RESUMO
Sarcopenia's impact on hepatocellular carcinoma (HCC) outcomes is well-documented, but the effects of pre-sarcopenia remain unclear. This study investigates the impact of pre-sarcopenia on tumor response and survival in patients with unresectable HCC undergoing transarterial chemoembolization (TACE). We retrospectively evaluated muscle volume using the SliceOmatic software in patients with unresectable HCC treated with TACE. Pre-sarcopenia was defined by Japan Society of Hepatology standards (men: 42 cm2/m2; women: 38 cm2/m2). Pre-sarcopenia and non-pre-sarcopenia groups were compared, and Cox proportional hazards model was used to identify survival-influencing variables. Subgroup analysis was conducted stratified by the tumor burden, using serum alpha-fetoprotein (AFP) levels at a diagnostic cutoff value of 200 ng/mL. Of the 100 patients, 39 had pre-sarcopenia. The presence of pre-sarcopenia was not associated with tumor complete response achievement. The median overall survival (OS) was significantly lower in the pre-sarcopenia group (18 months) than in the non-pre-sarcopenia group (30 months; log-rank P = 0.039). Subgroup analysis among 77 patients with AFP < 200 ng/mL revealed that OS was particularly poor in the pre-sarcopenia group (16 vs. 34 months; log-rank P < 0.001). Multivariate analysis identified increased AFP (adjusted hazard ratio [HR] per 10-unit increase 1.142; P < 0.001), higher Model for End-Stage Liver Disease score (adjusted HR per 1-unit increase 1.176; P < 0.001), and pre-sarcopenia (adjusted HR 2.965; P < 0.001) as predictors of shorter OS. Pre-sarcopenia is a significant predictor of increased mortality in patients with unresectable HCC undergoing TACE, especially in those with AFP < 200 ng/mL, suggesting its potential as a target for early intervention.
Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Sarcopenia , Humanos , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/complicações , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Feminino , Masculino , Sarcopenia/etiologia , Quimioembolização Terapêutica/métodos , Idoso , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , alfa-Fetoproteínas/metabolismo , alfa-Fetoproteínas/análise , Modelos de Riscos ProporcionaisRESUMO
Extramedullary hematopoiesis is a common complication of ineffective erythropoiesis and bone marrow replacement disorders. Because of its nonspecific presentation and radiological appearance, diagnosing focal intrahepatic extramedullary hematopoiesis is challenging and often misdiagnosed as a hepatic tumor. Herein, we describe the case of a 48-year-old male with thalassemia and AE Bart's disease with secondary hemochromatosis and cirrhosis who developed focal intrahepatic extramedullary hematopoiesis mimicking hepatocellular carcinoma. After hepatic resection, extramedullary hematopoiesis was not observed at any site, including in the remaining liver, at the 4-year follow-up.
RESUMO
BACKGROUND AND AIM: Although acute upper gastrointestinal bleeding (UGIB) can lead to anemia, evidence regarding the effects of oral iron supplementation on UGIB-induced anemia following discharge remains lacking. The present study aimed to investigate the effects of oral iron supplementation on hemoglobin response and iron storage in patients with anemia secondary to nonvariceal UGIB. METHODS: This randomized controlled trial included 151 patients with nonvariceal UGIB who had anemia at discharge. Patients were assigned to a 1:1 block in which they were either administered 6 weeks of 600 mg/d oral ferrous fumarate (treatment group, n = 77) or treated without iron supplementation (control group, n = 74). The primary outcome was composite hemoglobin response (hemoglobin elevation greater than 2 g/dL or no anemia at the end of treatment [EOT]). RESULTS: The proportion of patients achieving composite hemoglobin response was greater in the treatment group than in the control group (72.7% vs 45.9%; adjusted risk ratio [RR], 2.980; P = 0.004). At EOT, the percentage change in the hemoglobin level (34.2 ± 24.8% vs 19.4 ± 19.9%; adjusted coefficient, 11.543; P < 0.001) was significantly higher in the treatment group than in the control group; however, the proportions of patients with a serum ferritin level <30 µg/L and a transferrin saturation <16% were lower in the treatment group (all P < 0.05). No significant differences in treatment-associated adverse effects and adherence rates were observed between the groups. CONCLUSION: Oral iron supplementation exerts beneficial effects on anemia and iron storage following nonvariceal UGIB without significantly impacting rates of adverse effects or adherence.
Assuntos
Anemia Ferropriva , Anemia , Humanos , Ferro/efeitos adversos , Anemia Ferropriva/tratamento farmacológico , Anemia Ferropriva/etiologia , Hemoglobinas/análise , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/complicações , Suplementos NutricionaisRESUMO
Background: Holiday admissions are associated with poorer clinical outcomes compared with non-holiday admissions. However, data remain inconsistent concerning the "holiday effect" for patients with upper gastrointestinal bleeding. This study compared the differences between clinical courses of patients with upper gastrointestinal bleeding who were admitted on holidays and non-holidays in Thailand. Methods: We retrospectively reviewed the medical records of patients with upper gastrointestinal bleeding confirmed by endoscopy who were admitted on holidays and non-holidays between January 2016 and December 2017. Mortality, medical resource usage, time to endoscopy, and clinical outcomes were compared between the groups. Results: In total, 132 and 190 patients with upper gastrointestinal bleeding were admitted on holidays and non-holidays, respectively. Baseline characteristics, diagnosis of variceal bleeding, and pre-and post-endoscopic scores were not different between the two groups. Patients admitted on non-holidays were more likely to undergo early endoscopy, within 24 h of hospitalization (78.9% vs. 37.9%, p < 0.001), and had a shorter median time to endoscopy (median [interquartile range]: 17 [12-23] vs. 34 [17-56] h, p < 0.001) than those admitted on holidays. No significant differences in in-hospital mortality rate, number of blood transfusions, endoscopic interventions, additional interventions (including angioembolization and surgery), and length of stay were observed. Patients admitted on holidays had increased admission costs than those admitted on non-holidays (751 [495-1203] vs. 660 [432-1028] US dollars, p = 0.033). After adjusting for confounding factors, holiday admission was a predictor of early endoscopy (adjusted odds ratio 0.159; 95% confidence interval, 0096-0.264, p < 0.001), but was not associated with in-hospital mortality or other clinical outcomes. Conclusions: Patients with upper gastrointestinal bleeding who were admitted on holidays had a lower rate of early endoscopy, longer time to endoscopy, and higher admission cost than those admitted on non-holidays. Holiday admission was not associated with in-hospital mortality or other clinical outcomes.
RESUMO
OBJECTIVE: The Thailand management guideline allows the use of transarterial chemoembolization (TACE) for the treatment of intermediate-stage hepatocellular carcinoma (HCC) in patients with decompensated cirrhosis, whereas other guidelines do not. The aim of this study was to compare the overall survival between TACE and the best supportive care (BSC) in HCC patients with Child-Pugh score 5-8 cirrhosis and in subgroups with compensated cirrhosis (Child-Pugh score 5-6) and early decompensated cirrhosis (Child-Pugh score 7-8). METHODS: This retrospective study comprised 118 patients with intermediate-stage HCC. The overall survival was compared between TACE and BSC using the Kaplan-Meier method. RESULTS: The median overall survival time for all patients was 21.4 months in the TACE group and 8.2 months in the BSC group (P <0.001). In the subgroup analyses, the overall survival times for TACE and BSC were 26 months and 9 months, respectively, for compensated cirrhosis (P <0.001), and 14.5 months and 6.9 months, respectively, for early decompensated cirrhosis (P <0.001). In the Cox proportional-hazards model, TACE was an independent prognostic factor for prolonged overall survival in all patients [hazard ratio (HR) 0.29; 95% confidence interval (CI), 0.17-0.49; P <0.001], patients with compensated cirrhosis (HR, 0.31; 95% CI, 0.16-0.62; P <0.001), and patients with early decompensated cirrhosis (HR, 0.16; 95% CI, 0.061-0.44; P <0.001). CONCLUSION: TACE improves the overall survival in patients with intermediate-stage HCC and compensated or early decompensated cirrhosis.
Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/métodos , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/patologia , Cirrose Hepática/terapia , Neoplasias Hepáticas/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Alcohol consumption increases the risk of hepatocellular carcinoma (HCC) in patients with pre-existing liver disease, including viral hepatitis. However, studies on the impact of alcohol consumption on the outcomes of HCC are limited. We hypothesized that alcohol had an additional effect with chronic viral hepatitis infection on treatment outcomes after transarterial chemoembolization (TACE) in patients with intermediate-stage HCC (Barcelona Clinical Liver Cancer [BCLC] -B). AIM: To evaluate the additional effect of alcohol on treatment outcomes of TACE among HCC patients with viral hepatitis. METHODS: This study, conducted at Hatyai Hospital in Thailand, included HCC patients over 18 years of age with chronic viral hepatitis. Records of HCC patients with viral hepatitis classified as BCLC-B who underwent TACE as the first treatment modality between 2014 and 2019 were retrospectively reviewed. Patients with chronic viral hepatitis only were categorized under group A, and those with chronic viral hepatitis and concurrent alcohol consumption were categorized under group B. Both groups were compared, and the Cox proportional-hazards model was used to identify the survival-influencing variables. RESULTS: Of the 69 patients, 53 were categorized in group A and 16 in group B. There were no statistically significant differences in tumor characteristics between the two patient groups. However, Group A had a statistically significantly higher proportion of complete response (24.5% vs 0%, P = 0.030) and a higher median survival rate (26.2 mo vs 8.4 mo; log-rank P = 0.012) compared to group B. Factors associated with decreased survival in the proportional-hazards model included alcohol consumption (hazards ratio [HR], 2.377; 95% confidence interval [CI], 1.109-5.095; P = 0.026), presence of portal hypertension (HR, 2.578; 95%CI, 1.320-5.037; P = 0.006), largest tumor size > 5 cm (HR, 3.558; 95%CI, 1.824-6.939; P < 0.001), and serum alpha-fetoprotein level > 100 ng/mL (HR, 2.536; 95%CI, 1.377-4.670; P = 0.003). CONCLUSION: In HCC BCLC B patients with chronic viral hepatitis, alcohol consumption is an independent risk factor for increased mortality and decreases the rate of complete response and survival after TACE.
RESUMO
BACKGROUND: To evaluate the factors influencing the achievement of a sustained complete response (CR) and overall survival (OS) in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). METHODS: We retrospectively reviewed the records of HCC patients who underwent TACE as the first modality of treatment between 2014 and 2019. We investigated the factors affecting sustained CR (no recurrence within 6 months) and OS (time from diagnosis until either death or last follow-up). RESULTS: The study enrolled 161 patients; 159 (98.8%) had cirrhosis. Post-TACE, 19.9% (32/161) achieved sustained CR. In the multivariate analysis, a tumor size < 5 cm was a positive factor for achieving sustained CR (odds ratio, 5.012; p = 0.006). In the proportional hazards model, the factors associated with decreased survival included alcohol-related liver disease (hazards ratio [HR] 1.683; p = 0.036), presence of symptoms (HR 1.816; p = 0.005) and portal hypertension (HR 1.608; p = 0.038) at initial diagnosis, serum alpha-fetoprotein (AFP) > 100 ng/mL (HR 2.082; p < 0.001), and higher Child-Pugh classification (HR 1.1.639; p = 0.024). Achievement of sustained CR (HR, 0.355; p = 0.002) was independently associated with increased survival. CONCLUSIONS: The tumor size was a predictive factor for sustained CR. Alcohol-related liver disease, presence of symptoms and portal hypertension at initial diagnosis, elevated serum AFP, liver reserve status, and achieved sustained CR were independent factors affecting survival. We demonstrated the effect of alcohol-related liver disease on survival after TACE. Our results will aid physicians in the management and prognostication of HCC.
Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Hipertensão Portal , Neoplasias Hepáticas , Quimioembolização Terapêutica/métodos , Humanos , Hipertensão Portal/complicações , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , alfa-Fetoproteínas/análiseRESUMO
INTRODUCTION: We assessed the ability of the Child-Turcotte-Pugh score and the albumin-bilirubin grade to predict the outcomes of hepatocellular carcinoma (HCC) in patients treated with transarterial chemoembolization. METHODS: We retrospectively assessed 158 patients with HCC who underwent transarterial chemoembolization. The ability of the Child-Turcotte-Pugh score and the albumin-bilirubin grade to predict patient survival was assessed using the Kaplan-Meier method. The Cox proportional hazards model was used to evaluate survival-predictive variables and the relationship between the obtained score and overall survival. RESULTS: Child-Turcotte-Pugh A (n = 102 (64.6%)) patients showed better overall survival than Child-Turcotte-Pugh B (n = 56 (35.4%)) patients (log-rank P = 0.017), while no significant difference in the overall survival between albumin-bilirubin ≤ 1 (n = 37 (23.4%)) and albumin-bilirubin > 1 (n = 121 (76.6%)) was detected (log-rank P = 0.140). Multivariate analysis identified alcoholic liver disease (P = 0.029), tumor size > 5 cm (P = 0.004), and serum alpha-fetoprotein > 200 ng/mL (P < 0.001) as independent predictive factors of mortality risk. A higher Child-Turcotte-Pugh score was positively associated with decreased overall survival (P = 0.031); however, a higher albumin-bilirubin grade showed marginally significant association (P = 0.088). CONCLUSIONS: The Child-Turcotte-Pugh score precisely categorized the outcomes of HCC in patients undergoing transarterial chemoembolization, and cirrhotic patients with Child-Turcotte-Pugh A will have a better overall survival than those with Child-Turcotte-Pugh B, regardless of HCC status. These results suggest that the Child-Turcotte-Pugh classification system is a more powerful tool to predict patient outcomes than the albumin-bilirubin grading system.
Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/patologia , Bilirrubina , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/patologia , Estudos Retrospectivos , Albumina Sérica Humana/análise , Biomarcadores Tumorais , Resultado do Tratamento , Albuminas , PrognósticoRESUMO
BACKGROUND: Surveillance of hepatocellular carcinoma (HCC) is beneficial for detecting early-stage HCC. The factors that influence adherence to HCC surveillance and late-stage detection have never been evaluated. We investigated the predictive factors that contribute to patients accessing regular HCC surveillance and their association with the detection of late-stage HCC at the time of diagnosis. METHODS: We conducted a prospective observational study at Hatyai Hospital (Songkhla, Thailand) between 2014 and 2016. HCC surveillance includes performing hepatic ultrasonography with/without serum alpha-fetoprotein 6-12 months before the detection of HCC. Logistic regression analyses were conducted separately to examine the relationship between the variables and each endpoint. RESULTS: One hundred ninety-nine HCC patients were enrolled in the study; most patients were of low socioeconomic status, 90.5% had less than a bachelor's degree, and 69.3% of patients had a monthly income of <10,000 baths (US $312.50). Nearly all (93.5%) patients had cirrhosis, 39.7% had hepatitis B virus (HBV) infection, 24.6% had hepatitis C virus infection, and 24.6% had alcohol-related liver disease. The risk of HCC was recognized in 51.8% of patients, and regular HCC surveillance was achieved in 36.2% of patients. Multivariate logistic regression analysis revealed that a monthly income >10,000 baths (US $312.50) (odds ratio [OR], 4.566; p = 0.013), HBV infection (OR, 0.188; p = 0.001), and recognition of patients at risk of HCC (OR, 130.396; p<0.001) were independent predictive factors for adherence to HCC surveillance. Regular HCC surveillance (OR, 0.215; p = 0.003) and recognition of HBV infection (OR, 0.356; p = 0.040) were independent preventive factors for the detection of late-stage HCC at the time of diagnosis. CONCLUSION: In Thailand, awareness of patients at risk of developing HCC and the rate of regular HCC surveillance are low. Greater awareness will enable physicians to surveil and detect HCC.
Assuntos
Carcinoma Hepatocelular/diagnóstico , Diagnóstico Tardio , Detecção Precoce de Câncer , Neoplasias Hepáticas/diagnóstico , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/patologia , Feminino , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Fígado/diagnóstico por imagem , Cirrose Hepática/epidemiologia , Hepatopatias Alcoólicas/epidemiologia , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Socioeconômicos , Tailândia , Ultrassonografia , alfa-Fetoproteínas/análiseRESUMO
Follicular lymphoma (FL) is one of the most common types of non-Hodgkin lymphoma (NHL). The gastrointestinal tract is the most involved extra-nodal site of NHL. Primary duodenal FL (DFL) is a rare entity with only a few reported cases. It mainly involves the second part of the duodenum and has an excellent prognosis. We report the case of a 74-year-old man who underwent esophagogastroduodenoscopy. Endoscopic findings revealed multiple small whitish mucosal nodules which were detected around the major duodenal papilla. Biopsy of these lesions was compatible with grade I FL. Further investigation failed to demonstrate any evidence of nodal or systemic involvement; thus, the clinical staging was stage I, according to the Lugano staging system. A "watch and wait" policy was chosen. Neither lesion aggregation nor lymphadenopathy was noted during the 5-year follow-up period. In conclusion, this was an uncommon case of DFL with an indolent nature and excellent prognosis. However, further studies are needed to clarify the characteristics, prognosis, and therapeutic approach.
RESUMO
BACKGROUND: Immunoglobulin G4 (IgG4) associated autoimmune hepatitis (AIH) has been recognized as a type of autoimmune disease that responds to corticosteroid. The diagnosis is based on elevation of the serum IgG4 level, abundance of IgG4 enhanced plasma cell infiltration in the portal region of the liver, and satisfaction of the criteria for "definite AIH" under the revised International Autoimmune Hepatitis Group (IAIHG) scoring system. However, the clinical course of the disease is unclear. CASE PRESENTATION: A 65-year-old man with jaundice and peripheral blood eosinophilia. His IAIHG and simplified score was compatible with definite AIH and his IgG4 level was elevated. Magnetic resonance imaging did not reveal abnormalities in the hepatobiliary system or pancreas. A liver biopsy revealed interface hepatitis with IgG4 positive plasma cell infiltration in the portal region, without evidence of bile duct injury. He responded to 4-week period of induction prednisolone therapy and had no recurring symptoms under maintenance therapy of 5 mg prednisolone during the 3-year follow up. CONCLUSIONS: This was a rare case that demonstrated an association between IgG4 associated AIH and the presence of peripheral blood eosinophilia.
Assuntos
Eosinofilia , Hepatite Autoimune , Idoso , Eosinofilia/tratamento farmacológico , Hepatite Autoimune/complicações , Hepatite Autoimune/diagnóstico , Hepatite Autoimune/tratamento farmacológico , Humanos , Imunoglobulina G , Masculino , Prednisolona/uso terapêuticoRESUMO
BACKGROUND: Upper gastrointestinal bleeding (UGIB) has been classified into portal and non-portal hypertension (PHT) bleeding causes. Differentiating the two major categories of UGIB is therefore important for selection of the appropriate empirical treatment. OBJECTIVE: To evaluate the potential of certain clinical parameters for predicting the cause of UGIB. MATERIAL AND METHOD: The records of patients with UGIB who underwent endoscopy within 72 hours of diagnosis were retrospectively examined for the clinical parameters. Potential predictive factors for categorizing the cause of UGIB were identified by univariate and multivariate analysis. RESULTS: One hundred forty six UGIB patients were enrolled in the present study. One hundred nine patients had non-PHT bleeding and 37 patients were PHT bleeding. Multivariate analysis identified three independent factors for predicting PHT bleeding, presence of signs of chronic liver disease or PHT (Odds ratio (OR) 51.1, p < 0.05), presence of underlying cirrhosis (OR 28.4, p < 0.05) and an initial hematocrit < 30% (OR 12.7, p < 0.05). A presentation with coffee ground vomitus was the only factor that indicated a reduced possibility of PHT bleeding (OR 0.1, p < 0.05). CONCLUSION: The presence of underlying cirrhosis, signs of chronic liver disease or portal hypertension and an initial hematocrit < 30% were significantly correlated with PHT bleeding while the presentation of coffee ground vomitus indicated a less likely chance of PHT bleeding.