[Show abstract][Hide abstract] ABSTRACT: Purpose
To evaluate the frequency, CT findings, and fate of multiple infarcted regenerative nodules in patients with liver cirrhosis after variceal bleeding or septic shock.
During a recent 3-year period, 492 patients with hematemesis or melena (n = 445) and septic shock (n = 47) in liver cirrhosis visited our hospital. After applying the exclusion criteria, 136 patients with active variceal bleeding and 29 patients with septic shock were finally included in the study. We diagnosed multiple infarcted regenerative nodules based on the findings of the first follow-up (within 30 days) CT after events. We evaluated the shape, number, size, margin, location, and distribution of the infarcted regenerative nodules.
Thirty-four patients were diagnosed with multiple infarcted regenerative nodules (20.6% [34/165]): 29 among 136 patients with variceal bleeding (21.3% [29/136]) and 5 among 29 patients with septic shock (17.2% [5/29]). Most of the infarcted regenerative nodules were round in shape, more than ten in number (79.4%), measured 1 cm or less (76.3%), had well-defined margins (61.8%), were present in the periphery (67.6%), and had a clustered distribution (67.6%). Almost all of the infarcted regenerative nodules disappeared on the second follow-up CT (88.9% [16/18]).
In cirrhotic patients, multiple infarcted regenerative nodules were not rare (they were found in about one-fifth of the patients) on the first follow-up CT after variceal bleeding or septic shock. Majority of the infarcted regenerative nodules were more than ten in number, measured 1 cm or less, were located in the periphery, and had a clustered distribution.
[Show abstract][Hide abstract] ABSTRACT: This retrospective study assessed the clinical outcome of a transjugular intrahepatic portosystemic shunt (TIPS) procedure for managing portal hypertension in Koreans with liver cirrhosis.
Between January 2003 and July 2013, 230 patients received a TIPS in 13 university-based hospitals.
Of the 229 (99.6%) patients who successfully underwent TIPS placement, 142 received a TIPS for variceal bleeding, 84 for refractory ascites, and 3 for other indications. The follow-up period was 24.9±30.2 months (mean±SD), 74.7% of the stents were covered, and the primary patency rate at the 1-year follow-up was 78.7%. Hemorrhage occurred in 30 (21.1%) patients during follow-up; of these, 28 (93.3%) cases of rebleeding were associated with stent dysfunction. Fifty-four (23.6%) patients developed new hepatic encephalopathy, and most of these patients were successfully managed conservatively. The cumulative survival rates at 1, 6, 12, and 24 months were 87.5%, 75.0%, 66.8%, and 57.5%, respectively. A high Model for End-Stage Liver Disease (MELD) score was significantly associated with the risk of death within the first month after receiving a TIPS (P=0.018). Old age (P<0.001), indication for a TIPS (ascites vs. bleeding, P=0.005), low serum albumin (P<0.001), and high MELD score (P=0.006) were associated with overall mortality.
A high MELD score was found to be significantly associated with early and overall mortality rate in TIPS patients. Determining the appropriate indication is warranted to improve survival in these patients.
[Show abstract][Hide abstract] ABSTRACT: Background
Favorable association between modest alcohol consumption and cardiovascular disease had been reported in general population, however, whether observed benefit extend to men with established fatty liver disease remains unknown.
Cross-sectional study of 10,581 consecutive male participants aged 30 years or older undergoing abdominal ultrasonography and carotid artery ultrasonography were screened. Non-alcoholic fatty liver disease (NAFLD) was diagnosed with ultrasonography and exclusion of secondary causes for fat accumulation or other causes of chronic liver disease. Modest alcohol use was defined as consumption of less than 20 g of alcohol per day.
There were total 2280 men diagnosed with fatty liver, and the mean age was 51.8 years old. Among them, 1797 were modest alcohol drinkers. The prevalence of carotid plaques (55.3% vs. 43.4%, p < 0.001) and carotid artery stenosis (11.0% vs. 5.5%, p < 0.001) was higher in non-drinkers than modest drinkers. Modest alcohol consumption had the independent inverse association with carotid plaques [odd ratio (OR): 0.74, 95% confidence interval (CI): 0.60–0.92] and carotid artery stenosis (OR: 0.62, 95% CI: 0.43–0.90), adjusted for age, smoking and metabolic syndrome.
Modest alcohol consumption had a favorable association with carotid plaque or CAS in men with NAFLD.
[Show abstract][Hide abstract] ABSTRACT: Sorafenib is regarded as the standard treatment of care in Barcelona Clinic Liver Cancer (BCLC) stage C patients. However, the modest overall survival (OS) and disease control rate warrants for a better treatment modality. This study aimed to investigate the feasibility of combined transarterial chemoembolization and radiotherapy (TACE+RT) in comparison with sorafenib for advanced hepatocellular carcinoma (HCC).
From 2007 to 2011, a total of 116 patients with locally advanced HCC were retrospectively enrolled. 67 patients treated with TACE+RT was compared with 49 patients treated with sorafenib. Propensity score-matching generated a matched cohort composed of 27 patients from each group. OS was the primary endpoint for the analysis.
At baseline, the sorafenib group had a tendency for a tumor size≥10cm, presence of lymph node metastasis and main portal vein tumor thrombosis compared to the TACE+RT group. The OS in the TACE+RT group was significantly longer compared to the sorafenib group (14.1 months vs. 3.3 months, p < 0.001). In the propensity score-matched cohort, baseline characteristics did not differ between the two groups. The TACE+RT group showed prolonged OS compared to the sorafenib group (6.7 months vs. 3.1 months, p < 0.001). Multivariate analysis revealed that TACE+RT was the only independent prognostic factor associated with survival in the propensity score-matched cohort (HR = 0.172, p < 0.001).
The OS of TACE+RT was longer compared to sorafenib treatment in locally advanced HCC patients without distant metastasis. Further prospective studies are warranted to confirm these findings. This article is protected by copyright. All rights reserved.
Liver international: official journal of the International Association for the Study of the Liver 12/2013; 34(5). DOI:10.1111/liv.12445 · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Initial presentation of hepatocellular carcinoma (HCC) at an advanced stage in patients under a regular surveillance program is a devastating problem.
We assessed the prevalence and factors associated with this surveillance failure.
A total of 304 HCC patients who received regular surveillance were retrospectively reviewed. Surveillance failure was defined when the tumor was diagnosed at beyond the Milan criteria.
Surveillance failure rate was 5.9 %. Macronodular cirrhosis (MC), ultrasonography-only surveillance (US-S) and infiltrative tumor type were independent factors associated with surveillance failure. The surveillance failure rate was higher in patients with MC (10.3 vs. 3.2 %, p = 0.022), US-S (14.6 vs. 4.3 %, p = 0.013) and when the tumor was infiltrative type (57.1 vs. 2.1 %, p < 0.001). Based on the two baseline factors (MC and US-S), the surveillance failure rates were 35.7, 6.8, 5.9 and 2.6 % for MC(+)/US-S(+), MC(+)/US-S(-), MC(-)/US-S(+) and MC(-)/US-S(-), respectively (p < 0.001).
The HCC surveillance failure was not rare in clinical practice. These data suggest that special attention for surveillance failure might be needed for patients with MC who receive US-S.
Hepatology International 10/2013; 7(4). DOI:10.1007/s12072-013-9462-z · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pegylated interferon (peginterferon) and ribavirin is the current standard therapy for chronic hepatitis C. The aims of this study were to evaluate the efficacy of peginterferon and ribavirin and to identify predictors of a sustained virological response (SVR) to the retreatment of chronic hepatitis C in Korea.
The clinical records of 91 patients with chronic hepatitis C who were retreated with peginterferon and ribavirin were retrospectively analyzed. None of the patients had previously attained a SVR, and the patients were categorized according to their previous responses (nonresponder, relapser, or inadequate treatment) to conventional interferon/ribavirin.
The overall SVR rate was 54.9%. Independent predictors of a SVR were genotypes 2 and 3, relapse, an adherence to peginterferon of over 80%, and an early virological response (EVR). For genotype 1 patients, an adherence to peginterferon of over 80% was an independent predictor of a SVR.
Peginterferon and ribavirin therapy is effective for the retreatment of Korean chronic hepatitis C patients who have failed interferon/ribavirin, especially in patients with genotypes 2 and 3, relapse, an adherence to peginterferon over 80%, and an EVR. For genotype 1 patients, retreatment was effective in patients with an adherence to peginterferon over 80%.
Gut and liver 09/2013; 7(5):585-93. DOI:10.5009/gnl.2013.7.5.585 · 1.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AIM: To investigate whether the disease progression of chronic hepatitis C patients with normal alanine aminotransferase (ALT) levels differs by ALT levels. METHODS: A total of 232 chronic hepatitis C patients with normal ALT (< 40 IU/L) were analyzed. The patients were divided into "high-normal" and "low-normal"ALT groups after determining the best predictive cutoff level associated with disease progression for each gender. The incidence of disease progression, as defined by the occurrence of an increase of ≥ 2 points in the Child-Pugh score, spontaneous bacterial peritonitis, bleeding gastric or esophageal varices, hepatic encephalopathy, the development of hepatocellular carcinoma, or death related to liver disease, were compared between the two groups. RESULTS: Baseline serum ALT levels were associated with disease progression for both genders. The best predictive cutoff baseline serum ALT level for disease progression was 26 IU/L in males and 23 IU/L in females. The mean annual disease progression rate was 1.2% and 3.9% for male patients with baseline ALT levels ≤ 25 IU/L (low-normal) and > 26 IU/L (high-normal), respectively (P = 0.043), and it was 1.4% and 4.8% for female patients with baseline ALT levels ≤ 22 IU/L (low-normal) and > 23 IU/L (high-normal), respectively (P = 0.023). ALT levels fluctuated during the follow-up period. During the follow-up, more patients with "high-normal" ALT levels at baseline experienced ALT elevation (> 41 IU/L) than did patients with "low-normal" ALT levels at baseline (47.7% vs 27.9%, P = 0.002). The 5 year cumulative incidence of disease progression was significantly lower in patients with persistently "low-normal" ALT levels than "high-normal" ALT levels or those who exhibited an ALT elevation > 41 U/L during the follow-up period (0%, 8.3% and 34.3%, P < 0.001). CONCLUSION: A "high normal" ALT level in chronic hepatitis C patients was associated with disease progression, suggesting that the currently accepted normal threshold of serum ALT should be lowered.
World Journal of Gastroenterology 04/2013; 19(14):2256-2261. DOI:10.3748/wjg.v19.i14.2256 · 2.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sorafenib is an orally active multikinase inhibitor approved for the treatment of advanced hepatocellular carcinoma (HCC). However, clinical parameters that may predict the treatment outcomes in sorafenib-treated advanced HCC patients remains unknown.
A total of 99 advanced (BCLC C) HCC patients treated with sorafenib as an initial treatment modality from January 2007 to December 2011 were retrospectively reviewed. Overall survival was the primary endpoint for the analysis. Various clinical parameters including tumour stage and adverse effects to sorafenib were analysed. Univariate and multivariate analysis were carried out to identify clinical parameters predictive of the effect of sorafenib.
There were 86 males and 13 females included in this study, with a median age of 53 years. The median overall survival was 91 days. Sixty-nine patients had Child-Pugh class A cirrhosis and 30 patients had Child-Pugh class B cirrhosis. Hepatitis B virus was the predominant cause of HCC (75.8%). Noted adverse effects were hand-foot syndrome, diarrhoea, fatigue, abdominal pain, nausea and stomatitis. The presence of hand-foot syndrome and diarrhoea and the absence of portal vein thrombosis and lymph node metastasis predicted a better overall survival in the multivariate analysis. Excluding the absence of lymph node metastasis, the same parameters were associated with a longer radiological time to progression.
Advanced HCC patients treated with sorafenib who experienced hand-foot syndrome and diarrhoea showed better overall survival than patients without these side effects. These side effects may be used as clinical parameters predictive of sorafenib response in patients with HCC.
Liver international: official journal of the International Association for the Study of the Liver 04/2013; 33(6). DOI:10.1111/liv.12168 · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: The degree of steatosis is an important factor that determines the graft function in the recipient and the recovery of the remnant liver in the living donor. To date, there is no consensus regarding how to assess steatosis among potential living liver donors. We evaluate the prevalence and risk factors for steatosis in living liver donors with normal serum aminotransferase levels and without fatty liver on ultrasonography (US-negative). METHODS: The degree of steatosis was assessed for a total of 492 US-negative living liver donors with normal aminotransferase levels (age 30.1±9.9; male 301 [61.2%]). Total steatosis was defined by adding the degree of macrosteatosis and microsteatosis. RESULTS: No liver donor had a severe degree (≥60%) of macrosteatosis or microsteatosis. A moderate degree (30-59%) of macrosteatosis and microsteatosis was seen in 4 (0.8%) and 26 (5.3%) subjects, respectively. Severe and moderate degrees of total steatosis were seen in 3 (0.6%) and 53 (10.8%) subjects, respectively. Body mass index and serum triglyceride levels were independent factors associated with the moderate or greater degree of total steatosis. CONCLUSIONS: Noninvasive preoperative assessment for liver steatosis (US-negative with normal aminotransferase level) was sufficient to exclude severe macrosteatosis or microsteatosis and moderate macrosteatosis but not sufficient to exclude moderate microsteatosis or total steatosis in living liver donors.
[Show abstract][Hide abstract] ABSTRACT: Acute hepatic failure (AHF) is one of the most serious complications of transcatheter arterial chemoembolization (TACE). The aims of this study were to investigate risk factors of AHF after TACE and to establish a predictive model for AHF.
In the evaluation set, a total of 820 patients who underwent TACE as a first treatment for hepatocellular carcinoma were included. The demographic, laboratory, radiological and treatment-related factors were analysed to identify risk factors for AHF after TACE and a predictive model was established using the identified risk factors. In the validation set, a different cohort of 438 patients was included to validate the predictive model.
The incidence of post-TACE AHF was 15.1% (124/820). Multivariate analysis revealed that presence of portal vein thrombosis, high aspartate aminotransferase, bilirubin, and log alpha-foetoprotein levels, and low albumin and sodium levels were independent risk factors. A mathematical model was established using these independent risk factors, and the area under the receiver operating characteristic curve of the model was 0.773 (95% confidence interval, 0.726-0.820). The cut-off value of 9 had a sensitivity of 78.2%, a specificity of 72.3%, a positive likelihood ratio of 2.82, a negative likelihood ratio of 0.30, a positive predictive value of 28.9% and a negative predictive value of 95.8%.
The risk factors of post-TACE AHF were presence of portal vein thrombosis, high aspartate aminotransferase, bilirubin, and alpha-foetoprotein levels, and low serum albumin and sodium levels. A mathematical model to predict post-TACE AHF was established.
Liver international: official journal of the International Association for the Study of the Liver 02/2013; 33(2):197-202. DOI:10.1111/liv.12023 · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the efficacy and safety of tenofovir disoproxil fumarate (TDF) for chronic hepatitis B (CHB) patients after multiple failures.
A total of 29 CHB patients who had a suboptimal response or developed resistance to two or more previous nucleoside/nucleotide analogue (NA) treatments were included. Study subjects were treated with TDF alone (n = 13) or in combination with lamivudine (LAM, n = 12) or entecavir (ETV, n = 4) for ≥ 6 mo. Complete virologic response (CVR) was defined as an achievement of serum hepatitis B virus (HBV) DNA level ≤ 60 IU/mL by real-time polymerase chain reaction method during treatment. Safety assessment was based on serum creatinine and phosphorus level. Eleven patients had histories of LAM and adefovir dipivoxil (ADV) treatment and 18 patients were exposed to LAM, ADV, and ETV. Twenty-seven patients (93.1%) were hepatitis B e antigen (HBeAg) positive and the mean value of the baseline serum HBV DNA level was 5.5 log IU/mL ± 1.7 log IU/mL. The median treatment duration was 16 mo (range 7 to 29 mo).
All the patients had been treated with LAM and developed genotypic and phenotypic resistance to it. Resistance to ADV was present in 7 patients and 10 subjects had a resistance to ETV. One patient had a resistance to both ADV and ETV. The cumulative probabilities of CVR at 12 and 24 mo of TDF containing treatment regimen calculated by the Kaplan Meier method were 86.2% and 96.6%, respectively. Although one patient failed to achieve CVR, serum HBV DNA level decreased by 3.9 log IU/mL from the baseline and the last serum HBV DNA level during treatment was 85 IU/mL, achieving near CVR. No patients in this study showed viral breakthrough or primary non-response during the follow-up period. The cumulative probability of HBeAg clearance in the 27 HBeAg positive patients was 7.4%, 12%, and 27% at 6, 12, and 18 mo of treatment, respectively. Treatment efficacy of TDF containing regimen was not statistically different according to the presence of specific HBV mutations. History of prior exposure to specific antiviral agents did not make a difference to treatment outcome. Treatment efficacy of TDF was not affected by combination therapy with LAM or ETV. No patient developed renal toxicity and no cases of hypophosphatemia associated with TDF therapy were observed. There were no other adverse events related to TDF therapy observed in the study subjects.
TDF can be an effective and safe rescue therapy in CHB patients after multiple NA therapy failures.
World Journal of Gastroenterology 12/2012; 18(47):6996-7002. DOI:10.3748/wjg.v18.i47.6996 · 2.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The prognosis of patients with obstructive jaundice caused by hepatocellular carcinoma (HCC) is dismal, because effective biliary drainage is difficult due to frequent malfunction of the drainage tube caused by hemobilia and/or tumor emboli. Photodynamic therapy (PDT) improves biliary patency and prolongs survival in hilar cholangiocarcinoma. The aim of this study was to assess the safety and efficacy of PDT in unresectable HCC with bile duct invasion. Between January 2009 and September 2010, eleven patients with bile duct invasion of unresectable HCC were enrolled at Samsung Medical Center. PDT was performed with 180 J cm(-1) light activation 48 hours after administration of the photosensitizer at a dose of 2 mg kg(-1) body weight. Biliary drainages were performed in all patients. The safety and efficacy of PDT were prospectively evaluated. Eleven patients had successful PDT and biliary drainage. Jaundice improved in seven out of ten patients who had jaundice before PDT. Hemobilia, which had developed in six cases, was controlled by PDT. There were no complications from the photosensitizer. There was no 30-day mortality, and the mean survival was 140.5 days. PDT controlled hemobilia associated with bile duct invasion of HCC and could be an effective treatment option in these patients.
[Show abstract][Hide abstract] ABSTRACT: Intestinal bypass surgery, particularly jejuno-ileal bypass surgery, performed for the purpose of weight reduction may cause an unexpected exacerbation of nonalcoholic steatohepatitis (NASH). Here, we report a case of NASH caused by small intestinal bacterial overgrowth, which developed after jejuno-colic bypass surgery and resolved dramatically after surgical correction.
Gut and liver 10/2012; 6(4):520-3. DOI:10.5009/gnl.2012.6.4.520 · 1.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Several cross-sectional studies have shown an association between pre-S mutation and hepatocellular carcinoma (HCC). AIMS: We aim to verify whether pre-S mutation represents a risk for HCC development in a longitudinal way. METHODS: A total of 195 patients with chronic HBV infection [age: 43.7 ± 10.8 years, males: 141 (72.3 %), genotype C: 195 (100 %), hepatitis B e antigen (HBeAg) positive: 109 (55.9 %), cirrhosis: 79 (40.5 %), and pre-S mutation positive: 44 (22.6 %)] were followed up for a median of 7.2 years (range 1.0-7.8 years). RESULTS: HCC developed in 24 patients during follow-up. The 1-, 3-, and 5-year cumulative incidences of HCC were 0.5, 4.9, and 10.4 %, respectively. Patients with pre-S mutation had significantly higher 5-year cumulative incidences of HCC than those without (26.5 vs. 5.7 %, p < 0.001) and showed higher hazard ratio for HCC [3.04 (95 % CI 1.24-7.42), p = 0.015, adjusted for age, gender, HBeAg, cirrhosis and baseline HBV DNA level]. Notably, in patients aged ≥50 years, the 5-year cumulative incidences of HCC in patients with pre-S mutation were considerably high (58.3 %), compared to those without (16.1 %, p < 0.001). CONCLUSIONS: Patients with pre-S mutations had higher incidence of HCC during follow-up, especially in aged patients. Patients with pre-S mutations, especially older ones, may require careful attention to HCC development.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND & AIMS: The aim was to assess 10-year outcomes of radiofrequency ablation as a first-line therapy of early-stage hepatocellular carcinoma with an analysis of prognostic factors. METHODS: From April 1999 to April 2011, 1305 patients (male:female=993:312; mean age, 58.4years) with 1502 early-stage hepatocellular carcinomas (mean size, 2.2cm) were treated with percutaneous radiofrequency ablation as a first-line option. Follow-up period ranged from 0.4 to 146.6months (median, 33.4months). We assessed the 10-year follow-up results of recurrences and survival with the analyses of prognostic factors. RESULTS: Recurrences occurred in 795 patients (1-17 times), which were managed with various therapeutic modalities. The cumulative local tumor progression rates were 27.0% and 36.9% at 5 and 10years, respectively, for which the only significant risk factor was large tumor size (B=0.584, p=0.001). Cumulative intrahepatic distant and extrahepatic recurrence rates were 73.1% and 88.5%, and 19.1% and 38.2% at 5 and 10years, respectively. Corresponding overall survival rates were 59.7% and 32.3%, respectively. Poor survival was associated with old age (B=0.043, p=0.010), Child-Pugh class B (B=-1.054, p<0.001), absence of antiviral therapy during follow-up (B=-0.699, p=0.034), and presence of extrahepatic recurrence (B=0.971, p=0.007). CONCLUSIONS: Ten-year survival outcomes after percutaneous radiofrequency ablation as a first-line therapy of hepatocellular carcinoma were excellent despite frequent tumor recurrences. Overall survival was influenced by age, Child-Pugh class, antiviral therapy, or extrahepatic recurrence.
Journal of Hepatology 09/2012; 58(1). DOI:10.1016/j.jhep.2012.09.020 · 10.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background/Aims: Accurate staging of hepatocellular carcinoma (HCC) is critical for guiding optimal treatment, and the presence of extrahepatic metastases (EHM) can seriously affect the optimal choice of treatment in the sorafenib era. However, there is limited data about when and how to screen EHM for newly diagnosed HCC patients, especially for patients without symptoms or signs of EHM. Methodology: We analyzed 314 newly diagnosed HCC patients who had no symptoms or signs of EHM and who had undergone additional modalities. Results: EHM was found in 50 of 314 patients (15.9%). Fifteen of 50 EHM (30%) were missed by conventional modalities but revealed by additional modalities. The frequency of EHM were 0% (0/26), 7.6% (10/131), 25.0% (30/120) and 27.0% (10/37) for the modified UICC stages T1, T2, T3 and T4, respectively (p<0.001). The proportions of EHM detected by additional modalities were 50% (5/10 EHM), 33% (10/30 EHM) and 0% (0/10 EHM) for modified UICC stages T2, T3 and T4, respectively. Conclusions: Application of additional staging modalities resulted in change of HCC stage in a significant proportion of HCC patients beyond modified UICC stage T1 by revealing EHM that had not been detected by conventional modalities.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the outcome of sub-centimeter-sized nodules (SCSNs) detected during surveillance for hepatocellular carcinoma (HCC) in patients at risk.
We retrospectively analyzed a total of 142 patients with liver cirrhosis or chronic hepatitis B or C without a prior history of HCC in whom a SCSN was detected during HCC surveillance. We calculated the rate of HCC development from SCSNs in the study population and analyzed the differences in the baseline clinical characteristics and imaging features between the patients with SCSNs that eventually developed into HCC and patients with SCSNs that did not develop into HCC.
During 667 person-years of follow-up, HCC developed in 33 patients. The calculated HCC development rate was 4.9% per year. The cumulative one-, two-, three- and five-year HCC development rates were 5.6%, 10.6%, 14.1% and 20.4%, respectively. Upon baseline comparison, the HCC group was older (54.4 ± 8.3 years vs 48.9 ± 9.4 years; P = 0.003) and had lower albumin levels (3.56 ± 0.58 g/dL vs 3.84 ± 0.55 g/dL; P = 0.012) and higher baseline alpha-fetoprotein (AFP) levels (8.5 ng/mL vs 5.4 ng/mL; P = 0.035) compared to the non-HCC group. Nodule pattern and initial radiologic diagnosis also differed between the two groups. Multivariate analysis revealed that age [P = 0.012, odds ratio (OR) =1.075, 95% confidence interval (CI) =1.016-1.137], sex (P = 0.009, OR = 3.969, 95% CI: 1.403-11.226), and baseline AFP level (P = 0.024, OR = 1.039, 95% CI: 1.005-1.073) were independent risk factors for developing HCC.
The overall risk of HCC development in patients with SCSNs is similar to that in liver cirrhosis patients. Patients with these risk factors need to be closely monitored during follow-up.
World Journal of Gastroenterology 06/2012; 18(21):2654-60. DOI:10.3748/wjg.v18.i21.2654 · 2.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to identify the parameters that could noninvasively predict the presence of esophageal/gastric varices and portal hypertensive gastropathy (PHG) in patients with chronic liver disease (CLD), and to determine the accuracy of those parameters.
We retrospectively analyzed 232 patients with CLD who underwent both upper endoscopy and liver CT within an interval of 3 months. The multidimensional index (M-Index) for spleen volume was obtained from the multiplication of splenic length, width, and thickness, as measured by computer tomography.
The multivariate analysis revealed that platelet, albumin, and M-Index were independently associated with the presence of varices and PHG. We combined three independent parameters, and developed a varices and portal hypertensive gastropathy (VAP) scoring system (=[platelet count (/mm(3))×albumin (g/dL)]/[M-Index (cm(3))]). The area under the receiver operating characteristic curve of the VAP score was 0.850 (95% confidence interval, 0.801-0.899). The VAP cut-off value of 861 had a sensitivity of 85.3%, a positive likelihood ratio of 3.17, and a negative predictive value of 86.4%. For predicting high-risk lesions for bleeding, with a cut-off value of 861 the sensitivity was 92.0%, the positive likelihood ratio was 2.20, and the negative predictive value was 96.4%.
The VAP score can predict the presence of varices and PHG in patients with CLD and may increase the cost-benefit of screening endoscopy in the clinical practice setting. A prospective validation study is necessary in the future.
[Show abstract][Hide abstract] ABSTRACT: We compared the accuracy and usefulness of clinical diagnostic criteria for hepatocellular carcinoma in a hepatitis B virus (HBV)-endemic area.
We reviewed the medical records of 355 patients who had undergone liver resection or biopsy at our institution between January 2008 and December 2009. These patients were reevaluated using four noninvasive diagnostic criteria for hepatocellular carcinoma proposed by the European Association for the Study of the Liver (EASL), the American Association for the Study of Liver Diseases (AASLD), the Korean Liver Cancer Study Group and the National Cancer Center (KLCSG/NCC), and National Comprehensive Cancer Network (NCCN) guidelines.
The overall sensitivity was highest using the KLCSG/NCC criteria (79.8%), followed by the AASLD (51.5%), EASL (38.4%), and NCCN (10.1%; P<0.001) criteria, whereas the specificity (84.5-98.3%) and positive predictive value (96.2-98.3%) were similar for all of the criteria. The KLCSG/NCC criteria had an acceptable false-positive rate and the highest sensitivity among all of the patients, including those positive for HBsAg, those without liver cancer, and those with a tumor of at least 2 cm.
The KLCSG/NCC and AASLD criteria exhibited the highest sensitivity, and all four guidelines had a high specificity among all of the patients. Based on the sensitivity and false-positive rate, the KLCSG/NCC criteria was the most useful in the majority of patients. Inclusion of HBV infection in the clinical diagnostic criteria for hepatocellular carcinoma would be reasonable and may lead to an improvement in the sensitivity, with acceptable false-positive rates, in HBV-endemic areas.