Comparison of 2 curative treatment options for very early hepatocellular carcinoma: Efficacy, recurrence pattern, and retreatment.

Curative treatments for very early-stage hepatocellular carcinoma (HCC), defined as single HCC with a maximum diameter of <2 cm in patients with well-preserved liver function, consist of surgical resection or radiofrequency ablation (RFA). In this retrospective study, we compared the efficacy of both treatments in 154 patients with very early-stage HCCs who underwent resection or RFA as initial therapy and were followed up for a median of 56.8 months. Propensity score matching analysis was also conducted. Overall survival was comparable between treatment groups (median survival time of 143 vs 97 months for resection and RFA, respectively; P = .132). Resection group; however, demonstrated a significantly lower recurrence rate after initial therapy than RFA group (42.3% vs 65.7%; P = .006) with a longer median recurrence-free survival time (66.7 vs 33.8 months; P = .002), which was confirmed even after matching (P = .04). In contrast, the recurrence pattern in advanced-stage (9.6% vs 1.0%; P = .01) or incurable recurrences (19% vs 13%; P = .04) was more frequent following resection than RFA. Recurrent lesions were comparatively more curable in RFA group than in resection group (80% vs 54.5%; P = .02). The recurrence of HCC was independently associated with lower serum albumin level (P = .027), the presence of comorbid diabetes mellitus (P = .010), and RFA (P = .034). In conclusion, in patients with very early-stage HCC, surgical resection has achieved significantly better recurrence-free survival than RFA. A closer follow-up is required after resection.

How can we improve the performance of Model for End-Stage Liver Disease sodium score in patients with hepatitis B virus-related decompensated liver cirrhosis commencing antiviral treatment?

BACKGROUND AND AIM: We aimed to develop a more efficient prognostic model to predict 1-year mortality in patients with hepatitis B virus-related decompensated cirrhosis beginning antiviral treatment. METHODS: Using Cox regression analysis, survival analyses were performed on 554 patients with decompensated cirrhosis who were followed up from the start of nucleos(t)ide analogue antiviral treatment. RESULTS: At baseline, ascites and hepatic encephalopathy were found in 78.0% and 18.1% of patients, respectively. Eighty-six events (77 deaths and 9 emergency liver transplants) occurred within the first year of treatment. Severity of ascites, presence of hepatic encephalopathy, and the Model for End-Stage Liver Disease (MELD)-sodium (MELDNa) score were independent risk factors for 1-year mortality. The new prognostic model (the revised MELDNa) constructed by adding ascites and encephalopathy to the MELDNa score significantly improved the area under the receiver operating characteristics curve for predicting 1-year events at baseline compared with the Child-Turcotte-Pugh system, MELD and MELDNa models, and Fontana index (0.905 vs 0.867, 0.843, 0.871, and 0.815, respectively; P < 0.05). Furthermore, repetitive application of revised MELDNa at 0, 1, 2, 3, and 6 months of treatment could predict 81.4% (70/86) of 1-year events, which was significantly (P < 0.05) higher than the sensitivity of the Child-Turcotte-Pugh system (68.6%), MELD (70.9%) and MELDNa (68.6%) scores, and Fontana index (64.0%), achieving similar specificities of ~96%. CONCLUSIONS: Ascites and encephalopathy should be considered together with the MELDNa score when predicting short-term mortality and planning liver transplant in patients with decompensated hepatitis B virus-related cirrhosis starting antiviral treatment.

Preoperative localization and intraoperative parathyroid hormone assay in korean patients with primary hyperparathyroidism.

BACKGROUND: The intraoperative parathyroid hormone (IOPTH) assay is widely used in patients with primary hyperparathyroidism (PHPT). We investigated the usefulness of the IOPTH assay in Korean patients with PHPT. METHODS: We retrospectively reviewed the data of 33 patients with PHPT who underwent parathyroidectomy. Neck ultrasonography (US) and 99mTc-sestamibi scintigraphy (MIBI scan) were performed preoperatively and IOPTH assays were conducted. RESULTS: The sensitivity of neck US and MIBI scans were 91% and 94%, respectively. A 50% decrease in parathyroid hormone (PTH) levels 10 minutes after excision of the parathyroid gland was obtained in 91% (30/33) of patients and operative success was achieved in 97% (32/33) of patients. The IOPTH assay was 91% true-positive, 3% true-negative, 0% false-positive, and 6% false-negative. The overall accuracy of the IOPTH assay was 94%. In five cases with discordant neck US and MIBI scan results, a sufficient decrease in IOPTH levels helped the surgeon confirm the complete excision of the parathyroid gland with no additional neck exploration. CONCLUSION: The IOPTH assay is an accurate tool for localizing hyperfunctioning parathyroid glands and is helpful for evaluating cases with discordant neck US and MIBI scan results.