Can we perform esophagectomy for esophageal cancer patients with concomitant liver cirrhosis? A comprehensive systematic review and meta-analysis.

Liver cirrhosis is sometimes encountered in esophageal cancer patients intended for surgery. However, the impact of liver cirrhosis on patients with surgically treated esophageal cancer remains unclear. Therefore, we conducted the first meta-analysis focusing on current topic. We comprehensively searched relevant studies in Pubmed, Embase, and Web of Science on September 3, 2018. Data for analysis included both short-term (including morbidity and mortality rates) and long-term (5-year survival rate) outcomes. Our meta-analysis was conducted by using the STATA 12.0 package. We finally included a total of six cohort studies involving a total of 1426 patients (161 cirrhotic patients and 1265 noncirrhotic patients). Meta-analysis showed that cirrhotic patients had a significantly higher morbidity rate (risk ratio (RR) = 1.226; 95% Confidence interval (CI) = [1.043, 1.442]; P = 0.014) than noncirrhotic patients. For specific complications, cirrhotic patients had a significantly higher rate of pulmonary complications (RR = 2.354; 95%CI = [1.376, 4.026]; P = 0.002) and pleural effusion (RR = 2.414; 95%CI = [1.482, 3.613]; P < 0.001) than noncirrhotic patients and there was a trend toward a higher rate of anastomotic leak (RR = 1.759; 95%CI = [0.945, 3.274]; P = 0.075) in cirrhotic patients. Moreover, cirrhotic patients also had a significantly higher mortality rate (RR = 2.529; 95%CI = [1.480, 4.324]; P = 0.001) than noncirrhotic patients. Cirrhotic patients tended to yield a lower 5-year survival rate than those noncirrhotic patients after surgical resection of esophageal cancer (RR = 0.715; 95%CI = [0.492, 1.039]; P = 0.079). In conclusion, liver cirrhosis was significantly correlated with high morbidity and mortality rates. However, there was no sufficient evidence of unfavorable survival in cirrhotic patients. Esophagectomy can be performed for certain esophageal cancer patients with concomitant liver cirrhosis with acceptable operative risks, providing that careful preoperative evaluation and patient selection have been achieved.

[HBsAg loss with Pegylated-interferon alfa-2a in hepatitis B patients with partial response to nucleos(t)-ide analog: new switch study].

Objective: Hepatitis B surface antigen (HBsAg) loss is seldom achieved with nucleos(t)ide analog (NA) therapy in chronic hepatitis B patients but may be enhanced by switching to finite pegylated-interferon (Peg-IFN) alfa-2a. We assessed HBsAg loss with 48- and 96-week Peg-IFN alfa-2a in chronic hepatitis B patients with partial response to a previous NA. Methods: Hepatitis B e antigen (HBeAg)-positive patients who achieved HBeAg loss and hepatitis B virus DNA < 200 IU/mL with previous adefovir, lamivudine or entecavir treatment were randomized 1:1 to receive Peg-IFN alfa-2a for 48 (n = 153) or 96 weeks (n = 150). The primary endpoint of this study was HBsAg loss at end of treatment. The ClinicalTrials.gov identifier is NCT01464281. Results: At the end of 48 and 96 weeks' treatment, 14.4% (22/153) and 20.7% (31/150) of patients, respectively, who switched from NA to Peg-IFN alfa-2a cleared HBsAg. Rates were similar irrespective of prior NA or baseline HBeAg seroconversion. Among those who cleared HBsAg by the end of 48 and 96 weeks' treatment, 77.8% (14/18) and 71.4% (20/28), respectively, sustained HBsAg loss for a further 48 weeks. Baseline HBsAg < 1 500 IU/mL and week 24 HBsAg < 200 IU/mL were associated with the highest rates of HBsAg loss at the end of both 48- and 96-week treatment (51.4% and 58.7%, respectively). Importantly, extending treatment from 48 to 96 weeks enabled 48.3% (14/29) more patients to achieve HBsAg loss. Conclusion: Patients on long-term NA who are unlikely to meet therapeutic goals can achieve high rates of HBsAg loss by switching to Peg-IFN alfa-2a. HBsAg loss rates may be improved for some patients by extending treatment from 48 to 96 weeks, although the differences in our study cohort were not statistically significant. Baseline and on-treatment HBsAg may predict HBsAg loss with Peg-IFN alfa-2a.

[Analysis of the treatment with traditional Chinese medicine in chronic glomerulonephritis based on histopathologic type].

The histopathologic type of 189 cases of chronic glomerulonephritis (GN) were confirmed by renal biopsies, they were subdivided into 3 groups. 77 patients of Western medicine (WM) group was treated by conventional WM (prednison or CTX), and after treatment the total effective rate was 55.8%. The TCM-WM group was treated by the same WM plus treatment according to Syndrome Differentiation with Chinese medicinal herbs, and the total effective rate was 86% in 50 patients. The TCM group was treated by Chinese medicinal herbs, and the total effective rate was 67.3% in 62 cases. There was very significant difference (P < 0.01) between the WM and the TCM-WM group. Among the patients of TCM-WM and TCM groups, 67% of 112 cases were manifested as Dampness-Heat Syndrome, so it suggested that one of the important method for GN treatment is clearing away Dampness-Heat. The effects of TCM-WM group is much better than the WM group in treating mesangio-proliferative GN and membranous GN. It was difficult for WM in treating IgA nephropathy, membrano-proliferative GN and focal glomerulosclerosis, but Chinese medicinal herbs were effective with replenishing Qi and strengthening the Spleen, clearing away Dampness-Heat, promoting blood circulation and relieving Stasis, etc.