-
Haruhiko Takeda,
Hiroki Nishikawa, Eriko Iguchi,
Yoshiaki Ohara,
Azusa Sakamoto,
Sumio Saito,
Norihiro Nishijima,
Akihiro Nasu,
Hideyuki Komekado,
Ryuichi Kita,
Toru Kimura,
Yukio Osaki
[show abstract]
[hide abstract]
ABSTRACT: AIM: Examine the effect of branched-chain amino acid (BCAA) therapy for patients with unresectable hepatocellular carcinoma (HCC) treated with sorafenib. METHODS: Seventy-eight subjects with unresectable HCC with a serum level of albumin of ≤3.5 g/dL treated with sorafenib were evaluated. They were classified into two groups: those receiving BCAA granules (n = 34; BCAA group) or a regular diet (n = 44; control group). We compared overall survival and administration period of sorafenib, and analyzed absolute changes in serum levels of albumin during sorafenib therapy in 41 patients who continued sorafenib therapy for ≥1 month with a follow-up of >3 months. RESULTS: Median survival time (MST) in BCAA and control groups was 350 days and 143 days (p = 0.007), respectively. Median administration period of sorafenib in the two groups was 59 days and 41 days (p = 0.018). In the 41 patients described above, at 1 month, there was no significant change in the serum level of albumin between the two groups, but at 3 months, the difference in the absolute change in the serum level of albumin in the two groups reached significance (p = 0.023). In these subgroup analyses, the administration period of sorafenib as well as the MST in the BCAA group were significantly longer than those in the control group (p = 0.020 and 0.004). CONCLUSIONS: BCAA treatment during sorafenib therapy in HCC patients is useful for maintaining hepatic functional reserve, which may help to avoid early discontinuance of sorafenib therapy and improve survival.
Hepatology Research 04/2013; · 2.20 Impact Factor
-
Hiroki Nishikawa,
Yukio Osaki, Eriko Iguchi,
Haruhiko Takeda,
Yoshiaki Ohara,
Azusa Sakamoto,
Keiichi Hatamaru,
Shinichiro Henmi,
Sumio Saito,
Akihiro Nasu,
Ryuichi Kita,
Toru Kimura
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND AND AIMS. We aimed to compare clinical outcomes and safety of radiofrequency ablation (RFA) in single hepatocellular carcinoma (HCC) patients aged > 75 years (elderly group) versus patients aged < 75 years (control group). PATIENTS AND METHODS. There were 130 patients in the elderly group and 238 in the control group. Clinical outcomes including overall survival (OS), recurrence free survival (RFS) and local tumor progression (LTP), and safety were analysed for these two groups after initial RFA. RESULTS. The mean (+/- standard deviation [SD]) tumor diameter in the elderly and the control groups was 2.13 +/- 0.86 cm and 1.92 +/- 0.63 cm, respectively; the mean (+/- SD) observation period was 2.5 +/- 1.8 years and 3.2 +/- 2.0 years, respectively. The 1 and 3 year OS rates were 90.0 and 64.1%, respectively, in the elderly group and 97.6 and 83.7%, respectively, in the control group (P=0.001); the corresponding RFS rates were 66.9 and 21.3%, respectively, in the elderly group and 80.5 and 40.0%, respectively, in the control group (P=0.001). The 1 and 3 year LTP rates were 15.0 and 43.0%, respectively, in the elderly group and 8.3 and 26.3%, respectively, in the control group (P=0.002). In terms of duration of hospitalization (P=0.807) and serious adverse events related RFA (P=0.670), there was no significant difference between these two groups. CONCLUSION. The clinical outcomes in the elderly group were poorer than those in the control group, although RFA in the elderly patients was a safe procedure.
Journal of gastrointestinal and liver diseases: JGLD 12/2012; 21(4):397-405. · 1.81 Impact Factor
-
Hiroki Nishikawa,
Yukio Osaki, Eriko Iguchi,
Haruhiko Takeda,
Yoshiaki Ohara,
Azusa Sakamoto,
Keiichi Hatamaru,
Sumio Saito,
Akihiro Nasu,
Ryuichi Kita,
Toru Kimura
[show abstract]
[hide abstract]
ABSTRACT: Aim: To compare the overall survival (OS) in patients without recurrent hepatocellular carcinoma (HCC) after initial radiofrequency ablation (RFA) and in those with recurrence, treated with repeat-RFA.
We compared OS between patients without recurrence (group A; n=150) and those with recurrence treated with repeat-RFA (group B; n=130).
One-, 3- and 5-year OS after initial RFA was 92.6%, 84.1% and 81.0%, respectively, in group A, and 99.0%, 84.1% and 61.8% in group B (p=0.296). There was no significant difference in OS between group A patients and patients with a single recurrent HCC (p=0.834). On multivariate analysis, serum albumin >3.5g/dl and first HCC recurrence, comprising of two or three nodules were significant predicting factors of poorer OS.
Even if HCC recurs after initial RFA, survival comparable to that of patients without recurrence can be achieved in patients with a single recurrent tumor treated with repeat-RFA.
Anticancer research 11/2012; 32(11):5059-65. · 1.73 Impact Factor
-
Hiroki Nishikawa,
Yukio Osaki, Eriko Iguchi,
Yorimitsu Koshikawa,
Soichiro Ako,
Tadashi Inuzuka,
Haruhiko Takeda,
Jun Nakajima,
Fumihiro Matsuda,
Azusa Sakamoto,
Shinichiro Henmi,
Keiichi Hatamaru,
Tetsuro Ishikawa,
Sumio Saito,
Akihiro Nasu,
Ryuichi Kita,
Toru Kimura
[show abstract]
[hide abstract]
ABSTRACT: GOALS:: To elucidate whether long-term supplementation with branched-chain amino acid (BCAA) granules improves overall survival (OS) and recurrence-free survival (RFS) after radiofrequency thermal ablation (RFA) in patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC)≤3 cm in diameter with up to 3 nodules and a serum albumin level before RFA of ≤3.5 g/dL. BACKGROUND:: Whether BCAA treatment after curative RFA for patients with HCV-related HCC improves OS and RFS remains unclear. STUDY:: We compared the OS rate and the RFS rate between the BCAA group (n=115) and the control group (n=141). We also examined factors contributing to OS and RFS. RESULTS:: The 1 and 3 years OS rates after RFA were 94.0% and 70.0%, respectively, in the BCAA group, and 94.0% and 49.8%, respectively, in the control group (P=0.001). The corresponding RFS rates 1 and 3 years after RFA were 61.8% and 28.0%, respectively, in the BCAA group, and 52.0% and 12.0%, respectively, in the control group (P=0.013). In the multivariate analysis, in terms of OS, BCAA treatment, and serum albumin level of ≥3.4 g/dL, and in terms of RFS, age 70 years or older, BCAA treatment, and a serum albumin level of ≥3.4 g/dL were significant independent factors, respectively. CONCLUSIONS:: BCAA treatment may improve OS and RFS after RFA in patients with HCV-related HCC≤3 cm in diameter with up to 3 nodules and a serum albumin level before RFA of 3.5 g/dL.
Journal of clinical gastroenterology 10/2012; · 2.21 Impact Factor
-
Hiroki Nishikawa,
Yukio Osaki, Eriko Iguchi,
Haruhiko Takeda,
Fumihiro Matsuda,
Jun Nakajima,
Azusa Sakamoto,
Keiichi Hatamaru,
Sumio Saito,
Akihiro Nasu,
Ryuichi Kita,
Toru Kimura
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: In our previous study, we classified the radicality (R grading) of percutaneous radiofrequency ablation (RFA) therapy for single hepatocellular carcinoma (HCC) according to the extent of the ablated margin, and demonstrated that this grading system was useful for predicting local tumor progression (LTP) after RFA. The aim of this study was to measure the overall survival (OS), the recurrence free survival (RFS), and the distant recurrence (DR) rate for each R grade (A-D), and to examine the relationship between clinical outcome and R grading. METHODS: This study involved 368 patients with solitary HCC who had undergone RFA. The mean tumor diameter was 2.0 ± 0.7 cm. We calculated the post-RFA cumulative OS, RFS, and DR rate for each R grade and analyzed the factors contributing to clinical outcomes. RESULTS: In the multivariate analysis, significant factors were as follows: tumor size >2 cm, serum albumin >3.5 g/dL, prothrombin time >70 %, HCC recurrence within 1 year, and R grading (grade A) in OS; cause of liver disease (hepatitis B), gamma glutamyl transpeptidase (GGT) >80 IU/L, platelet count >10 × 10(4)/mm(3), and R grading (grade A or B) in RFS; GGT >80 IU/L, platelet count >10 × 10(4)/mm(3), and R grading (grade A or B) in DR. In patients with sufficient Lipiodol accumulation (n = 219), very similar results were obtained. However, in patients with grade A and B (n = 232), R grade was not a significant independent factor linked to OS, although grade A patients had lower LTP rate. CONCLUSIONS: Our proposed R grading system appears to be useful for predicting clinical outcomes after RFA.
Journal of Gastroenterology 10/2012; · 4.16 Impact Factor
-
Hiroki Nishikawa,
Yukio Osaki, Eriko Iguchi,
Haruhiko Takeda,
Jun Nakajima,
Fumihiro Matsuda,
Azusa Sakamoto,
Shinichiro Henmi,
Keiichi Hatamaru,
Sumio Saito,
Akihiro Nasu,
Ryuichi Kita,
Toru Kimura
[show abstract]
[hide abstract]
ABSTRACT: The aim of the present study was to compare overall survival between stage IVA or stage IVB hepatocellular carcinoma (HCC) patients who received transcatheter arterial chemoembolization (TACE) and those who were treated with sorafenib. This retrospective comparative study included 55 patients with stage IVA or IVB HCC in whom TACE was performed as an initial treatment (the TACE group) and 56 patients with stage IVA or IVB HCC to whom sorafenib was administered (the sorafenib group). We compared the overall survival between these two groups. In the TACE group, there were 46 stage IVA HCC patients and 9 stage IVB HCC patients. In the sorafenib group, there were 26 stage IVA HCC patients and 30 stage IVB HCC patients. Median overall survival times were 6.6 months in the TACE group and 9.2 months in the sorafenib group. The 1- and 2-year overall survival rates were 34.4 and 14.2%, respectively, in the TACE group and 34.0 and 6.7%, respectively, in the sorafenib group. In terms of overall survival, there was no significant difference between the two groups (P=0.814). In subgroup analyses, according to HCC stage [stage IVA (P=0.266) or stage IVB (P=0.183)] and Child-Pugh classification [Child-Pugh A (P=0.915) or Child-Pugh B (P=0.676)], there were also no significant differences between the two groups. In conclusion, our study results suggest that TACE could serve as a first-line treatment for stage IV HCC patients as well as sorafenib therapy.
Experimental and therapeutic medicine 09/2012; 4(3):381-386.
-
Hiroki Nishikawa, Eriko Iguchi,
Yorimitsu Koshikawa,
Soichiro Ako,
Tadashi Inuzuka,
Haruhiko Takeda,
Jun Nakajima,
Fumihiro Matsuda,
Azusa Sakamoto,
Sinichiro Henmi,
Keiichi Hatamaru,
Tetsuro Ishikawa,
Sumio Saito,
Ryuichi Kita,
Toru Kimura,
Yukio Osaki
[show abstract]
[hide abstract]
ABSTRACT: The clearance of hepatitis C virus infection by interferon therapy significantly reduces the incidence of hepatocellular carcinoma and death in elderly chronic hepatitis patients. However, there are few reports concerning the efficacy and safety of pegylated interferon-alpha2b plus ribavirin combination therapy in elderly patients. The aims of the present study were to examine the effect and safety of pegylated interferon-alpha2b plus ribavirin combination therapy in 427 patients with chronic hepatitis C infection. We compared the rates of sustained virological response--defined as the absence of detectable hepatitis C virus in serum 24 weeks after the treatment ended--and the treatment discontinuation rate between 319 younger patients aged < 65 years and 108 elderly patients aged ≥ 65 years. We also examined the factors contributing to a sustained virological response.
There was no significant difference in the sustained virological response rate between younger patients and elderly patients according to their hepatitis C virus genotype (41.5% (100/241) and 40.7% (35/86) for genotype 1; P = 0.899, 89.7% (70/78) and 86.4% (19/22) for genotype 2; P = 0.703, respectively). There was also no significant difference in the treatment discontinuation rate between the two age groups (10.3% (33/319) and 13.9% (15/108), respectively; P = 0.378). There were no serious adverse events requiring hospitalization. The factors contributing significantly to a sustained virological response in elderly patients were gender, hepatitis C virus genotype, platelet count, and the presence of a rapid or early virological response (undetectable hepatitis C virus in serum at weeks 4 or 12 of treatment, respectively). However, upon multivariate analysis, the presence of an early virological response was the only significant factor (odds ratio: 0.115, 95% confidence interval: 0.040- 0.330, P < 0.001).
The efficacy and safety of pegylated interferon-alpha2b plus ribavirin combination therapy in elderly patients are not always inferior to those in younger patients. Obtaining an early virological response may be essential to achieve a sustained virological response in elderly patients with chronic hepatitis C infection.
BMC Research Notes 03/2012; 5:135.
