Beom Kyung Kim

Yonsei University Hospital, Sŏul, Seoul, South Korea

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Publications (67)238.48 Total impact

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    ABSTRACT: Background /A ims: Early detection of liver cirrhosis in its subclinical stage is of paramount importance to identify high-risk individuals of developing hepatocellular carcinoma (HCC). This study investigated whether transient elastography (TE) can identify patients with subclinical cirrhosis (SCC) who are at increased risk of developing HCC among chronic hepatitis B (CHB) patients without clinical evidence of cirrhosis.Methods: A total of 2,876 CHB patients without clinical cirrhosis who received TE examinations between April 2006 and December 2012 were enrolled in this prospective study. SCC was defined as a non-clinical cirrhosis, but with a liver stiffness (LS) value ≥13 kPa.Results: The mean age of the study population was 46.1 years, and male gender was predominant (n=1,775, 61.7%). The mean LS value was 7.9 kPa and SCC was identified in 285 (9.9%) patients. During the median follow-up period of 48.9 (range, 6.6-96.2) months, HCC developed in 16 patients (13.3 per 1,000 person-years) in the SCC group and 36 (3.4 per 1,000 person-years) in the non-SCC group. The cumulative incidence rate of HCC in the SCC group was significantly higher than that in the non-SCC group (P<0.001, long-rank test). On multivariate analysis, SCC was independently associated with a risk of developing HCC, regardless of antiviral therapy (without antiviral therapy: hazard ratio [HR] 4.680, 95% confidence interval [CI] 1.187-18.441, P=0.027; with antiviral therapy: HR 3.344, 95% CI 1.526-7.328, P=0.003).Conclusion: Our data suggest that TE can identify CHB patients with SCC who are at increased risk of developing HCC, even when cirrhosis is not clinically apparent. This article is protected by copyright. All rights reserved.
    Hepatology 01/2015; · 11.19 Impact Factor
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    ABSTRACT: The aim of this study is to evaluate prognostic significances of not only the initial and the best response during repeated trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), if eligible, but also time-point of achieving treatment responses.
    Journal of Hepatology. 01/2015;
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    ABSTRACT: To investigate the prevalence of significant liver fibrosis assessed using transient elastography (TE) and its predictors in asymptomatic general population. A total of 159 subjects without chronic viral hepatitis who underwent comprehensive medical health check-up between January 2012 and July 2012 were prospectively recruited. Significant liver fibrosis was defined as liver stiffness value > 7.0 kPa. The mean age and body mass index (BMI) of the study population (men 54.7%) was 56.0 years and 24.3 kg/m(2). Among the study subjects, 11 (6.9%) showed significant liver fibrosis. On univariate analysis, BMI, alanine aminotransferase (ALT), homeostasis model assessment of insulin resistance, carotid intimal media thickness (IMT), number of calcified plaques on carotid ultrasound, and visceral fat area on computed tomography were significantly higher in subjects with significant liver fibrosis than in those without (all P < 0.05). However, on multivariate analysis, BMI [odds ratio (OR) =1.487; P = 0.045], ALT (OR = 1.078; P = 0.014), carotid IMT (OR = 3.244; P = 0.027), and the number of calcified carotid plaques (OR = 1.787; P = 0.031) were independent predictors of significant liver fibrosis. The prevalence of significant liver fibrosis assessed using TE was 6.9% in apparently healthy subjects. High BMI, high ALT, thicker carotid IMT, and higher numbers of calcified carotid plaques were independently associated with the presence of significant liver fibrosis.
    World journal of gastroenterology : WJG. 01/2015; 21(4):1158-66.
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    ABSTRACT: Radiological response assessment criteria in hepatocellular carcinoma (HCC) have evolved to accurately evaluate tumor responses. The WHO criteria and the subsequent Response Evaluation Criteria in Solid Tumors (RECIST) evaluate change in tumor size; however, these criteria generally ignore tumor necrosis and therefore may underestimate treatment responses. Thus, a panel of experts of the European Association for the Study of Liver (EASL) amended the response criteria to take into account tumor necrosis. In 2010, the modified RECIST (mRECIST) was developed, which consider both the concept of tumor viability based on arterial enhancement and single linear summation, ultimately simplifying EASL criteria. Currently, the mRECIST represents the gold standard for radiologically evaluating tumor response during HCC treatment. Here, the authors review application and performance of mRECIST as well as other HCC response assessment criteria and discuss unmet and open issues regarding response evaluation for HCC treatments.
    Expert Review of Gastroenterology and Hepatology 11/2014; · 2.55 Impact Factor
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    ABSTRACT: BackgroundsComputed tomography (CT) and magnetic resonance imaging (MRI) play important roles in diagnosis and staging of hepatocellular carcinoma (HCC). However, prognostic roles of radiological characteristics are not yet determined.Methods Eighty-eight patients treated with chemoembolization were analyzed. Radiological parameters at baseline were assessed in all patients using both dynamic CT and MRI. Treatment responses were assessed using modified RECIST 4 weeks after the first chemoembolization.ResultsGross vascular invasion (GVI), bile duct invasion, irregular tumor margin (ITM), peripheral ragged enhancement (PRE), and satellite nodules on CT or MRI were associated with non-response (stable disease or progression) after chemoembolization, respectively (all p≤0.05). GVI, ITM, and PRE on CT or MRI were also independently associated with poor overall survival (OS), respectively (all p≤0.05). Using these results, a prognostic scoring system for CT and MRI were developed; 0, absence of all 3 features (GVI, ITM, and PRE); 1, presence of one feature; 2, presence of two features; and 3, presence of three features. After adjusting tumor size, tumor number, and alpha-fetoprotein level, both CT and MRI scores were independently associated with OS (both p<0.001). Patients with CT or MRI score≥2 had a worse OS than those with score<2 (adjusted hazard ratios, 3.837 and 2.938, respectively). MRI-specific parameters such as signal intensity on T2- or T1-weighted images, fat signal, or hyperintensity on diffusion-weighted images did not have prognostic value (all p>0.05).Conclusions Radiologic parameters by CT and MRI may be useful in biological characterization of tumors and prognostification for HCC treated with chemoembolization.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 11/2014; · 4.41 Impact Factor
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    ABSTRACT: To elucidate the benefits of successful antiviral therapy in chronic hepatitis C (CHC) patients METHODS: A total of 463 CHC patients who underwent pegylated interferon alfa and ribavirin therapy were classified as sustained virological response (SVR) or non-SVR based on response to antiviral therapy. We investigated disease progression to cirrhosis in non-cirrhotic patients, development of cirrhosis-related complications such as ascites, variceal bleeding, and hepatic encephalopathy in patients with cirrhosis, and development of hepatocellular carcinoma (HCC).
    Digestive Diseases and Sciences 09/2014; · 2.26 Impact Factor
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    ABSTRACT: Background&AimsLiver stiffness (LS) measurement using transient elastography and the FibroTest (FT) are alternatives to liver biopsy (LB) in assessing liver fibrosis. We investigated the prognostic role of the combined use of LS and FT in predicting liver-related events (LREs) in patients with chronic hepatitis B (CHB).Methods Consecutive patients with CHB who underwent LB, along with LS and FT on the same day from 2007 to 2010 were recruited. LRE was defined as hepatic decompensation, hepatocellular carcinoma (HCC), or liver-related death.ResultsA total of 151 patients (86 male) were analyzed. During follow-up (median 59.9 months), overall 18 (11.9%) patients experienced LREs. The areas under receiver-operating characteristic curves of LS, FT, LS+FT and LSxFT in predicting LRE were 0.701, 0.668, 0.702 and 0.741, respectively. After adjusting for age and histological fibrosis staging, significant variables in univariate analysis (both P<0.05), LS+FT and LSxFT were independent predictors of LREs with hazard ratios (HRs) of 1.080 and 1.126 (all P<0.05), respectively. When subjects were divided into three groups according to quartile stratification (low quartile, interquartile and high quartile) using LS+FT and LSxFT, cumulative LRE development rate significantly increased with a corresponding increase in value among three groups, respectively (log-rank test, all P<0.05).Conclusion The combined use of LS and FT significantly predicted forthcoming LRE development, but with only a slight additional benefit compared to LS or FT alone.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2014; · 4.41 Impact Factor
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    ABSTRACT: This study assessed the antiviral efficacy and safety of tenofovir disoproxil fumarate (TDF) for up to 12 months in Korean treatment-naïve chronic hepatitis B (CHB) patients.
    Clinical and molecular hepatology. 09/2014; 20(3):261-6.
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    ABSTRACT: The controlled attenuation parameter (CAP) is a noninvasive method of assessing hepatic steatosis. We defined the normal range of CAP values in healthy subjects and evaluated the associated factors.
    Digestive Diseases and Sciences 08/2014; · 2.26 Impact Factor
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    ABSTRACT: Backgrounds/Aims:Serum fibrosis markers such as Enhanced Liver Fibrosis (ELF) test, have been suggested as alternatives for liver biopsy (LB) in assessing liver fibrosis. We investigated the efficacy of ELF test in predicting development of liver-related events (LRE) in patients with chronic hepatitis B (CHB).Methods:A total of 170 patients (103 men, 60.6%) with CHB who underwent LB and serological tests for determining ELF were enrolled. All patients were followed-up to monitor LRE development, defined as hepatic decompensation, hepatocellular carcinoma, and/or liver-related death.Results:The mean age was 45.3 years. During follow-up period (median, 41 months), 39 (22.9%) patients experienced LRE. In patients with LRE, age, proportion of male gender, ELF test results, age–spleen–platelet ratio (ASPRI), liver stiffness (LS) value, and histological fibrosis stage were significantly higher than those in patients without LRE (all P<0.05). Areas under receiver-operating characteristic curves to predict LRE development were 0.808 for ELF test, 0.732 for LS value, 0.713 for histological fibrosis stages using Batts and Ludwig scoring system, and 0.687 for ASPRI. On multivariate analysis, along with age, ELF test was an independent predictor of LRE development (adjusted hazard ratio [HR] 1.438, P<0.001). When we applied a three-tier stratification of our study population using cut-off ELF values of 8.10 and 10.40, patients with low (P=0.002; adjusted HR 0.045, 95% confidence interval [CI] 0.006–0.330) and intermediate (P<0.001; adjusted HR 0.239, 95% CI 0.122–0.469) ELF range were found less likely to develop LRE compared to those with high ELF range.Conclusion:ELF is useful in a non-invasive prediction of LRE development. TE showed statistically similar prognostic performance for LRE as ELF, but other non-invasive tests were inferior. (Hepatology 2014;)
    Hepatology 08/2014; · 11.19 Impact Factor
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    ABSTRACT: Advanced cancer patients with refractory ascites often do not respond to conventional treatments including dietary sodium restriction, diuretics, and repeated large volume paracentesis. In these patients, continuous peritoneal drainage by an indwelling catheter may be an effective option for managing refractory ascites with a relative low complication rate. Peritoneal catheter-induced complications include hypotension, hematoma, leakage, cellulitis, peritonitis, and bowel perforation. Although bowel perforation is a very rare complication, it can become disastrous and necessitates emergency surgical treatment. Herein, we report a case of a 57-year-old male with refractory ascites due to advanced liver cancer who experienced iatrogenic colonic perforation after peritoneal drainage catheter insertion and was treated successfully with endoscopic clipping. (Korean J Gastroenterol 2014;63:373-377).
    The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 06/2014; 63(6):373-7.
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    ABSTRACT: OBJECTIVES:In the era of antiviral therapy, the prognostic significance of serum hepatitis B virus (HBV) DNA level as a biological gradient substantially diminished, as most patients can achieve complete virological response (CVR). We aimed to investigate the predictive roles of liver stiffness (LS) for liver-related events (LREs) among patients with CVR.METHODS:We analyzed 192 patients with chronic HBV infection who achieved CVR (defined as HBV DNA <20 IU/ml) through entecavir therapy. LS values at CVR were measured using transient elastography. LREs were defined as any cirrhotic complication, hepatocellular carcinoma, and liver-related mortality.RESULTS:The median age of the patients was 49 years, and 134 (69.8%) were male. The median LS value at CVR was 8.8 kPa. During follow-up, LREs occurred in 25 (13.0%) patients. When the population was stratified into three groups (<8.0 kPa, 8.0-13.0 kPa, and >13.0 kPa), cumulative LRE incidences increased significantly in association with LS values (log-rank test, P=0.001). Patients with an LS value >13.0 kPa (hazard ratio (HR)=12.336, 95% confidence interval (CI) 1.335-114.010; P=0.027) and 8.0-13.0 kPa (HR=8.832, 95% CI 1.092-71.432; P=0.041) were at significantly greater risk compared with those with an LS value <8.0 kPa. On multivariate analysis, age and LS values were seen to be independent predictors (all P<0.05). When LS values were incorporated into the REACH-B scoring model instead of serum HBV DNA level, a better predictive performance was seen compared with a conventional approach (areas under the receiver operating characteristic curve, 0.814 vs. 0.629, respectively).CONCLUSIONS:LS values at CVR are useful for predicting forthcoming LRE development. Thus, in the era of potent antiviral therapy, tailored surveillance strategies might be established based upon LS values at CVR.Am J Gastroenterol advance online publication, 24 June 2014; doi:10.1038/ajg.2014.157.
    The American Journal of Gastroenterology 06/2014; · 9.21 Impact Factor
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    ABSTRACT: Liver stiffness (LS) value using transient elastography is a reliable, noninvasive tool for assessing liver fibrosis. LS-based prediction model, LSPS (= LS value x spleen diameter/platelet count) is well correlated with the risk of developing portal hypertension-related cirrhotic complications. Here, we assessed the prognostic performance of LSPS in predicting the development of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB).
    Liver international: official journal of the International Association for the Study of the Liver 06/2014; · 4.41 Impact Factor
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    ABSTRACT: This study evaluated the down-staging efficacy and impact on resectability of concurrent chemoradiotherapy (CCRT) followed by hepatic arterial infusion chemotherapy (HAIC) in locally advanced hepatocellular carcinoma, and identified prognostic factors of disease-free survival (DFS) and overall survival (OS) after curative resection.
    Annals of Surgical Oncology 06/2014; · 3.94 Impact Factor
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    ABSTRACT: Preoperative liver stiffness (LS) measurement using transient elastography (TE) is useful for predicting late recurrence after curative resection of hepatocellular carcinoma (HCC). We developed and validated a novel LS value-based predictive model for late recurrence of HCC.
    PLoS ONE 06/2014; 9(6):e99167. · 3.53 Impact Factor
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    ABSTRACT: Controlled attenuation parameter (CAP) can measure hepatic steatosis. However, factors affecting its accuracy have not been described yet. This study investigated predictors of discordance between liver biopsy (LB) and CAP.
    PLoS ONE 06/2014; 9(6):e98689. · 3.53 Impact Factor
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    ABSTRACT: Backgrounds and AimsIn chronic hepatitis B virus (HBV) infection, quantitative HBV surface antigen (qHBsAg) is useful for monitoring viral replication and treatment responses. We aimed to determine whether pre-S mutations have any effect on circulating qHBsAg.Methods Plasmids expressing 1–8 amino acid deletion in pre-S1 (“pre-S1Δ1-8”) and 3-25 amino acid deletion in pre-S2 (“pre-S2Δ3-25”) were constructed. At 72 h post-transfection into Huh7 cells, qHBsAg were measured using electrochemiluminescence immunoassay analyzer. To mimic milieus of quasispecies, we co-transfected either pre-S1Δ1-8 or pre-S2Δ3-25 with wild type (WT).ResultsPre-S mutations affected transcription and replication ability of HBV because of altered overlapping polymerase. Compared with WT, extracellular qHBsAg in pre-S1Δ1-8 and pre-S2Δ3-25 were on average 3.87-fold higher and 0.92-fold lower, respectively, whereas intracellular qHBsAg in pre-S1Δ1-8 and pre-S2Δ3-25 were 0.57-fold lower and 1.60-fold higher, respectively. Immunofluorescence staining of cellular HBsAg showed that pre-S1Δ1-8 had less staining and that pre-S2Δ3-25 had denser staining. As ratios of either pre-S1Δ1-8 or pre-S2Δ3-25:WT increased from 0:10 to 10:0 gradually, relative extracellular qHBsAg increased from 1.0 to 3.85 in pre-S1Δ1-8 co-transfection, whereas those decreased from 1.0 to 0.88 in pre-S2Δ3-25 co-transfection.Conclusion Pre-S mutations exhibit different phenotypes of genome replication and HBsAg expression according to their locations. Thus, qHBsAg level for diagnosis and prognostification in chronic HBV infection should be used more cautiously, considering emergences of pre-S deletion mutants.
    Journal of Gastroenterology and Hepatology 04/2014; 29(4). · 3.33 Impact Factor
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    ABSTRACT: Although advanced hepatocellular carcinoma (HCC) with extrahepatic metastasis is recommended to be treated by a systemic chemotherapeutic agent without local treatment targeting the liver, studies reported that causes of death in these patients were mostly from progression of intrahepatic lesions. Thus, this study investigated prognosis and factors predicting survival in these patients so as to evaluate the role of local treatments against intrahepatic lesions when the patients already had extrahepatic metastasis. This retrospective study evaluated medical records of 277 patients with HCC and extrahepatic metastasis. The median survival was 5.9 months, and 257 patients died during the follow up. Factors affecting survival of HCC patients with extrahepatic metastasis were poor response to treatment of hepatic lesions (HR 2.207; 95 % CI; p < 0.001), applying local treatment specifically targeting intrahepatic lesions (HR 0.591; 95 % CI 0.436-0.803; p = 0.001), intrahepatic tumor size larger than 3 cm (HR 2.065; 95 % CI 1.444-2.954; p < 0.001), and ECOG performance status 2 or higher (HR 1.543; 95 % CI 1.057-2.253; p = 0.025). The patients with either complete or partial response to the therapy had 1- and 2-year survival rate of 48.8 and 12.1 % whereas patient with either stable or progressive disease had 1-year survival rate of 11.4 %. These results suggest that even in the HCC patients with extrahepatic metastasis, effective local treatment may still be beneficial for the survival especially in patients with acceptable performance status.
    Clinical and Experimental Metastasis 02/2014; 31(4). · 3.46 Impact Factor
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    ABSTRACT: Background/AimsSorafenib is recommended as a standard treatment for advanced hepatocellular carcinoma (HCC). We investigated the efficacy and safety of sorafenib as a first-line therapy in Korean patients with advanced HCC. Methods From 2007 to 2012, 86 patients with advanced HCC (Barcelona Clinic Liver Cancer stage C) treated with sorafenib as a first-line therapy were enrolled from five tertiary hospitals. Predictors of overall survival (OS) and progression-free survival (PFS) were analyzed. ResultsThe median age was 59.5 years and 71 (82.6%) were males; 57 (66.3%) patients were in Child-Pugh class A. The median OS and PFS were 5.0 (range, 4.0-5.9) and 3.2 (range, 2.6-3.7) months, respectively. Regarding OS, Child-Pugh class A (6.0 vs. 2.8 months), tumor diameter < 5 cm (6.0 vs. 4.3 months), baseline α-fetoprotein (AFP) < 200 ng/mL (5.8 vs. 4.1 months), and the advent of hand-foot-skin reaction (HFSR) of ≥ grade 2 (5.9 vs. 4.0 months) were independent favorable predictors (all P < 0.05). Similarly, regarding PFS, Child-Pugh class A (4.3 vs. 2.1 months), tumor diameter < 5 cm (3.9 vs. 2.8 months), baseline AFP < 200 ng/mL (5.6 vs. 2.8 months) and the advent of HFSR of ≥ grade 2 (4.5 vs. 2.6 months) were independent favorable predictors (all P < 0.05). All toxicities during sorafenib treatment were manageable. Conclusions Because the efficacy of sorafenib seems marginal in Korean patients with treatment-naïve HCC, how to select candidates with favorable outcomes should be further investigated.
    Journal of Gastroenterology and Hepatology 02/2014; · 3.33 Impact Factor
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    ABSTRACT: Spontaneous bacterial peritonitis (SBP) is a common and life-threatening infection in patients with advanced cirrhosis. The prognostic value of a novel marker, the delta neutrophil index (DNI), was investigated relative to mortality in patients with SBP. Seventy-five patients with SBP were studied from April 2010 to May 2012. DNI at initial diagnosis of SBP was determined and compared with 30-day mortality rates. Of the patients, 87.7% were men, and the median age of all patients was 59.0 yrs. The area under the receiver-operating characteristic (ROC) curve of DNI for 30-day mortality was 0.701 (95% confidence interval [CI], 0.553-0.849; p = 0.009), which was higher than that of C-reactive protein (0.640, 95% CI, 0.494-0.786; p = 0.076) or the model for end-stage liver disease score (0.592, 95% CI, 0.436-0.748; p = 0.235). From the ROC curve, with the sum of sensitivity and specificity, the cutoff value of DNI was determined to be 5.7%. In the high-DNI group (DNI ≥5.7%), septic shock and 30-day mortality were more prevalent compared with the low-DNI group (84.2% vs. 48.2%, p = 0.007; 57.9% vs. 14.3%, p<0.001, respectively). Patients with an elevated DNI had a higher risk of 30-day mortality compared with those with a low DNI (4.225, 95% CI, 1.631-10.949; p = 0.003). A higher DNI at the time of SBP diagnosis is an independent predictor of 30-day mortality in patients with SBP.
    PLoS ONE 01/2014; 9(1):e86884. · 3.53 Impact Factor

Publication Stats

523 Citations
238.48 Total Impact Points

Institutions

  • 2007–2015
    • Yonsei University Hospital
      • Department of Internal Medicine
      Sŏul, Seoul, South Korea
  • 2011
    • Yonsei University
      • Department of Internal Medicine
      Sŏul, Seoul, South Korea
  • 2010
    • Seoul Medical Center
      Sŏul, Seoul, South Korea