective study. Reviewed International journal

Yosuke Ariizumi, Nobuhiro Hanai, Takahiro Asakage, Akira Seto, Toshifumi Tomioka, Junji Miyabe, Hisashi Kessoku, Takashi Mukaigawa, Go Omura, Masanori Teshima, Daisuke Nishikawa, Yuki Saito, Yukinori Asada, Takuo Fujisawa, Takuma Makino, Hiroshi Nishino, Daisuke Sano, Mitsuhiko Nakahira, Kunihiko Tokashiki, Hirokazu Uemura, Tsutomu Ueda, Akihiro Sakai, Muneyuki Masuda, Takahiro Tsujikawa, Yusuke Hiei, Naoki Nishio, Hidetoshi Matsui, Naomi Kiyota, Akihiro Homma

Head & neck Vol. 46 ( 2 ) page： 269 - 281 2024.2

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Total pharyngolaryngectomy (TPL) is standard treatment for hypopharyngeal cancer. However, extensive thyroidectomy and paratracheal nodal dissection (PTND) can cause hypoparathyroidism. We sought to determine the optimum extent of resection. METHODS: We analyzed the clinicopathological information of 161 pyriform sinus cancer patients undergoing TPL from 25 Japanese institutions. Rates of recurrence and risk factors for hypoparathyroidism, as well as incidence of pathological contralateral level VI nodal metastasis and stomal recurrence, were investigated. RESULTS: The extent of thyroidectomy and nodal dissection were not independent risk factors for recurrence. Incidences of contralateral level VI nodal involvement and stomal recurrence were 1.8% and 1.2%, respectively. Patients undergoing hemithyroidectomy/ipsilateral PTND did not develop stomal recurrence and had the lowest incidence of hypoparathyroidism. Prognosis in patients without tracheostomy prior to hemithyroidectomy/ipsilateral PTND was comparable to that with more extensive resections. CONCLUSIONS: Hemithyroidectomy/ipsilateral PTND may be sufficient for pyriform sinus cancer cases without tracheostomy.

DOI： 10.1002/hed.27572

喉頭摘出者における音声収録アプリを用いた術前音声の保存 Save the Voiceプロジェクト Reviewed

西尾直樹, 戸田智基, 小林和弘, 三谷壮平, 飴矢美里, 向山宣昭, 木村宏之, 徳倉達也, 坪井崇, 藤本保志, 曾根三千彦

喉頭 Vol. 35 ( 2 ) page： 142 - 147 2023.12

喉頭摘出術後患者の合成音声を用いた代用音声の満足度調査 Reviewed

飴矢美里, 三谷壮平, 勢井洋史, 木谷卓史, 西尾直樹, 羽藤直人

喉頭 Vol. 35 ( 2 ) page： 148 - 154 2023.12

Efficacy of endoscopic cricopharyngeal myotomy using a curved rigid laryngoscope in patients with sporadic inclusion body myositis: four retrospective case reviews. Reviewed International journal Open Access

Mayu Shigeyama, Naoki Nishio, Sayaka Yokoi, Nobuaki Mukoyama, Akihisa Wada, Takashi Maruo, Seiya Noda, Ayuka Murakami, Takashi Tsuboi, Masahisa Katsuno, Yasushi Fujimoto, Michihiko Sone

Nagoya journal of medical science Vol. 85 ( 4 ) page： 866 - 874 2023.11

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

Sporadic inclusion body myositis (s-IBM) is an acquired degenerative inflammatory myopathy that leads to slowly progressive muscle weakness and atrophy of the limbs, face, and pharynx. Owing to the slow progression of the disease, the indications for surgical intervention remain unclear. Herein, we retrospectively reviewed the records of four patients with s-IBM who had undergone cricopharyngeal myotomy for severe dysphagia at our institution between 2016 and 2021. Among these, one patient underwent transcervical cricopharyngeal myotomy and laryngeal suspension, as videofluoroscopic examination of swallowing revealed poor laryngeal elevation. The remaining three patients underwent endoscopic cricopharyngeal myotomy using a curved rigid laryngoscope. Preoperatively, the mean Hyodo score was 8 points (range: 6-10) using a flexible endoscope. The mean surgical duration was 104 min, and no severe complications were observed. Postoperatively, all patients achieved improvement in swallowing function and food intake. Moreover, swallowing function was maintained in all four patients even 6-12 months postoperatively. Cricopharyngeal myotomy may be a safe surgical procedure with the potential to improve swallowing function, and a Hyodo score of 6 may be considered a surgical indication for cricopharyngeal myotomy in patients with s-IBM.

DOI： 10.18999/nagjms.85.4.866

Impact of acute kidney injury on overall survival in postoperative patients with head and neck cancer who received chemoradiotherapy with cisplatin: A supplementary analysis of a phase II/III trial of JCOG1008. Open Access

Hypopharyngeal Injury by Transesophageal Echocardiography During Cardiac Surgery. Reviewed International journal Open Access

Yohei Aoki, Takahiro Tamura, Wataru Uchida, Hiroshi Morioka, Mayumi Yamamoto, Satoshi Yuhara, Naoki Nishio, Masato Mutsuga, Satoshi Furune, Shogo Suzuki, Kimitoshi Nishiwaki

Journal of cardiothoracic and vascular anesthesia Vol. 37 ( 10 ) page： 2027 - 2031 2023.10

Imamura, Y; Kiyota, N; Tahara, M; Kodaira, T; Hayashi, R; Nishino, H; Asada, Y; Mitani, H; Iwae, S; Nishio, N; Onozawa, Y; Hanai, N; Ohkoshi, A; Hara, H; Monden, N; Nagaoka, M; Minami, S; Kitabayashi, R; Sasaki, K; Homma, A

JOURNAL OF CLINICAL ONCOLOGY Vol. 41 ( 16 ) 2023.6

A risk prediction model for cisplatin-induced acute kidney injury in patients with head and neck cancer who receive chemoradiotherapy: A supplement analysis of a phase II/III trial of JCOG1008 Reviewed International journal Open Access

JOURNAL OF CLINICAL ONCOLOGY Vol. 41 ( 16 ) 2023.6

Darolutamide for patients with androgen receptor positive salivary gland cancers (DISCOVARY): The results of phase 2 study of darolutamide monotherapy

Okano, S; Tahara, M; Imamura, Y; Uryu, H; Otsuka, T; Ohkoshi, A; Sano, D; Tsukahara, K; Ono, K; Hanazawa, T; Kano, S; Nishio, N; Nagaoka, M; Kiyota, N

JOURNAL OF CLINICAL ONCOLOGY Vol. 41 ( 16 ) 2023.6

Comparison of quality of life and psychological distress in patients with tongue cancer undergoing a total/subtotal glossectomy or extended hemiglossectomy and free flap transfer: a prospective evaluation Reviewed

K. Suzuki, N. Nishio, H. Kimura, T. Tokura, S. Kishi, N. Ozaki, Y. Fujimoto, M. Sone

International Journal of Oral and Maxillofacial Surgery Vol. 52 ( 6 ) page： 621 - 629 2023.6

Abdominal pain accompanied by elevated serum inflammatory markers and biliary enzymes for diagnosing immune checkpoint inhibitor-induced sclerosing cholangitis. Reviewed International journal Open Access

Takafumi Yamamoto, Kazuyuki Mizuno, Takanori Ito, Shinya Yokoyama, Kenta Yamamoto, Norihiro Imai, Yoji Ishizu, Takashi Honda, Takuya Ishikawa, Akira Kanamori, Satoshi Yasuda, Hidenori Toyoda, Kenji Yokota, Tetsunari Hase, Naoki Nishio, Osamu Maeda, Makoto Ishii, Michihiko Sone, Yuichi Ando, Masashi Akiyama, Masatoshi Ishigami, Hiroki Kawashima

Investigational new drugs Vol. 41 ( 3 ) page： 512 - 521 2023.6

Language：English Publishing type：Research paper (scientific journal)

Immune-related sclerosing cholangitis (irSC) is relatively rare and its clinical characteristics are not well known. In this study, we aimed to summarize the clinical features of irSC. Clinical data were collected retrospectively from 1,393 patients with advanced malignancy treated with immune-checkpoint inhibitors (ICIs) between August 2014 and October 2021. We analyzed patients with immune-related adverse events of liver injury (liver-irAEs) and compared irSC and non-irSC groups. Sixty-seven patients (4.8%) had a liver-irAE (≥ grade 3) during the follow-up period (median, 262 days). Among these, irSC was observed in eight patients (11.9%). All patients in the irSC group were treated with anti-PD-1/PD-L1 antibodies. Compared with the non-irSC group, the irSC group showed mainly non-hepatocellular liver injury (87.5 % vs 50.8 %, P = 0.065), and had elevated serum inflammatory markers (e.g., CRP and NLR) and biliary enzymes (e.g., GGTP and ALP) at the onset of liver-irAEs. Furthermore, most patients with irSC had abdominal pain. In the non-irSC group, the liver injury of 23 patients improved only with the discontinuation of ICIs, and 22 patients improved with medication including prednisolone (PSL). Conversely, almost all patients (n=7) in the irSC group were treated with PSL, but only two patients experienced an improvement in liver injury. We found that irSC is characterized by a non-hepatocellular type of liver injury with abdominal pain and a high inflammatory response and is refractory to treatment. Further examination by imaging is recommended to detect intractable irSC in cases with these characteristics.

DOI： 10.1007/s10637-023-01366-3