Reassessing hepatocellular carcinoma staging in a changing patient population.

OBJECTIVE: Hepatocellular carcinoma (HCC) staging systems were developed using data predominantly from patients who had hepatitis and cirrhosis. Given the recent change in prevalence of viral hepatitis and cirrhosis at oncology centers, which has altered the natural history of HCC, we aimed at comparing the accuracy of HCC staging systems in patients with or without hepatitis and cirrhosis. METHODS: A total of 438 patients were enrolled. Baseline clinicopathologic parameters, Barcelona Clinic Liver Cancer stage, Cancer of the Liver Italian Program score, TNM (6th edition) stage, Okuda stage, and Chinese University Prognostic Index score were prospectively obtained for all patients, and retrospectively analyzed. Kaplan-Meier analysis was used to determine overall survival (OS), Cox regression analyses were performed, and Harrell's Correspondence Index compared the staging systems' ability to predict OS duration. Subgroup analyses of patients with or without hepatitis or cirrhosis were performed. RESULTS: Median patient OS was 13.9 months; 165 patients (37.7%) had no cirrhosis and 256 patients (58.4%) had no hepatitis. Overall, all staging systems were significantly less predictive of OS in patients who did not have cirrhosis or hepatitis. CONCLUSION: Our results advocate the need to further stratify HCC based on cirrhosis and hepatitis status, which may change patient risk-stratification and, ultimately, treatment decisions.

Genetic variation in the PNPLA3 gene and hepatocellular carcinoma in USA: risk and prognosis prediction.

Nonalcoholic fatty liver disease (NAFLD) is an emerging epidemic with high prevalence in Western countries. Genome-wide association studies had reported that a variation in the patatin-like phospholipase domain containing 3 (PNPLA3) gene is associated with high susceptibility to NAFLD. However, the relationship between this variation and hepatocellular carcinoma (HCC) has not been well established. We investigated the impact of PNPLA3 genetic variation (rs738409: C>G) on HCC risk and prognosis in the United States by conducting a case-control study that included 257 newly diagnosed and pathologically confirmed Caucasian patients with HCC (cases) and 494 healthy controls. Multivariate logistics and Cox regression models were used to control for the confounding effects of HCC risk and prognostic factors. We observed higher risk of HCC for subjects with a homozygous GG genotype than for those with CC or CG genotypes, the adjusted odds ratio (OR) was 3.21 (95% confidence interval [CI], 1.68-6.41). We observed risk modification among individuals with diabetes mellitus (OR = 19.11; 95% CI, 5.13-71.20). The PNPLA3 GG genotype was significantly associated with underlying cirrhosis in HCC patients (OR = 2.48; 95% CI, 1.05-5.87). Moreover, GG allele represents an independent risk factor for death. The adjusted hazard ratio of the GG genotype was 2.11 (95% CI, 1.26-3.52) compared with CC and CG genotypes. PNPLA3 genetic variation (rs738409: C>G) may determine individual susceptibility to HCC development and poor prognosis. Further experimental investigations are necessary for thorough assessment of the hepatocarcinogenic role of PNPLA3.

Comparison of three modes of positive pressure mask ventilation during induction of anaesthesia: a prospective, randomized, crossover study.

BACKGROUND: Mask ventilation of apnoeic patients may be associated with alveolar hypoventilation, hyperventilation and gastric insufflation, which may be affected by the mode of ventilation during induction of anaesthesia. This study is to compare the effect of three modes of positive pressure mask ventilation during induction of anaesthesia regarding ventilatory variables and gastric insufflation. METHODS: Ninety (90) patients, ASA I-II were included in this prospective, randomized, crossover study. Patients were divided into three groups of different sequence of modes of ventilation. Each patient was ventilated with pressure-controlled ventilation (PCV), manual-controlled ventilation (MCV), and volume-controlled ventilation (VCV) during the induction of anaesthesia. Respiratory and haemodynamic variables were monitored. Gastric insufflation was detected with a stethoscope applied to epigastric area. RESULTS: Haemodynamic variables showed no significant differences between the three modes of ventilation. PCV was associated with lower peak airway pressures (11.4 +/- 1.2 cmH2O) compared with MCV and VCV (14.3 +/- 1.7 and 13.3 +/- 1.5 cmH2O; respectively P < 0.0001). Inspiratory and expiratory tidal volumes showed no significant differences between the three modes. Gastric insufflation was detected in one patient (1.1%) in the PCV group compared to three patients (3.3%) in the MCV group and three patients (3.3%) in the VCV group. CONCLUSION: We concluded that in this model of apnoeic patients with an unprotected airway, PCV was associated with lower peak airway pressure which may provide additional patient safety.