Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 18 de 18
Filtrar
Mais filtros

Bases de dados
Tipo de documento
País de afiliação
Intervalo de ano de publicação
1.
Hepatol Res ; 53(10): 1031-1042, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37306040

RESUMO

AIM: The present study focused on Geriatric Nutritional Risk Index (GNRI), which is based on bodyweight and serum albumin, and known as an easy-to-use nutritional assessment tool in clinical settings, to elucidate the prognostic predictive ability of GNRI in patients treated with atezolizumab plus bevacizumab (Atez/Bev) for hepatocellular carcinoma (HCC). METHODS: A total of 525 HCC patients treated with Atez/Bev, based on their classification of unsuitable status for curative treatments and/or transarterial catheter chemoembolization, were enrolled (Child-Pugh A:B:C = 484:40:1, Barcelona Clinic Liver Cancer stage 0:A:B:C:D = 7:25:192:283:18). Prognosis was evaluated retrospectively using GNRI. RESULTS: Atez/Bev was used in 338 of the present cohort as first-line systemic chemotherapy (64.4%). Median progression-free survival based on GNRI indicating normal, mild decline, moderate decline, and severe decline was 8.3, 6.7, 5.3, and 2.4 months, respectively, whereas median overall survival was 21.4, 17.0, 11.5. and 7.3 months, respectively (both p < 0.001). The concordance index (c-index) values of GNRI for predicting prognosis (progression-free survival/overall survival) were superior to those of Child-Pugh class and albumin-bilirubin grade (0.574/0.632 vs. 0.527/0.570 vs. 0.565/0.629). As a subanalysis, muscle volume loss was observed in 37.5% of 256 patients with computed tomography data available. Along with GNRI decline, frequency of muscle volume loss became progressively larger (normal vs. mild vs. moderate vs. severe = 17.6% vs. 29.2% vs. 41.2% vs. 57.9%, p < 0.001), and a GNRI value of 97.8 was predictive of its occurrence (AUC 0.715, 95% CI 0.649-0.781; specificity/sensitivity = 0.644/0.688). CONCLUSION: These findings indicate that GNRI is an effective nutritional prognostic tool for predicting prognosis and muscle volume loss complication in HCC patients treated with Atez/Bev.

2.
Hepatol Commun ; 6(3): 461-472, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34676692

RESUMO

The identification of patients with advanced fibrosis who do not need any further hepatocellular carcinoma (HCC) surveillance after the eradication of hepatitis C is pivotal. In this study, we developed a simple serum-based risk model that could identify patients with low-risk HCC. This was a nationwide multicenter study involving 16 Hospitals in Japan. Patients with advanced fibrosis (1,325 in a derivation cohort and 508 in a validation cohort) who achieved sustained virological responses at 24 weeks after treatment (SVR24) were enrolled. The HCC risk model at any point after SVR24 and its change were evaluated, and subsequent HCC development was analyzed. Based on the multivariable analysis, patients fulfilling all of the factors (GAF4 criteria: gamma-glutamyl transferase < 28 IU/L, alpha-fetoprotein < 4.0 ng/mL, and Fibrosis-4 Index < 4.28) were classified as low-risk and others were classified as high-risk. When patients were stratified at the SVR24, and 1 year, and 2 years after SVR24, subsequent HCC development was significantly lower in low-risk patients (0.5-1.1 per 100 person-years in the derivation cohort and 0.9-1.1 per 100 person-years in the validation cohort) than in high-risk patients at each point. HCC risk from 1 year after SVR24 decreased in patients whose risk improved from high-risk to low-risk (HCC incidence: 0.6 per 100 person-years [hazard ratio (HR) = 0.163 in the derivation cohort] and 1.3 per 100 person-years [HR = 0.239 in the validation cohort]) than in those with sustained high risk. Conclusion: The HCC risk model based on simple serum markers at any point after SVR and its change can identify patients with advanced fibrosis who are at low HCC risk, and these patients may be able to reduce HCC surveillance.


Assuntos
Carcinoma Hepatocelular , Hepatite C Crônica , Hepatite C , Neoplasias Hepáticas , Antivirais/uso terapêutico , Carcinoma Hepatocelular/diagnóstico , Hepacivirus , Hepatite C/complicações , Hepatite C Crônica/complicações , Humanos , Cirrose Hepática/complicações , Neoplasias Hepáticas/diagnóstico , Medição de Risco , Fatores de Risco
3.
J Viral Hepat ; 28(3): 538-547, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33215790

RESUMO

To investigate the long-term prognosis of liver disease in patients with hepatitis C virus (HCV) eradication after antiviral therapy versus those with persistent HCV infection. Four hundred and eighty patients (5259 person-years [PYs]) who received interferon-based therapy and achieved sustained virologic response and 848 patients (3853 PYs) with persistent HCV infection were included. In the analysis of 1-year liver disease state transition probability matrices using Markov chain models, progression to cirrhosis from the chronic hepatitis state was observed (0.00%-0.63%) in patients with HCV eradication. Among patients with chronic hepatitis or cirrhosis and HCV eradication, hepatocellular carcinoma (HCC) development was observed in males aged ≥ 50 years (0.97%-1.96%) and females aged ≥ 60 years (0.26%-5.00%). Additionally, in patients with cirrhosis and HCV eradication, improvement to chronic hepatitis was also observed (4.94%-10.64%). Conversely, in patients with chronic hepatitis and persistent HCV infection, progression to cirrhosis was observed in males aged ≥ 30 years and female aged ≥ 40 years (0.44%-1.99%). In males aged ≥ 40 years and female aged ≥ 50 years with cirrhosis, the transition probability for HCC was relatively high (4.17%-14.02%). Under the assumption of either chronic hepatitis or cirrhosis at age 40 or 60 years as the starting condition for simulation over the next 30 or 40 years, respectively, the probability of HCC was higher in patients with persistent HCV infection than those with HCV eradication. In conclusion, HCV eradication can reduce the risk of developing cirrhosis or HCC in patients with chronic HCV infection.


Assuntos
Carcinoma Hepatocelular , Hepatite C Crônica , Hepatite C , Neoplasias Hepáticas , Adulto , Antivirais/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/epidemiologia , Feminino , Hepacivirus/genética , Hepatite C/tratamento farmacológico , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/epidemiologia , Humanos , Cirrose Hepática/tratamento farmacológico , Cirrose Hepática/epidemiologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/epidemiologia , Masculino , Cadeias de Markov
4.
Hepatol Res ; 50(12): 1319-1327, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32876367

RESUMO

AIM: A new method has recently been developed for diagnosing hepatic steatosis based on attenuation measurement using ultrasound. We investigated the ability of attenuation imaging (ATI) to detect steatosis that was identified by proton density fat fraction (PDFF) on magnetic resonance imaging (MRI) in patients with chronic liver disease. METHODS: A total of 119 patients with chronic liver disease (non-B, non-C) were analyzed. The relationship between ATI values and steatosis grades determined by PDFF was evaluated. Additionally, the diagnostic ability of ATI was evaluated using receiver operating characteristic curve analysis, and the correlation between ATI values and PDFF values was determined. RESULTS: The ATI values of steatosis grades 0, 1, 2, and 3 were 0.55, 0.61, 0.74, and 0.84 dB/cm/MHz, respectively (P < 0.001). There was a statistically significant trend of higher ATI values with higher steatosis grades (P < 0.001). The correlation coefficient (r) between PDFF values and ATI values was 0.70 (95% confidence interval [CI] 0.59-0.78; P < 0.001), corresponding to a strong relationship. The diagnostic ability of ATI for steatosis grades ≥1, ≥2, and 3, as determined by PDFF, were 0.81 (95% CI 0.73-0.89), 0.87 (95% CI 0.79-0.96), and 0.94 (95% CI 0.89-0.98), respectively. The r between PDFF values and ATI values was 0.49 (95% CI 0.31-0.63; P < 0.001) for patients with mild or no steatosis (grade ≤1), and 0.75 (95% CI 0.57-0.86; P < 0.001) for obese patients (body mass index ≥25 kg/m2 ). CONCLUSION: ATI values had an excellent diagnostic ability to detect hepatic steatosis.

5.
Hepatol Res ; 50(8): 936-946, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32401388

RESUMO

AIM: The long-term prognosis of patients with chronic hepatitis C virus (HCV) infection who have received antiviral therapy and who demonstrate HCV eradication remains incompletely characterized. In this study, we investigated the long-term prognosis of liver disease in patients with eradication of HCV. METHODS: A total of 552 patients with chronic HCV infection (6815 person-years) who were treated with interferon-based therapy and who achieved sustained virologic response were included. Yearly transition probabilities for each liver state (chronic hepatitis, cirrhosis, and hepatocellular carcinoma [HCC]) were calculated using a Markov chain model. RESULTS: In the analysis of 1-year liver disease state transition probabilities, progression to cirrhosis occurred in 0.5-2.1% of male patients with chronic hepatitis across all age groups. In male patients with cirrhosis, HCC developed in 0.6-1.9% of patients over the age of 50 years. In female patients with chronic hepatitis, progression to cirrhosis occurred in 0.4-2.1% of patients across all age groups. In addition, in female patients with cirrhosis, HCC developed in those aged 60-69 (0.4%) and 70-79 (0.4%) years. Under the assumption of either a chronic hepatitis or cirrhosis state at age 40 or 60 years as the starting condition for simulation over the next 40 or 20 years, respectively, the probability of HCC gradually increased with age and was higher in male patients. CONCLUSIONS: The development or progression of cirrhosis and the development of HCC are risks in HCV patients despite HCV eradication, not only in those with cirrhosis but also in those with chronic hepatitis.

6.
Metron ; 77(2): 67-86, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31708595

RESUMO

Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer deaths worldwide, and its early detection is a critical determinant of whether curative treatment is achievable. Early stage HCC is typically asymptomatic. Thus, screening programmes are used for cancer detection in patients at risk of tumour development. Radiological screening methods are limited by imperfect data, cost and associated risks, and additionally are unable to detect lesions until they have grown to a certain size. Therefore, some screening programmes use additional blood/serum biomarkers to help identify individuals in whom to target diagnostic cancer investigations. The GALAD score, combining the levels of several blood biomarkers, age and sex, has been developed to identify patients with early HCC. Here we propose a Bayesian hierarchical model for an individual's longitudinal GALAD scores whilst in HCC surveillance to identify potentially significant changes in the trend of the GALAD score, indicating the development of HCC, aiming to improve early detection compared to standard methods. An absorbent two-state continuous-time hidden Markov model is developed for the individual level longitudinal data where the states correspond to the presence/absence of HCC. The model is additionally informed by the information on the diagnosis by standard clinical practice, taking into account that HCC can be present before the actual diagnosis so that there may be false negatives within the diagnosis data. We fit the model to a Japanese cohort of patients undergoing HCC surveillance and show that the detection capability of this proposal is greater than using a fixed cut-point.

7.
J Med Virol ; 91(10): 1837-1844, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31254403

RESUMO

BACKGROUND: Long-term prognosis of patients with chronic hepatitis C infection (HCV) remains incompletely characterized. We investigated the long-term prognosis of liver disease in patients with chronic HCV infection who have not received antiviral therapy. METHODS: A total of 2304 patients with chronic HCV who were not received interferon-based therapy were included. RESULTS: In the assessment of 1-year disease state of liver transition probabilities, progression to chronic hepatitis occurred in 12% to 14% of patients across all age groups in male asymptomatic carriers. In male patients with chronic hepatitis, progression to cirrhosis was observed mostly in the 60 to 69 (7.6%) and ≥70 age groups (9.6%). In addition, in male patients with cirrhosis, HCC development occurred in approximately 5% of patients over the age of 40. In female asymptomatic carriers, progression to chronic hepatitis was observed in 6% to 14% of patients across all age groups. In female patients with chronic hepatitis, progression to cirrhosis was observed mostly in the 60 to 69 (8.7%) and ≥70 (7.4%) age groups. In addition, in female patients with cirrhosis, HCC development occurred in 0.9% to 3.3% of patients over the age of 50. Under assumptions of either chronic hepatitis or asymptomatic carrier state at age 40 as the starting condition for simulation over the following 40 years, the probability of HCC gradually increased with age and was higher in male patients. CONCLUSIONS: There is a risk of cirrhosis or HCC development in HCV patients with not only chronic hepatitis but the asymptomatic carrier state as well.


Assuntos
Hepatite C Crônica/patologia , Adulto , Idoso , Simulação por Computador , Feminino , Genótipo , Hepacivirus/genética , Hepatite C Crônica/virologia , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Prognóstico , RNA Viral/genética , Fatores de Tempo
8.
Eur J Gastroenterol Hepatol ; 31(11): 1452-1459, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31082998

RESUMO

AIM: Even during nucleos(t)ide analogue therapy, development of hepatocellular carcinoma (HCC) has been observed in patients with chronic hepatitis B virus (HBV) infection. We simulated the long-term prognosis of liver disease in patients with chronic HBV who received nucleos(t)ide analogue therapy. PATIENTS AND METHODS: A total of 254 patients with chronic HBV receiving nucleos(t)ide analogue therapy were enrolled. Yearly transition probabilities between liver disease states [chronic hepatitis, cirrhosis, HCC, and hepatitis B surface antigen (HBsAg)-negative status] were calculated using a Markov chain model. RESULTS: In the analysis of 1-year liver disease state transition probabilities, the development of HCC occurred in men with chronic hepatitis in their 50s (1.8%) and at least 70 years (2.8%) and in patients with cirrhosis in all age groups (40-49, 50-59, 60-69, and ≥ 70 years). HBsAg-negative status was present in patients with chronic hepatitis in their 50s (1.8%) and 60s (2.6%), and in patients with cirrhosis in their 60s (0.6%). In female patients, the development of HCC occurred in patients with cirrhosis during their 50s (0.8%), 60s (0.8%), and older (4.5%). HBsAg-negative status was simulated in patients with cirrhosis in their 50s (0.8%) and 60s (0.8%). Assuming a chronic hepatitis state at age 40 as the starting condition for simulation over the next 40 years, the probability of developing HCC increased gradually with age in male patients and in female patients after the age of 70 years. CONCLUSION: There is a risk of development of HCC in middle-aged men with chronic hepatitis or cirrhosis and older women with cirrhosis even while receiving nucleos(t)ide analogue therapy.


Assuntos
Antivirais/uso terapêutico , Carcinoma Hepatocelular/etiologia , Hepatite B Crônica/tratamento farmacológico , Cirrose Hepática/etiologia , Neoplasias Hepáticas/etiologia , Adenina/análogos & derivados , Adenina/uso terapêutico , Adulto , Idoso , Carcinoma Hepatocelular/diagnóstico , Feminino , Guanina/análogos & derivados , Guanina/uso terapêutico , Antígenos de Superfície da Hepatite B/sangue , Hepatite B Crônica/sangue , Hepatite B Crônica/complicações , Humanos , Lamivudina/uso terapêutico , Cirrose Hepática/diagnóstico , Neoplasias Hepáticas/diagnóstico , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Nucleosídeos/análogos & derivados , Organofosfonatos/uso terapêutico , Prognóstico
9.
Liver Cancer ; 8(2): 121-129, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31019902

RESUMO

BACKGROUND/AIM: The frequency of hepatocellular carcinoma (HCC) in patients with good hepatic reserve function has been increasing in Japan along with the progression of antiviral therapies and aging of the society. We evaluated the usefulness of modified albumin-bilirubin (ALBI) grade as a tool for assessment of hepatic reserve function. MATERIALS/METHODS: We enrolled 6,649 naïve HCC patients treated from 2000 to 2017 and divided them into training (Ehime Prefecture group: E group, n = 2,357) and validation (validation group: V group, n = 4,292) cohorts. Child-Pugh classification and ALBI and modified ALBI (mALBI) grading were compared using with Japan Integrated Staging (JIS), ALBI-TNM (ALBI-T), and mALBI-T scores, which were calculated based on TNM stage and each assessment tool, retrospectively. RESULTS: In the E group, Akaike's Information Criterion (AIC) and c-index values for mALBI-T (13,725.2/0.744) were better as compared to those of ALBI-T (13,772.6/0.733) and JIS score (13,874.7/0.720), with similar results observed in the V group (mALBI-T: 27,727.4/0.760; ALBI-T: 27,817.8/0.750; JIS: 27,807.5/0.748). Although there were some significant differences between the groups with regard to clinical background factors (age, etiology, tumor size, tumor number, treatment modalities), for all patients the AIC and c-index values of mALBI-T (45,327.1/0.755) were also better than those of ALBI-T (45,467.7/0.744) and JIS scores (45,555.8/0.739), indicating its superior stratification ability and prognostic predictive value in patients with HCC. CONCLUSION: The detailed stratification ability of mALBI grade for hepatic reserve function is suitable for the recent trend of HCC patients, while mALBI-T may provide a more accurate predictive value than existing total staging scoring systems.

10.
J Gastroenterol ; 53(11): 1196-1205, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29675604

RESUMO

BACKGROUND: The relationship between the hepatitis B e antigen (HBeAg) seroconversion and the long-term natural history of liver disease has not been sufficiently investigated. METHODS: A total of 408 [4352 person-year (PY) units] patients with chronic hepatitis B virus (HBV) without antiviral therapy were enrolled. The study patients were divided into three groups, as follows: Group A (2666 PY units), seroconverted of HBeAg at age < 40; Group B (413 PY units), seroconverted of HBeAg at age ≥ 40; Group C (1273 PY units), persistently HBeAg positive. Yearly transition probabilities from each liver state [chronic HBV infection, chronic hepatitis B, cirrhosis, hepatocellular carcinoma (HCC), and hepatitis B surface antigen (HBsAg) negativity] were calculated using the Markov chain model. RESULTS: In the analysis of 1 year liver disease state transition probabilities, the liver states remained almost the same in Group A. In Groups B and C, each liver state tended to progress to a worse state. Assuming a chronic hepatitis B state at age 40 as the starting condition for simulation over the next 40 years, the chronic hepatitis B state accounted for approximately 60% of males aged ≥ 50 and approximately 40% of females aged ≥ 60 in Group A, and the HBsAg-negative state accounted for approximately 30-40% of males and females aged ≥ 60. In Groups B and C, the probabilities of patients with cirrhosis and HCC gradually increased with age. CONCLUSIONS: Not only patients with persistent HBeAg positive, but also patients with delayed HBeAg seroconversion showed poor prognosis of liver-related natural history.


Assuntos
Hepatite B Crônica/complicações , Cirrose Hepática/virologia , Adulto , Fatores Etários , Idoso , Carcinoma Hepatocelular/imunologia , Carcinoma Hepatocelular/virologia , Progressão da Doença , Feminino , Seguimentos , Antígenos de Superfície da Hepatite B/sangue , Antígenos E da Hepatite B/sangue , Hepatite B Crônica/imunologia , Humanos , Cirrose Hepática/imunologia , Neoplasias Hepáticas/imunologia , Neoplasias Hepáticas/virologia , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Prognóstico , Soroconversão
11.
Hepatol Res ; 48(3): E61-E67, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28628718

RESUMO

AIM: To evaluate the efficacy of the newly proposed albumin-bilirubin (ALBI) grade for therapy selection, clinical features of patients treated with radiofrequency ablation (RFA) were elucidated. METHODS: From 2000 to 2015, 1101 patients with HCC (<3 cm, ≤3 tumors) treated with RFA were enrolled, with the following clinical features: 734 men and 367 women; 779 with hepatitis C virus, 153 with hepatitis B virus, 5 with hepatitis C and B, and 164 others; and Child-Pugh classification (CP) A : B ratio of 842:259. Liver damage classification (LD) using the indocyanine green retention rate at 15 min and ALBI-grade were compared in regard to the prognoses of those patients. RESULTS: Median tumor size was 1.7 cm (interquartile range, 1.4-2.2 cm) and single tumors were found in 802 cases (72.8%) (tumor-node-metastasis stage of the Liver Cancer Study Group of Japan I : II : III = 536:454:111). In the LD-A group, the number of cases with ALBI-grade 1, 2, and 3 were 294, 224, and 1, respectively, while those in the LD-B group were 47, 490, and 12, respectively. In the LD-C group, 19 and 14 patients were ALBI-2 and -3, respectively. Akaike Information Criterion values for CP, LD-grade, and ALBI-grade were 6015.4, 5988.8, and 5990.7, respectively. However, there was no significant difference regarding prognosis between LD-A/B (n = 228) and C (n = 31) (median survival time, 4.8 vs. 3.9 years, P = 0.0818) in CP-B, whereas a significant difference was observed regarding prognosis for ALBI-1/2 (n = 232) and ALBI-3 (n = 27) (median survival time, 4.8 vs. 2.7 years, P = 0.0168). CONCLUSION: Albumin-bilirubin grade showed an assessment ability similar to that of LD-grade. Furthermore, there was a small improvement in prognosis following RFA in patients with an ALBI-grade of 3. Although only two serological parameters, albumin and total bilirubin, are used, assessment with ALBI-grade may be more useful than with LD-grade for avoiding a non-beneficial RFA procedure.

12.
J Cancer Res Clin Oncol ; 141(7): 1311-9, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25648362

RESUMO

PURPOSE: We evaluated the prognosis of hepatocellular carcinoma (HCC) patients with Child-Pugh (C-P) class A based on FIB-4 index, which is a liver fibrosis marker. PATIENTS AND METHODS: A total of 915 HCC patients with C-P class A were investigated. We assessed the prognosis using FIB-4 index, and factors associated with survival rates were analyzed in these patients. RESULTS: When patients were categorized according to FIB-4 index as <2.0 (n = 93), ≥ 2.0 and <4.0 (n = 311), and ≥ 4.0 (n = 511), survival rates at 5 years were 70.5% [95% confidence interval (CI) 59.0-79.9], 56.4% (95% CI 50.1-62.5), and 47.1% (95% CI 42.2-52.1), respectively. Patients with FIB-4 index <2.0 had a higher survival rate than the other groups (≥ 4.0 vs ≥ 2.0 and <4.0, p = 0.010; ≥ 2.0 and <4.0 vs <2.0, p = 0.028). We were able to predict prognosis in patients with C-P score 5 by FIB-4 index, but survival rate did not significantly differ in patients with C-P score 6. Multivariate analysis identified C-P score, FIB-4 index [≥ 2.0 and <4.0; hazard ratios (HRs) 1.638 (95% CI 1.084-2.474); p = 0.019/≥ 4.0; HR 1.828 (95% CI 1.217-2.744); p = 0.004], Lens culinaris agglutinin-reactive α-fetoprotein, tumor size, number, vascular invasion, antiviral therapy, and hepatectomy as independent predictive factors for survival. CONCLUSIONS: The FIB-4 index is useful for assessing prognosis in HCC patients with C-P class A, especially those with C-P score 5.


Assuntos
Carcinoma Hepatocelular/diagnóstico , Indicadores Básicos de Saúde , Cirrose Hepática/patologia , Neoplasias Hepáticas/diagnóstico , Fígado/fisiopatologia , Fatores Etários , Idoso , Alanina Transaminase/metabolismo , Aspartato Aminotransferases/metabolismo , Biomarcadores/análise , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/fisiopatologia , Feminino , Humanos , Fígado/metabolismo , Fígado/patologia , Cirrose Hepática/complicações , Testes de Função Hepática/métodos , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Prognóstico
13.
J Clin Oncol ; 33(6): 550-8, 2015 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-25512453

RESUMO

PURPOSE: Most patients with hepatocellular carcinoma (HCC) have associated chronic liver disease, the severity of which is currently assessed by the Child-Pugh (C-P) grade. In this international collaboration, we identify objective measures of liver function/dysfunction that independently influence survival in patients with HCC and then combine these into a model that could be compared with the conventional C-P grade. PATIENTS AND METHODS: We developed a simple model to assess liver function, based on 1,313 patients with HCC of all stages from Japan, that involved only serum bilirubin and albumin levels. We then tested the model using similar cohorts from other geographical regions (n = 5,097) and other clinical situations (patients undergoing resection [n = 525] or sorafenib treatment for advanced HCC [n = 1,132]). The specificity of the model for liver (dys)function was tested in patients with chronic liver disease but without HCC (n = 501). RESULTS: The model, the Albumin-Bilirubin (ALBI) grade, performed at least as well as the C-P grade in all geographic regions. The majority of patients with HCC had C-P grade A disease at presentation, and within this C-P grade, ALBI revealed two classes with clearly different prognoses. Its utility in patients with chronic liver disease alone supported the contention that the ALBI grade was indeed an index of liver (dys)function. CONCLUSION: The ALBI grade offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in HCC that has been extensively tested in an international setting. This new model eliminates the need for subjective variables such as ascites and encephalopathy, a requirement in the conventional C-P grade.


Assuntos
Bilirrubina/sangue , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/fisiopatologia , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/fisiopatologia , Fígado/fisiopatologia , Albumina Sérica/metabolismo , Idoso , Carcinoma Hepatocelular/patologia , Estudos de Coortes , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Gradação de Tumores , Estadiamento de Neoplasias
14.
BMC Med Genomics ; 3: 48, 2010 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-20969775

RESUMO

BACKGROUND: HCV infection frequently induces chronic liver diseases. The current standard treatment for chronic hepatitis (CH) C combines pegylated interferon (IFN) and ribavirin, and is less than ideal due to undesirable effects. MicroRNAs (miRNAs) are endogenous small non-coding RNAs that control gene expression by degrading or suppressing the translation of target mRNAs. In this study we administered the standard combination treatment to CHC patients. We then examined their miRNA expression profiles in order to identify the miRNAs that were associated with each patient's drug response. METHODS: 99 CHC patients with no anti-viral therapy history were enrolled. The expression level of 470 mature miRNAs found their biopsy specimen, obtained prior to the combination therapy, were quantified using microarray analysis. The miRNA expression pattern was classified based on the final virological response to the combination therapy. Monte Carlo Cross Validation (MCCV) was used to validate the outcome of the prediction based on the miRNA expression profile. RESULTS: We found that the expression level of 9 miRNAs were significantly different in the sustained virological response (SVR) and non-responder (NR) groups. MCCV revealed an accuracy, sensitivity, and specificity of 70.5%, 76.5% and 63.3% in SVR and non-SVR and 70.0%, 67.5%, and 73.7% in relapse (R) and NR, respectively. CONCLUSIONS: The hepatic miRNA expression pattern that exists in CHC patients before combination therapy is associated with their therapeutic outcome. This information can be utilized as a novel biomarker to predict drug response and can also be applied to developing novel anti-viral therapy for CHC patients.


Assuntos
Perfilação da Expressão Gênica , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/genética , Interferons/uso terapêutico , Fígado/metabolismo , MicroRNAs/genética , Combinação de Medicamentos , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Células HEK293 , Hepatite C Crônica/imunologia , Humanos , Interferons/farmacologia , Fígado/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Método de Monte Carlo , Reação em Cadeia da Polimerase , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento
15.
Helicobacter ; 13(5): 346-51, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19250509

RESUMO

BACKGROUND: Eradicating Helicobacter pylori markedly reduces ulcer recurrence in patients with peptic ulcer disease (PUD). Many decision analysis studies have concluded that eradicating H. pylori in PUD patients is more cost-effective than maintaining antisecretory therapy. In 1995, we introduced an H. pylori eradication program into a large transportation company that experienced increased incidences of PUD among its employees along with increased medical costs, and we performed trend analysis of the actual medical costs of PUD in this cohort. METHODS: In this cohort, there were approximately 8500 employees. H. pylori-positive PUD patients were identified at the annual health check up. The patients received eradication therapy with lansoprazole, amoxicillin, and clarithromycin. After eradication, the patients were followed up by a yearly health check up. The annual number of patients who received eradication was recorded, and the annual direct medical costs of PUD therapy were analyzed. RESULTS: A total of 440 H. pylori-positive PUD patients received eradication therapy in a 7-year period. Based on an intention-to-treat analysis, the eradication rate was 84.5% (372 of 440). The largest number of patients who received eradication therapy was found in 1995 (n = 115), and from 1995 to 2001 this number decreased yearly by 12.5 (95% confidence interval (CI): 5 to 20). Between 1989 and 1995, the annual medical costs arising of PUD therapy increased by yen2.25 million (95% CI: 1.19 to 3.31) per year, being highest ( yen22.75 million) in 1995. Between 1995 and 2001, the costs decreased by yen3.88 million (95% CI: 3.16 to 4.59) per year. The cost in 2001 was 5.7% of the cost in 1995. The eradication program was terminated in 2001 because the prevalence of PUD diminished markedly, and the associated medical costs decreased as well. CONCLUSIONS: H. pylori eradication could reduce the number of PUD patients and associated medical costs in the workplace setting.


Assuntos
Infecções por Helicobacter/complicações , Úlcera Péptica/tratamento farmacológico , Úlcera Péptica/economia , Estudos de Coortes , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Custos de Cuidados de Saúde/tendências , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/crescimento & desenvolvimento , Helicobacter pylori/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/microbiologia , Fatores de Tempo
16.
Hepatol Res ; 37 Suppl 2: S166-71, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17877479

RESUMO

The efficacies of tumor markers, alfa-fetoprotein (AFP), Lens culinaris agglutinin A-reactive fraction of alfa-fetoprotein (AFP-L3), and des-gamma-carboxy prothrombin (DCP) were evaluated for assessment of progression of hepatocellular carcinoma (HCC) and patient prognosis. The prevalence of elevated levels of each tumor marker increased with progression of tumor stage for all three markers among patients with HCC. Survival was poorer among patients with elevated levels of tumor markers than among those without elevated levels.Evaluation of tumor progression with tumor markers was based only on the results of laboratory tests. The tests are objective, simple to perform, and easy to repeat, and therefore, may be useful to supplement conventional tumor staging for the evaluation of tumor progression and prediction of patient outcome.

18.
Liver Int ; 24(5): 425-31, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15482338

RESUMO

AIM: We evaluated the usefulness of Doppler ultrasonography (DUS) for the analysis of tumor hemodynamics in small hepatocellular carcinoma (HCC). METHODS: We compared Doppler ultrasound (DUS) findings with angiography-assisted computed tomography (Angio-CT) such as CT during arterial portography and during hepatic arteriography in the evaluation of the intratumoral hemodynamics, and with pathologic findings in 45 small HCC nodules (< or =3.0 cm in diameter) of 43 patients. DUS flow pattern of each nodule was categorized into three types: afferent continuous flow (Type 1), afferent pulsatile flow with afferent continuous flow (Type 2), and afferent pulsatile flow without afferent continuous flow (Type 3). Intratumoral blood supply was determined by Angio-CT, and pathologic findings were evaluated on resected or biopsied specimen. RESULTS: Based on Angio-CT findings, Type 1 nodules showed decreased arterial blood supply (ABS) without decreased portal blood supply (PBS). Type 2 nodules showed unchanged ABS but decreased PBS. Type 3 nodules showed both increased ABS and decreased PBS. DUS findings well represented blood supply of HCC evaluated by Angio-CT. In addition, all Type 1 and 2 nodules were well-differentiated HCC, and all Type 3 nodules were moderately or poorly differentiated HCC; DUS findings well reflected differentiation of HCC. CONCLUSIONS: DUS is a non-invasive imaging method and can be used for the evaluation of the stage of malignancy of small HCC.


Assuntos
Velocidade do Fluxo Sanguíneo , Carcinoma Hepatocelular/fisiopatologia , Neoplasias Hepáticas/fisiopatologia , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Idoso , Angiografia , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Feminino , Artéria Hepática/patologia , Artéria Hepática/fisiopatologia , Humanos , Fígado/irrigação sanguínea , Fígado/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Sistema Porta/patologia , Sistema Porta/fisiopatologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA