50 results on '"Suzuki, Yoshiyuki"'
Search Results
2. Dynamics of Circulating miR-122 Predict Liver Cancer and Mortality in Japanese Patients with Histopathologically Confirmed NAFLD and Severe Fibrosis Stage.
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Akuta, Norio, Kawamura, Yusuke, Suzuki, Fumitaka, Saitoh, Satoshi, Arase, Yasuji, Muraishi, Nozomu, Fujiyama, Shunichiro, Sezaki, Hitomi, Hosaka, Tetsuya, Kobayashi, Masahiro, Kobayashi, Mariko, Suzuki, Yoshiyuki, Ikeda, Kenji, and Kumada, Hiromitsu more...
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DISEASE progression ,LIVER tumors ,BIOPSY ,FATTY liver ,FIBROSIS ,SEVERITY of illness index ,DESCRIPTIVE statistics ,EXTRACELLULAR space ,NUCLEIC acids ,BLOOD - Abstract
Introduction: It is unclear whether the relationships between changes in fibrosis and circulating microRNA-122 (miR-122) dynamics might influence the prognosis of nonalcoholic fatty liver disease (NAFLD). Methods: This study investigates the impact of serum miR-122 dynamics and histological changes on the incidence of liver cancer and mortality in 81 Japanese NAFLD patients who underwent serial liver biopsies. The median interval between the first and second liver biopsies was 2.9 years. Results: The fibrosis stage scores indicated progression, no change, and improvement (a decrease of one point or more) in 21.0%, 56.8%, and 22.2% of the patients, respectively. There were 64 patients in the high-risk group who had no improvement in stage scores. Among these, the miR-122 levels were significantly lower in 7 patients with liver cancer than those of the 54 patients who had no liver cancer at the second liver biopsy. The cumulative rates of liver cancer were significantly higher in cases with miR-122 ratios <0.5 (serum miR-122 level at second biopsy to that at first biopsy) than those with ratios ≥0.5. The cumulative survival rates in cases with miR-122 ratios <0.5 tended to be lower than those with ratios ≥0.5. Of the 64 high-risk patients, 39 indicated stage 2 or greater (severe fibrosis stage) at the first liver biopsy and also showed similar results of cumulative liver cancer and survival rates. Conclusions: Longitudinal examination of serial liver biopsies indicated that the circulating miR-122 dynamics might be useful in predicting the prognosis for NAFLD patients with severe fibrosis stage and no improvement of the stage scores. [ABSTRACT FROM AUTHOR] more...
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- 2022
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Catalog
3. Impact of hepatitis B core‐related antigen on the incidence of hepatocellular carcinoma in patients treated with nucleos(t)ide analogues.
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Hosaka, Tetsuya, Suzuki, Fumitaka, Kobayashi, Masahiro, Fujiyama, Shunichirou, Kawamura, Yusuke, Sezaki, Hitomi, Akuta, Norio, Suzuki, Yoshiyuki, Saitoh, Satoshi, Arase, Yasuji, Ikeda, Kenji, Kobayashi, Mariko, and Kumada, Hiromitsu more...
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HEPATITIS B ,HEPATITIS associated antigen ,LIVER cancer ,DNA ,BIOLOGICAL tags ,QUANTITATIVE research - Abstract
Summary: Background: Chronic hepatitis B virus (HBV) infection is an aetiologic factor for hepatocellular carcinoma (HCC). Baseline HBV DNA is a known independent predictor of HCC, and the serum hepatitis B core‐related antigen (HBcrAg) level corresponds to intrahepatic covalently closed circular DNA. Aim: To investigate whether the baseline and on‐treatment serum HBcrAg levels can predict HCC incidence in patients with chronic hepatitis B following nucleos(t)ide analogue (NA) therapy. Methods: This retrospective cohort study included 1268 patients treated with NAs for >1 year. In all patients, serum HBcrAg and hepatitis B surface antigen levels were measured at baseline and 1 year. Results: During a median follow‐up of 8.9 years, 113 patients (8.9%) developed HCC (10.3/1000 person‐years). These patients were stratified by baseline hepatitis B e‐antigen (HBeAg) status into HBeAg+ and HBeAg‐ cohorts. High on‐treatment HBcrAg levels at 1 year were found to associate significantly with HCC (HBeAg+ cohort: P = 0.017; HBeAg‐ cohort: P = 4.30 × 10−5; cut‐off values: 4.9 log U/mL and 4.4 log U/mL, respectively). In a multivariate Cox regression analysis, patients with persistently high on‐treatment HBcrAg levels had a higher risk of HCC than those with low HBcrAg levels (HBeAg+: hazard ratio [HR], 6.15, 95% confidence interval [CI]: 1.89‐20.0, P = 0.003; HBeAg‐ cohort: HR, 2.54, 95% CI: 1.40‐4.60; P = 0.002). A sub‐analysis of patients without alcoholism yielded similar findings. Conclusions: Patients with persistently high on‐treatment HBcrAg levels were more likely to develop HCC despite sustained viral suppression via long‐term NA treatment. [ABSTRACT FROM AUTHOR] more...
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- 2019
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4. No‐touch ablation in hepatocellular carcinoma has the potential to prevent intrasubsegmental recurrence to the same degree as surgical resection.
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Kawamura, Yusuke, Ikeda, Kenji, Shindoh, Junichi, Kobayashi, Yuta, Kasuya, Kayoko, Fujiyama, Shunichiro, Hosaka, Tetsuya, Kobayashi, Masahiro, Saitoh, Satoshi, Sezaki, Hitomi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, Hashimoto, Masaji, and Kumada, Hiromitsu more...
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THERAPEUTIC touch ,LIVER cancer ,CATHETER ablation ,MAGNETIC resonance imaging ,SERUM ,COMPUTED tomography - Abstract
Aim: The aim of this study was to clarify the utility of a no‐touch pincer ablation procedure that uses bipolar electrodes to prevent intrasubsegmental tumor recurrence after radiofrequency ablation (RFA) for patients with hepatocellular carcinoma (HCC) compared to surgical resection. Methods: We evaluated 175 consecutive patients with HCC (single nodule, tumor diameter ≤ 30 mm) who underwent surgical resection (146 received partial resection) and 313 patients who received RFA; 277 patients received touch ablation using a monopolar or bipolar RFA device, and 36 received no‐touch ablation using a bipolar RFA device. Pretreatment arterial and portal phase dynamic computed tomography (CT) or magnetic resonance imaging (MRI) images were classified into four enhancement patterns: Type 1 and Type 2 are homogeneous enhancement patterns without or with increased arterial blood flow, respectively; Type 3 is a heterogeneous enhancement pattern with a septum‐like structure; and Type 4 is an irregularly shaped ring structure enhancement pattern. Results: Cumulative recurrence rates significantly differed between procedures (surgical resection, 7.5%; no‐touch ablation, 2.9%; and touch ablation, 17.7% at the third year; P = 0.005). Multivariate Cox proportional hazards analysis revealed that enhancement pattern type (Type 3: hazard ratio [HR], 2.95; P = 0.002; and Type 4: HR, 3.88, P = 0.002), treatment procedure (touch ablation: HR, 3.36; P < 0.001), and serum α‐fetoprotein level (≥30 μg/L: HR, 1.87; P = 0.009) were significant predictors of intrasubsegmental recurrence. No significant differences between no‐touch ablation and surgical resection were observed. Conclusion: The no‐touch pincer ablation procedure has the potential to prevent intrasubsegmental recurrence after RFA for patients with HCC to the same degree as partial resection. [ABSTRACT FROM AUTHOR] more...
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- 2019
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5. Platelet-Albumin Score as a Sensitive Measure for Surgical Risk Prediction and Survival Outcomes of Patients with Hepatocellular Carcinoma.
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Shindoh, Junichi, Kawamura, Yusuke, Kobayashi, Yuta, Kiya, Yoshitaka, Sugawara, Toshitaka, Akuta, Norio, Kobayashi, Masahiro, Suzuki, Yoshiyuki, Ikeda, Kenji, and Hashimoto, Masaji
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PLATELET count ,LIVER cancer ,ALBUMINS ,STATISTICAL models ,MULTIVARIATE analysis ,ASCITES ,COMPARATIVE studies ,HEPATOCELLULAR carcinoma ,LIVER tumors ,RESEARCH methodology ,MEDICAL cooperation ,PHARMACOKINETICS ,RESEARCH ,RESEARCH evaluation ,RISK assessment ,SERUM albumin ,SURGICAL complications ,EVALUATION research ,DISEASE incidence ,RETROSPECTIVE studies ,RECEIVER operating characteristic curves ,PREOPERATIVE period - Abstract
Background: Given that patients with hepatocellular carcinoma (HCC) usually suffer from dual diseases (i.e., HCC and underlying liver disease), a complete survival estimation model is difficult to establish because both the oncological stage and the underlying liver function affect the survival outcome.Methods: A new surgical risk model for estimating the survival of patients undergoing resection for HCC was created using a cohort treated between 1995 and 2013 (training set, n = 889), and its efficacy was then validated using a cohort treated between 2014 and 2017 (validation set, n = 310).Results: The following statistical model was developed based on the results of multivariate analysis: albumin-platelet (PAL) score = - 0.777 × albumin (g/dL) - 0.575 × log10 (platelet count [104/μL]) (cut-off value, - 3.77 and - 3.04 for grading). A time-dependent receiver-operating curve analysis revealed that the area under the curve for 3-year survival was 0.644 in the training set and 0.666 in the validation set. The incidences of postoperative morbidity were 14.0% for PAL grade 1, 18.7% for PAL grade 2, and 26.1% for PAL grade 3 (P = 0.039), while the incidences of refractory ascites were 2.2, 7.1, and 12.5% (P = 0.005), respectively, in the training set. The reproducibility of these results was confirmed in the validation set with morbidity rates of 13.5, 23.3, and 40.7% (P = 0.003), respectively, and the incidences of refractory ascites were 0.7, 10.7, and 22.2% (P < 0.0001), respectively.Conclusions: The PAL score can be used as a grading system for the stratification of survival outcomes and surgical risks of patients undergoing HCC resection. [ABSTRACT FROM AUTHOR] more...- Published
- 2019
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6. Predictors of pruritus in patients with chronic liver disease and usefulness of nalfurafine hydrochloride.
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Akuta, Norio, Kumada, Hiromitsu, Fujiyama, Shunichiro, Kawamura, Yusuke, Sezaki, Hitomi, Hosaka, Tetsuya, Kobayashi, Masahiro, Kobayashi, Mariko, Saitoh, Satoshi, Suzuki, Yoshiyuki, Suzuki, Fumitaka, Arase, Yasuji, and Ikeda, Kenji more...
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ITCHING ,LIVER disease treatment ,LIVER diseases ,MULTIVARIATE analysis ,LIVER cancer ,PATIENTS ,THERAPEUTICS - Abstract
Aim Pruritus is one of the complications of chronic liver disease, and it is important to investigate the predictors. Methods Six hundred and seventy-three consecutive Japanese patients with chronic liver disease were retrospectively investigated for itch severity. Furthermore, 138 of all 673 patients were introduced to nalfurafine hydrochloride, and the improvement of itch severity was evaluated. The itch severity was self-assessed using the pruritus scores by Kawashima's criteria and visual analog scale. Results Two hundred and twenty-nine of the 673 patients (34.0%) were evaluated as 1 point or more of pruritus severity of Kawashima's criteria, and 46 patients (6.8 %) as 3 points or more. Multivariate analysis established that being negative for hepatitis B surface antigen (HBsAg) and presence of hepatocellular carcinoma (HCC) were significant determinants of pruritus (≥1 point of Kawashima's criteria), and being negative for HBsAg and having lower levels of platelet count were significant determinants of severe pruritus (≥3 points). Ninety-three of the 138 patients (67.4%) with nalfurafine hydrochloride indicated improvement of itch, defined as a decrease in VAS of 50 mm or more. There were no significant differences in treatment efficacy of nalfurafine hydrochloride, regardless of the three predictors of pruritus (HBsAg, HCC and platelet count). Conclusion The present retrospective study indicated the predictors for pruritus, based on the large number of patients with chronic liver disease. Furthermore, this study demonstrated that nalfurafine hydrochloride may be useful for pruritus, regardless of the predictors. [ABSTRACT FROM AUTHOR] more...
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- 2018
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7. Direct-Acting Antivirals Decreased Tumor Recurrence After Initial Treatment of Hepatitis C Virus-Related Hepatocellular Carcinoma.
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Ikeda, Kenji, Kawamura, Yusuke, Kobayashi, Masahiro, Kominami, Yoko, Fujiyama, Shunichiro, Sezaki, Hitomi, Hosaka, Tetsuya, Akuta, Norio, Saitoh, Satoshi, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu more...
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LIVER cancer ,ANTIVIRAL agents ,SURGERY ,CATHETER ablation ,DISEASE relapse ,HEPATITIS C diagnosis ,TUMOR treatment ,CANCER relapse ,COMPARATIVE studies ,DRUG administration ,HEPATECTOMY ,HEPATITIS C ,HEPATOCELLULAR carcinoma ,LIVER tumors ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,TIME ,TUMOR classification ,EVALUATION research ,TREATMENT effectiveness ,PROPORTIONAL hazards models ,RETROSPECTIVE studies ,KAPLAN-Meier estimator ,CHEMOEMBOLIZATION ,DISEASE complications ,THERAPEUTICS - Abstract
Background: Suppressive activity of recurrence by interferon-free direct-acting antivirals (DAA) is not elucidated after curative treatment of hepatocellular carcinoma (HCC).Patients and Methods: A total of 177 patients received DAA after curative manners of HCC: 89 patients underwent DAA therapy after initial HCC treatment, and the other 88 patients after repeated therapy of 2-10 times. Among a cohort of HCC patients with surgery and radiofrequency ablation, 89 patients were chosen adjusting age, gender, and Barcelona Clinic Liver Cancer (BCLC) staging with 89 patients with initial HCC therapy.Results: HCC recurrence rates at the end of first and second year were 18.1 and 22.1% in patients with once of HCC therapy, 28.2 and 41.6% in those with 2-3 times of therapy, and 60.2 and 74.5% in those with 4 or more times of therapy, respectively (P < 0.0001). Recurrence rates were compared between 89 patients with DAA therapy after initial HCC therapy and 89 age-, gender-, and BCLC staging-matched patients without antiviral therapy after initial HCC therapy. HCC recurrence rates at first and second year were 18.1 and 25.0% in patients with DAA therapy and 21.8 and 46.5% in those without DAA therapy, respectively (P = 0.003). Multivariate analysis showed DAA therapy significantly decreased recurrence rate with a hazard ratio of 0.353 (confidence interval: 0.191-0.651) after adjustment with covariates of tumor multiplicity, alpha-fetoprotein value, and prothrombin time.Conclusions: DAA therapy significantly decreased recurrence rate when it was performed after initial HCC therapy. [ABSTRACT FROM AUTHOR] more...- Published
- 2017
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8. Potential of a no-touch pincer ablation procedure that uses a multipolar radiofrequency ablation system to prevent intrasubsegmental recurrence of small and single hepatocellular carcinomas.
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Kawamura, Yusuke, Ikeda, Kenji, Fujiyama, Shunichiro, Hosaka, Tetsuya, Kobayashi, Masahiro, Saitoh, Satoshi, Sezaki, Hitomi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu more...
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LIVER cancer ,MAGNETIC resonance imaging of cancer ,BLOOD flow measurement ,CANCER relapse ,CATHETER ablation - Abstract
Objective The aim of this study was to clarify the usefulness of a no-touch pincer ablation procedure that uses bipolar electrodes to prevent intrasubsegmental tumor recurrence after radiofrequency ablation (RFA) for patients with hepatocellular carcinoma (HCC). Methods We studied 303 consecutive patients with HCC (single nodule and tumor diameter ≤30 mm) who received RFA between January 2005 and April 2015; 268 patients received touch ablation using a monopolar or bipolar RFA device, and 35 received no-touch ablation using a bipolar RFA device. The pretreatment arterial and portal phase dynamic computed tomography or magnetic resonance images were classified into four enhancement patterns. Type 1 and Type 2 are homogeneous enhancement patterns without or with increased arterial blood flow, respectively. Type 3 is a heterogeneous enhancement pattern with a septum-like structure, and Type 4 is an irregularly shaped ring structure enhancement pattern. Results With regard to intrasubsegmental tumor recurrence, among the 268 patients who underwent the touch ablation procedure, tumors recurred in 52 (19.4%) patients, and among the 35 patients who underwent the no-touch ablation procedure, tumors recurred in one (2.9%) patient. Cumulative intrasubsegmental tumor recurrence rates tended to be higher with touch ablation ( P = 0.083). Multivariate Cox proportional hazards analysis revealed that ablation procedure (touch ablation, hazard ratio [HR] 10.32, P = 0.032), type of enhancement pattern (Type 3, HR 3.05, P = 0.006; and Type 4, HR 8.87, P < 0.001) and serum des-γ-carboxyprothrombin level (≥100 AU/L; HR 2.73, P = 0.035) were significant predictors for intrasubsegmental recurrence. Conclusion The no-touch pincer ablation procedure has the potential to prevent intrasubsegmental recurrence after RFA for patients with HCC. [ABSTRACT FROM AUTHOR] more...
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- 2017
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9. Beneficial effect of arterial embolization with warmed miriplatin for multiple hepatocellular carcinoma.
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Ikeda, Kenji, Kawamura, Yusuke, Kobayashi, Masahiro, Fujiyama, Shunichiro, Sezaki, Hitomi, Hosaka, Tetsuya, Akuta, Norio, Saitoh, Satoshi, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu more...
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LIVER cancer ,RESPONSE rates ,CHEMOEMBOLIZATION ,SPONTANEOUS cancer regression - Abstract
Aim The effect of transcatheter arterial chemoembolization (TACE) is not necessarily sufficient in patients with multiple hepatocellular carcinoma (HCC). We evaluated the antitumor activity and adverse events of TACE using warmed miriplatin suspension for multiple HCC. Methods Seventy patients with multiple HCC received TACE using warmed miriplatin/lipiodol suspension, including patients who were TACE-naïve (group A, n = 5), those undergoing initial TACE after radical therapies (group B, n = 31), and those with a history of repeated TACE (group C, n = 34). Median tumor size was 19.5 mm and a median of four nodules. Results Complete necrosis (TE 4) and partial necrosis (TE 3) of 50% or more were attained in 24 and 19 patients at 3 months after TACE, respectively. Response rates (TE 4 + TE 3) were 60.0% in group A, 83.9% in group B, and 41.2% in group C ( P = 0.038). Survival rates of all patients after TACE were 82.6% after 1 year, 65.6% after 2 years, and 47.7% after 3 years. Three-year survival rates of patients in groups A, B, and C were 53.3%, 78.8%, and 29.7%, respectively ( P = 0.0029). Conclusion Transcatheter arterial chemoembolization using warmed miriplatin induced high response rate in multiple HCC, and the rate was significantly high in those patients with recurrent multiple HCCs after curative therapies. [ABSTRACT FROM AUTHOR] more...
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- 2017
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10. Usefulness and limitations of balloon-occluded transcatheter arterial chemoembolization using miriplatin for patients with four or fewer hepatocellular carcinoma nodules.
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Kawamura, Yusuke, Ikeda, Kenji, Fujiyama, Shunichiro, Hosaka, Tetsuya, Kobayashi, Masahiro, Saitoh, Satoshi, Sezaki, Hitomi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu more...
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LIVER cancer ,ORGANOPLATINUM compounds ,MEDICAL balloons ,CHEMOEMBOLIZATION ,TREATMENT effectiveness ,THERAPEUTICS - Abstract
Aim The aim of this study is to clarify the usefulness and limitations of balloon-occluded transcatheter arterial chemoembolization (B-TACE) using miriplatin for patients with four or fewer hepatocellular carcinoma (HCC) nodules. Methods We studied 47 nodules in 30 consecutive patients who received miriplatin by B-TACE to treat HCC with four or fewer nodules per patient. The treatment effect was evaluated using the Response Evaluation Criteria in Cancer of the Liver. Results Nodules were divided according to the presence or absence of portal vein visualization during B-TACE. In the presence group, dynamic computed tomography at 3 months post-therapy showed Response Evaluation Criteria in Cancer of the Liver treatment effect (TE) 4 in 88% (14/16), TE3 in 0% (0/16), TE2 in 0% (0/16), TE1 in 12% (2/16), and objective response in 88% of nodules. In the absence group, the results were TE4 in 35% (11/31), TE3 in 13% (4/31), TE2 in 26% (8/31), TE1 in 26% (8/31), and objective response decreased to 48% of nodules. In addition to typical hypervascular nodules, we treated three nodules with irregular ring enhancement that predicted poorly differentiated HCC and four nodules that included a hypoenhancement area that predicted well to moderately differentiated HCC. All irregular ring enhancement nodules achieved TE4. Other nodules that were predicted to be well to moderately differentiated HCC did not have portal vein visualization during B-TACE and could not achieve TE4. Conclusion Balloon-occluded transcatheter arterial chemoembolization is a useful technique for treatment of classical hypervascular HCC, and portal vein visualization during the B-TACE procedure may provide more favorable local control. [ABSTRACT FROM AUTHOR] more...
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- 2017
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11. Effects of Alcohol Consumption on Hepatocarcinogenesis in Japanese Patients With Fatty Liver Disease.
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Kawamura, Yusuke, Arase, Yasuji, Ikeda, Kenji, Akuta, Norio, Kobayashi, Masahiro, Saitoh, Satoshi, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Inao, Mie, Mochida, Satoshi, and Kumada, Hiromitsu
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Background & Aims The effect of ethanol consumption on hepatocarcinogenesis in patients with fatty liver disease (FLD) is not clear. We aimed to investigate the influence of alcohol consumption on hepatocarcinogenesis and determine the risk factors for hepatocellular carcinoma (HCC) in a large number of Japanese patients with FLD without viral hepatitis. Methods This multicenter, retrospective cohort study was conducted at a specialized center for hepatology in Japan and included 9959 patients with FLD without viral hepatitis, diagnosed by ultrasonography from January 1997 through December 2011. The patients’ level of ethanol consumption was divided into 4 categories: <20 g/day (n = 6671), 20–39 g/day (n = 753), 40–69 g/day (n = 1589), and ≥70 g/day (n = 946). The primary endpoint was the onset of HCC. Statistical analyses performed included the Kaplan-Meier method and Cox proportional hazard analysis. The median follow-up period was 5.4 years. Results Of the study cohort, 49 cases (0.49%) developed HCC during the follow-up period. The annual incidence rate of HCC was 0.05% in patients with FLD and a daily ethanol consumption <20 g/day. Increasing levels of ethanol consumption were associated with increased annual incidence rates of HCC: 0.06% for patients with 20–39 g/day ethanol consumption (hazard ratio [HR], 1.54; 95% confidence interval [CI], 0.34–7.04), 0.16% for patients with 40–69 g/day ethanol consumption (HR, 3.49; 95% CI, 1.50–8.12), and 0.22% for patients with ≥70 g/day ethanol consumption (HR, 10.58; 95% CI, 5.06–22.13), compared with patients with ethanol consumption <20 g/day. Multivariate analysis showed that ethanol consumption ≥40 g/day was an independent risk factor for HCC: for 40–69 g/day the HR was 2.48 (95% CI, 1.01–6.05; P < .047) and for ≥70 g/day the HR was 12.61 (95% CI, 5.68–28.00; P < .001). Conclusions Based on a multicenter, retrospective analysis of almost 10,000 patients with FLD, ethanol consumption ≥40 g/day is an independent risk factor for HCC. [ABSTRACT FROM AUTHOR] more...
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- 2016
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12. Potential of a no-touch pincer ablation procedure for small hepatocellular carcinoma that uses a multipolar radiofrequency ablation system: An experimental animal study.
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Kawamura, Yusuke, Ikeda, Kenji, Fukushima, Taito, Hara, Tasuku, Hosaka, Tetsuya, Kobayashi, Masahiro, Saitoh, Satoshi, Sezaki, Hitomi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu more...
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LIVER cancer ,ABLATION techniques ,CATHETER ablation ,LABORATORY swine ,CARBONIZATION ,MEDICAL statistics - Abstract
Aim Treatment of hepatocellular carcinoma located on the liver surface is frequently difficult because direct puncture of the tumor must be avoided during needle insertion. The aim of this study was to investigate the utility of a no-touch pincer ablation procedure that uses a multipolar radiofrequency ablation ( RFA) system for a tumor located on the liver surface. Methods The experimental animals were three pigs, and RFA was performed with two internally cooled bipolar electrodes. Three ablative procedures were compared: linear insertion at regular 13-mm intervals (pattern 1; virtual target tumor size, <10 mm); fan-shape insertion, maximum interval 20 mm (pattern 2; virtual target tumor size, <15 mm); and 25 mm (pattern 3; virtual target tumor size, <20 mm). All electrodes were inserted at a 30-mm depth. For patterns 1 and 2, ablation was performed on three other parts of the liver, and for pattern 3, ablation was performed on two other parts. Results For the median transverse and longitudinal diameter to the shaft, with the pattern 1 procedure, the ablative areas were 32 mm × 30 mm, and with the pattern 2 procedure, the ablative areas were 27 mm × 30 mm with carbonization of the liver surface. In contrast, with the pattern 3 procedure, the ablative areas were 45 mm × 26 mm; however, the ablative margin did not reach the surface, and carbonization was not apparent. Conclusion The no-touch pincer ablation procedure (with an electrode interval of ≤20 mm) may be useful when performed with two internally cooled bipolar electrodes for small nodules that protrude from the liver surface. [ABSTRACT FROM AUTHOR] more...
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- 2014
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13. Clinical significance of hepatectomy for primary biliary cirrhosis patients with hepatocellular carcinoma: Report of a single center case series and review of the published work.
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Sasaki, Kazunari, Matsuda, Masamichi, Ohkura, Yu, Kawamura, Yusuke, Inoue, Masafumi, Suzuki, Yoshiyuki, Hashimoto, Masaji, Ikeda, Kenji, Kumada, Hiromitsu, and Watanabe, Goro
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HEPATECTOMY ,SURGICAL excision ,STANDARD deviations ,LIVER cancer ,VIRAL hepatitis ,LIVER transplantation - Abstract
Aim Hepatectomy for hepatocellular carcinoma ( HCC) in patients with primary biliary cirrhosis ( PBC) has seldom been reported, and the clinical significance of this procedure remains unclear, although HCC has often been observed in end-stage PBC patients. Methods To understand the characteristics of hepatectomy on HCC in PBC patients, we examined seven cases at our institute, as well as 22 reported hepatectomy cases in the English-language and Japanese published work. Furthermore, to assess the treatment efficacy of hepatectomy for HCC in PBC patients, we compared these patients with viral hepatitis patients who underwent hepatectomies at our institute during the same period. Results In the review of 29 cases, more than 70% of the patients were aged over 65 years, and the mean Mayo risk score was low at 5.17. The resected tumors were mainly solitary (79%), and the median maximum tumor size was 37 mm. Approximately two-thirds of the patients met the Milan criteria. In the comparison between the PBC and viral hepatitis cases, there were no differences in the postoperative prognoses, although the tumor size was greater in the PBC cases. Conclusion Hepatectomy for HCC in selected PBC cases is a feasible and potentially curative treatment option, similar to hepatectomy for HCC in viral hepatitis patients. This procedure is particularly useful for patients with preserved liver function who are not ideal candidates for liver transplantation. [ABSTRACT FROM AUTHOR] more...
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- 2014
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14. Antitumor efficacy of transcatheter arterial chemoembolization with warmed miriplatin in hepatocellular carcinoma.
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Seko, Yuya, Ikeda, Kenji, Kawamura, Yusuke, Fukushima, Taito, Hara, Tasuku, Sezaki, Hitomi, Hosaka, Tetsuya, Akuta, Norio, Suzuki, Fumitaka, Kobayashi, Masahiro, Suzuki, Yoshiyuki, Saitoh, Satoshi, Arase, Yasuji, and Kumada, Hiromitsu more...
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LIVER cancer ,ANTINEOPLASTIC agents ,CISPLATIN ,DRUG derivatives ,CANCER chemotherapy ,CANCER tomography ,TREATMENT effectiveness - Abstract
Aim Patients with unresectable hepatocellular carcinoma ( HCC) often undergo transcatheter arterial chemoembolization ( TACE). Miriplatin is a lipophilic cisplatin derivative used in TACE that is effective in HCC. However, the difference in antitumor efficacy between warmed versus room temperature miriplatin is unclear. Methods Chemotherapy efficacy was evaluated by dynamic computed tomography 1-3 months after TACE, according to the Modified Response Evaluation Criteria in Solid Tumors. A total of 203 patients with HCC who received TACE with miriplatin for the first time were included in a follow-up study to retrospectively investigate its efficacy and safety. Overall, 45 patients underwent TACE with warmed (40° C) miriplatin and 158 patients received TACE with room temperature miriplatin. Results Seventy patients (44.3%) treated with room temperature miriplatin and 32 patients (71.1%) who received warmed miriplatin experienced complete or partial responses. Multivariate analysis identified miriplatin temperature (warmed miriplatin, risk ratio ( RR) = 2.26, P = 0.047), tumor number (solitary, RR = 3.48, P = 0.007), α-fetoprotein ( AFP) level (<50 ng/ mL, RR = 2.35, P = 0.012) and history of TACE (no history, RR = 2.22, P = 0.041) as predictors of objective response following TACE with miriplatin, and no serious complications were observed. Conclusion Warm temperature, solitary tumors, low AFP level and first TACE are significant and independent predictors of objective response after TACE using miriplatin. These results suggest that warmed miriplatin can be considered as one of the standard treatments for unresectable HCC. [ABSTRACT FROM AUTHOR] more...
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- 2013
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15. Randomized controlled trial of a new procedure of radiofrequency ablation using an expandable needle for hepatocellular carcinoma.
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Hirakawa, Miharu, Ikeda, Kenji, Kobayashi, Masahiro, Kawamura, Yusuke, Hosaka, Tetsuya, Sezaki, Hitomi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Saitoh, Satoshi, Arase, Yasuji, and Kumada, Hiromitsu more...
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LIVER cancer patients ,LIVER cancer ,RANDOMIZED controlled trials ,CATHETER ablation ,NEEDLE biopsy ,DRUG efficacy ,SCIENTIFIC observation - Abstract
Aim To evaluate the efficacy of a new ablation procedure for the stepwise hook extension technique using a SuperSlim needle for radiofrequency ablation ( RFA) treatment of hepatocellular carcinoma ( HCC), a randomized controlled trial was performed. Methods Thirty patients with HCC measuring 20 mm or less were randomly treated with a conventional four stepwise expansion technique (group 1) and the new stepwise expansion technique (group 2; the electrode was closed in the shaft after the same three steps of the conventional procedure and then fully extended). All patients underwent the RFA procedure using a 10-hook expandable electrode of 17-G diameter ( Le Veen SuperSlim 30 mm). We compared the ablation time, required energy and ablated lesions in the two groups. Results The long and short diameters of RFA-induced necrosis were significantly larger in group 2 (37 and 28 mm) than group 1 (30 and 26 mm, P = 0.001 and =0.045, respectively). Irregular and small needle expansion resulting in the parachute-like or irregularly shaped ablated zone was observed in more cases in group 1 than in group 2. The new technique made all tines expand uniformly and largely, which produced a near-oval ablated zone of which the long axis is perpendicular to the needle shaft. Conclusion The two kinds of stepwise procedures allow the selection of a more suitable procedure according to the tumor size and shape in each RFA. [ABSTRACT FROM AUTHOR] more...
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- 2013
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16. Transcatheter Arterial Chemotherapy with Miriplatin for Hepatocellular Carcinoma Patients with Chronic Renal Failure: Report of Three Cases.
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Imai, Norihiro, Ikeda, Kenji, Seko, Yuya, Kawamura, Yusuke, Sezaki, Hitomi, Hosaka, Tetsuya, Akuta, Norio, Kobayashi, Masahiro, Saitoh, Satoshi, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu more...
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DRUG therapy ,CANCER patients ,KIDNEY diseases ,LIVER cancer ,CREATINE - Abstract
Miriplatin is a novel lipophilic platinum complex that was developed to treat hepatocellular carcinoma (HCC). Although HCC patients frequently have coexisting chronic renal failure, little prospective data are available regarding the clinical toxicity of chemotherapeutic agents used to treat HCC patients with chronic renal failure. In a phase II study, the plasma concentration of total platinum in patients who received miriplatin was very low, and no severe renal toxicity caused by miriplatin injection was reported. Here, we present three cases of HCC with stage 4 chronic renal failure who received transcatheter arterial chemotherapy with miriplatin. All cases were male, ages 72, 84, and 83 years, and had serum creatinine levels of 2.3, 1.6, and 1.9 mg/dL, respectively. Their estimated glomerular filtration rates were 21.9, 20.3, and 22.2 mL/min, respectively. All cases were treated for unresectable HCC with transcatheter arterial chemotherapy with miriplatin. No serious adverse events were observed, and serum creatinine levels did not elevate, even in the patient who experienced renal failure caused by cisplatin administration. These results might suggest that transcatheter arterial chemotherapy with miriplatin can be safely used in HCC patients with chronic renal failure. [ABSTRACT FROM AUTHOR] more...
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- 2013
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17. Difference in malignancies of chronic liver disease due to non-alcoholic fatty liver disease or hepatitis C in Japanese elderly patients.
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Arase, Yasuji, Kobayashi, Mariko, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Kawamura, Yusuke, Akuta, Norio, Imai, Norihiro, Kobayashi, Masahiro, Sezaki, Hitomi, Matsumoto, Naoki, Saito, Satoshi, Hosaka, Tetsuya, Ikeda, Kenji, Kumada, Hiromitsu, Ohmoto, Yuki, Amakawa, Kazuhisa, Hsieh, Shiun Dong, Ogawa, Kyoko, Tanabe, Maho, and Tsuji, Hiroshi more...
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LIVER cancer ,OLDER patients ,HEPATITIS C virus ,ETIOLOGY of diseases ,PROPORTIONAL hazards models ,FATTY liver - Abstract
Aim: Malignancies that include hepatocellular carcinoma often occurred in patients with chronic liver disease. The aim of this retrospective match control study was to assess the cumulative development incidence and predictive factors for total malignancies in elderly Japanese patients with non-alcoholic hepatic diseases (NAFLD) or hepatitis C virus (HCV). Methods: A total of 1600 NAFLD patients with age of ≥60 years were enrolled, and 1600 HCV patients with age of ≥60 years were selected as control by matching 1:1 with NAFLD group for age, sex, and follow-up period. The primary goal is the first development of malignancies. Evaluation was performed by the use of the Wilcoxon rank sum test, the Kaplan-Meier method, and Cox proportional hazard model. The mean observation period is 8.2 years in both NAFLD and HCV group, respectively. Results: The number of patients with the development of malignancies was 167 in the NAFLD group and 395 in the HCV group. The 10th development rate of malignancies was 13.9% in the NAFLD group and 28.2% in the HCV group (risk ratio 2.27; P < 0.001). The incident rates of hepatocellular carcinoma in all the malignancies were 6.0% (10/167) in the NAFLD group and 67.6% (267/395) in the HCV group ( P < 0.001). The malignancies in the NAFLD group were observed in the following order: gastric cancer 34 cases (20.4%) > colon cancer 31 cases (18.6%) > prostate cancer 21 cases (12.6%). Conclusions: The incident rates of hepatocellular carcinoma in all the malignancies were approximately 6% in the NAFLD group and two-thirds in the HCV group. [ABSTRACT FROM AUTHOR] more...
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- 2012
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18. Large-Scale Long-Term Follow-Up Study of Japanese Patients With Non-Alcoholic Fatty Liver Disease for the Onset of Hepatocellular Carcinoma.
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Kawamura, Yusuke, Arase, Yasuji, Ikeda, Kenji, Seko, Yuya, Imai, Norihiro, Hosaka, Tetsuya, Kobayashi, Masahiro, Saitoh, Satoshi, Sezaki, Hitomi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Ohmoto, Yuki, Amakawa, Kazuhisa, Tsuji, Hiroshi, and Kumada, Hiromitsu more...
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CANCER risk factors ,LIVER cancer ,FOLLOW-up studies (Medicine) ,FATTY liver ,ASPARTATE aminotransferase ,ULTRASONIC imaging ,PUBLIC hospitals - Abstract
OBJECTIVES:The aim of this study was to determine the incidence and risk factors of hepatocellular carcinoma (HCC), and to elucidate the utility of two non-invasive predictive procedures for liver fibrosis: the aspartate aminotransferase (AST) to platelet ratio index (APRI) and the BARD score (which includes the following three variables: body mass index, AST/alanine aminotransferase ratio, and diabetes) in the prediction of HCC in a large population of Japanese patients with non-alcoholic fatty liver disease (NAFLD).METHODS:This was a retrospective cohort study conducted at a public hospital. Study subjects included 6,508 patients with NAFLD diagnosed by ultrasonography. The median follow-up period was 5.6 years. The primary end point was the onset of HCC. Evaluation was performed using Kaplan-Meier methodology and Cox's proportional hazards analysis.RESULTS:In all, 16 (0.25%) new cases with HCC were diagnosed during the study. The cumulative rates of NAFLD-related HCC were 0.02% at year 4, 0.19% at year 8, and 0.51% at year 12. The annual rate of new HCC was 0.043%. Multivariate analysis identified serum AST level ≥40 IU/L (hazard ratio (HR): 8.20; 95% confidence interval (95% CI): 2.56-26.26; P<0.001), platelet count <150 × 10
3 /μl (HR: 7.19; 95% CI: 2.26-23.26; P=0.001), age ≥60 years (HR: 4.27; 95% CI: 1.30-14.01; P=0.017), and diabetes (HR: 3.21; 95% CI: 1.09-9.50; P=0.035) as independent risk factors for HCC. With regard to the APRI, 184 patients (2.83%) were considered to have significant fibrosis (equivalent to non-alcoholic steatohepatitis (NASH) stage 3-4). The cumulative rate of HCC was significantly higher in this group (HR: 25.03; 95% CI: 9.02-69.52; P<0.001). In contrast, regarding the BARD score, 3,841 (59%) patients were considered to have advanced fibrosis (NASH stage 3-4). However, no significant associations between the BARD score and the incidence of HCC were observed (HR: 1.16; 95% CI: 0.40-3.37; P=0.780).CONCLUSIONS:This retrospective study indicates that the annual incidence rate of HCC among Japanese NAFLD patients is low. Elderly NAFLD patients with diabetes, elevated serum AST, and especially thrombocytopenia (suggested to be associated with advanced liver fibrosis) should be monitored carefully during follow-up that includes using the APRI to ensure early diagnosis and treatment of HCC. [ABSTRACT FROM AUTHOR] more...- Published
- 2012
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19. Highly sensitive AFP-L3% assay is useful for predicting recurrence of hepatocellular carcinoma after curative treatment pre- and postoperatively.
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Kobayashi, Masahiro, Hosaka, Tetsuya, Ikeda, Kenji, Seko, Yuya, Kawamura, Yusuke, Sezaki, Hitomi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Saitoh, Satoshi, Arase, Yasuji, and Kumada, Hiromitsu more...
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LIVER cancer ,CURATIVE medicine ,CANCER relapse ,POSTOPERATIVE care ,CAPILLARY electrophoresis ,RETROSPECTIVE studies ,RADIO frequency - Abstract
Aim: The micro-total analysis system (µTAS), a fully automated immunoassay system using microchip capillary electrophoresis, is highly sensitive and able to quickly assay the AFP-L3%. The clinical usefulness of this system was studied. Methods: We retrospectively enrolled 250 patients who underwent curative treatment for primary hepatocellular carcinoma (HCC) (93 patients underwent hepatic resection and 157, radiofrequency ablation [RFA]). Results: The sensitivity for µTAS AFP-L3% was 40.3% at the cutoff value of 5% in a range of AFP less than 20 ng/mL where the conventional method was unable to determine AFP-L3%. The sensitivity for AFP-L3% remained high even at stage I and at tumor size less than 2 cm (42.5% and 46.0%, respectively). Recurrence rate of patients with AFP-L3% greater than 5% was significantly higher than that of patients with less than 5% ( P = 0.001). Furthermore, in resected patients, the postoperative AFP-L3% remained elevated with value greater than 5% was related to HCC recurrence ( P = 0.001). Multivariate analysis revealed that multiple tumors ( P = 0.004), preoperative AFP-L3% greater than 5% ( P = 0.003), albumin less than 3.5 g/dL ( P = 0.008), and RFA ( P = 0.003) were significant prognostic factors of recurrence. Conclusions: The µTAS was found to be a highly sensitive assay for AFP-L3% in patients with curative treatment of HCC. A cutoff value of 5% was useful for predicting recurrence after the curative treatment and detecting small tumors and early stage HCC. Additionally, postoperative AFP-L3% was found to be a prognostic factor of HCC recurrence. [ABSTRACT FROM AUTHOR] more...
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- 2011
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20. Previous Chemoembolization Response after Transcatheter Arterial Chemoembolization (TACE) Can Predict the Anti-Tumor Effect of Subsequent TACE with Miriplatin in Patients with Recurrent Hepatocellular Carcinoma.
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Imai, Norihiro, Ikeda, Kenji, Seko, Yuya, Kawamura, Yusuke, Sezaki, Hitomi, Hosaka, Tetsuya, Akuta, Norio, Kobayashi, Masahiro, Saitoh, Satoshi, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu more...
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THERAPEUTIC embolization ,ANTINEOPLASTIC agents ,LIVER cancer ,CANCER treatment ,ONCOLOGIC surgery - Abstract
Aim: The purpose of this retrospective study was to evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) with miriplatin in patients with unresectable hepatocellular carcinoma (HCC). Methods: From 2007 to 2010, 122 consecutive patients with unresectable HCC were treated by TACE with miriplatin-lipiodol suspension in our institute. Twenty-two patients (18%) had a solitary nodule and 100 patients (82%) had multiple nodules. Ninety-eight patients (80%) had a history of TACE. Results: Thirty-five of the 122 treated patients (29%) showed complete response (CR). And no serious complications were observed. Patients who had shown CR after previous TACE (pre-CR) were significantly more likely to show CR in the current study compared with patients who had shown less successful responses after previous TACE (56 vs. 20%, p = 0.003). Multivariate analysis revealed that response after previous TACE (pre-CR, risk ratio: 4.76; p = 0.035), tumor multiplicity (solitary, risk ratio: 9.69; p = 0.003), and injection artery (peripheral to segmental hepatic artery, risk ratio: 5.28;p = 0.040) were significant independent predictors associated with CR after TACE using miriplatin. Conclusion: In repetition of TACE treatment, switching the TACE agent from epirubicin or cisplatin to miriplatin offered a favorable treatment effect, especially in patients who had shown a CR after previous TACE. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR] more...
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- 2011
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21. Stage progression of small hepatocellular carcinoma after radical therapy: comparisons of radiofrequency ablation and surgery using the Markov model.
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Ikeda, Kenji, Kobayashi, Masahiro, Kawamura, Yusuke, Imai, Norihiro, Seko, Yuya, Hirakawa, Miharu, Hosaka, Tetsuya, Sezaki, Hitomi, Akuta, Norio, Saitoh, Satoshi, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu more...
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LIVER cancer ,RADIO frequency ,MARKOV processes ,METASTASIS - Abstract
Stage progression of 374 small hepatocellular carcinomas (HCC) was retrospectively analysed. During 8 years, 236 patients with the early stage of HCC received radiofrequency ablation (RFA), and 138 underwent surgery as an initial therapy. More patients of young age and with better liver function tended to undergo surgical treatment. Based on 1892 patient-year data, the Markov model analysed the stepwise progression of early stage (multiple up to three nodules, 3 cm or less each) to intermediate stage (four nodules or more, or larger than 3 cm), to advanced stage (portal invasion, extrahepatic metastasis or Child-Pugh C) and to death. The recurrence rates after RFA and surgery were 53.3 and 40.6% in the third year. The annual progression rates from the early stage to the intermediate stage, advanced stage and death were 5.40, 1.63 and 1.73% in the RFA group and 3.90, 1.87 and 0.62% in the surgery group respectively. The progression rate from the early to the intermediate stage was significantly lower (2.34% annually) in the younger patient group (<60 years) than that in the older group (≥60 years, 5.70%, P=0.0053). In contrast, the progression rate from the intermediate to the advanced stage was significantly higher in the younger patient group (<60 years, 37.50% annually) than that in the older groups (60-69 years, 30.30%, 70 years or older 22.09%, P=0.0011). Multivariate hazard analysis showed that initial treatment did not significantly affect the stage progression rate (hazard ratio of RFA 1.09, P=0.70) and the survival rate (hazard ratio of RFA 1.09, P=0.73). Although the recurrence rate was slightly higher in the RFA group, additional ablation procedures could control the progression of HCC, with a rate comparable to the surgical group. [ABSTRACT FROM AUTHOR] more...
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- 2011
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22. Administration of interferon for two or more years decreases early stage hepatocellular carcinoma recurrence rate after radical ablation: A retrospective study of hepatitis C virus-related liver cancer.
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Ikeda, Kenji, Kobayashi, Masahiro, Seko, Yuya, Imai, Norihiro, Hirakawa, Miharu, Kawamura, Yusuke, Sezaki, Hitomi, Hosaka, Tetsuya, Akuta, Norio, Saitoh, Satoshi, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu more...
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INTERFERONS ,LIVER cancer ,CATHETER ablation ,CANCER relapse ,HEPATITIS C virus ,RNA ,VIROLOGY ,MULTIVARIATE analysis - Abstract
Since hepatocellular carcinoma often recurs after surgical resection or radiofrequency ablation, we analyzed a retrospective large cohort of patients with small hepatocellular carcinoma caused by hepatitis C virus (HCV). Among 379 patients with HCV RNA-positive small hepatocellular carcinoma (multiple up to three nodules, 3 cm or less each), 77 received interferon-alpha injection and 302 received no anti-viral therapy. Four patients (5.2%) attained sustained virological response (SVR). Cumulative recurrence rates in the treated and untreated groups were 41.1% and 57.5% at the end of the third year, and 63.0% and 74.5% at the fifth year, respectively ( P = 0.013). Fifth year-recurrence rates in treated group were 25.0% in SVR, 85.7% in biochemical response, 71.1% in no response, and 46.7% in patients with continuous administration. When four patients with SVR were excluded, recurrence rates in short-term interferon therapy (<2 years) and long-term therapy (≥2 years) were 46.2% and 39.3% at the third year, and 66.2% and 57.4% at the fifth year, respectively ( P = 0.012). Multivariate analysis showed that long-term interferon therapy significantly decreased recurrence rate (hazard ratio for interferon <2 years 0.80, interferon ≥2 years 0.60, P = 0.044), after adjustment with background covariates including indocyanine green retention rate ( P = 0.018), alpha-fetoprotein ( P = 0.051), and tumor treatment ( P = 0.066). A long-term administration of low-dose interferon significantly decreased recurrence of hepatocellular carcinoma after surgical resection or radiofrequency ablation. [ABSTRACT FROM AUTHOR] more...
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- 2010
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23. New classification of dynamic computed tomography images predictive of malignant characteristics of hepatocellular carcinoma.
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Kawamura, Yusuke, Ikeda, Kenji, Hirakawa, Miharu, Yatsuji, Hiromi, Sezaki, Hitomi, Hosaka, Tetsuya, Akuta, Norio, Kobayashi, Masahiro, Saitoh, Satoshi, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu more...
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LIVER cancer ,CANCER tomography ,CANCER histopathology ,SURGICAL excision ,SEPTUM (Brain) ,BLOOD flow ,RETROSPECTIVE studies ,ONCOLOGIC surgery - Abstract
Aim: The aim of this study was to elucidate whether the histopathological characteristics of hepatocellular carcinoma (HCC) can be predicted from baseline dynamic computed tomography (CT) images. Methods: This retrospective study included 86 consecutive patients with HCC who underwent surgical resection between January 2000 and September 2008. The arterial- and portal-phase dynamic CT images obtained preoperatively were classified into four enhancement patterns: Type-1 and Type-2 are homogeneous enhancement patterns without or with increased arterial blood flow, respectively; Type-3, heterogeneous enhancement pattern with septum-like structure; and Type-4, heterogeneous enhancement pattern with irregular ring-like structures. We also evaluated the predictive factors for poorly-differentiated HCC, specific macroscopic type of HCC (simple nodular type with extranodular growth [SNEG] and confluent multinodular [CMN]) by univariate and multivariate analyses. Results: The percentages of poorly-differentiated HCC according to the enhancement pattern were three of 51 nodules (6%) of Type-1 and -2, three of 24 (13%) of Type-3, and eight of 11 (73%) of Type-4. The percentages of SNEG/CMN according to the enhancement pattern were 12 of 51 nodules (24%) of Type-1 and -2, 13 of 24 (54%) of Type-3, and five of 11 (45%) of Type-4. Multivariate analysis identified Type-4 pattern as a significant and independent predictor of poorly-differentiated HCC ( P < 0.001) while Type-3 pattern was a significant predictor of SNEG/CMN ( P = 0.017). Conclusion: Heterogeneity of dynamic CT images correlates with malignant characteristics of HCC and can be potentially used to predict the malignant potential of HCC before treatment. [ABSTRACT FROM AUTHOR] more...
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- 2010
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24. Development of HCC in patients receiving adefovir dipivoxil for lamivudine-resistant hepatitis B virus mutants.
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Hosaka, Tetsuya, Suzuki, Fumitaka, Kobayashi, Masahiro, Hirakawa, Miharu, Kawamura, Yusuke, Yastuji, Hiromi, Sezaki, Hitomi, Akuta, Norio, Suzuki, Yoshiyuki, Saitoh, Satoshi, Arase, Yasuji, Ikeda, Kenji, Miyakawa, Yuzo, and Kumada, Hiromitsu more...
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LIVER cancer ,CANCER risk factors ,HEPATITIS B ,HEPATITIS B virus ,DRUG side effects ,LAMIVUDINE - Abstract
Aim: To identify factors for the development of hepatocellular carcinoma (HCC) in the patients who receive adefovir add-on lamivudine for treatment of lamivudine-resistant hepatitis B virus (HBV) mutants. Methods: A total of 247 patients who developed lamivudine-resistant HBV mutants, with an increase of HBV DNA ≥ 1 log copies/mL, received adefovir dipivoxil 10 mg add-on lamivudine 100 mg daily during a median of 115 weeks (range: 25–282 weeks). They were followed for the development of HCC by imaging modalities every 3−6 months. Results: HCC developed in 18 of the 247 (7.3%) patients. Eight factors were in significant association with the development of HCC by the univariate analysis. They included age, cirrhosis, platelet counts, levels of bilirubin, aspartate aminotransferase (AST), alanine aminotransferase and α-fetoprotein, as well as YMDD mutants at the start of adefovir dipivoxil. By the multivariate analysis, AST levels, YIDD mutants, cirrhosis and age were independent factors for the development of HCC. By the Kaplan-Meier analysis, AST levels ≥ 70 IU/L, YIDD mutants, cirrhosis and age ≥ 50 years increased the risk of HCC ( P = 0.018, P = 0.035, P = 0.002 and P = 0.014, respectively). HCC developed more frequently in the patients with than without cirrhosis at the start of adefovir (10/59 [16.9%] vs. 8/188 [4.3%], P = 0.002). Conclusion: HCC can develop in cirrhotic patients receiving adefovir add-on lamivudine. Hence, the patients with baseline AST ≥ 70 IU/L and YIDD mutants would need to be monitored closely for HCC. [ABSTRACT FROM AUTHOR] more...
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- 2010
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25. Development of hepatocellular carcinoma in elderly patients with chronic hepatitis C with or without elevated aspartate and alanine aminotransferase levels.
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Kobayashi, Mariko, Suzuki, Fumitaka, Akuta, Norio, Suzuki, Yoshiyuki, Sezaki, Hitomi, Yatsuji, Hiromi, Kawamura, Yusuke, Hosaka, Tetsuya, Kobayashi, Masahiro, Arase, Yasuji, Ikeda, Kenji, Mineta, Rie, Iwasaki, Satomi, Watahiki, Sachiyo, Miyakawa, Yuzo, and Kumada, Hiromitsu more...
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HEPATITIS C ,LIVER cancer ,OLDER people ,OLDER patients ,ALANINE aminotransferase - Abstract
Objective. Hepatocellular carcinoma (HCC) in the elderly infected with hepatitis C virus (HCV) is expected to increase globally within the next two decades. The purpose of the study was to define the natural history of elderly patients with chronic hepatitis C needs in order to prevent HCC from arising in these patients. Material and methods. Treatment-naive patients aged ≥65 years with platelet counts >120×103/mm3 were classified as 120 with aspartate and alanine aminotransferase (ASAT and ALAT) levels ≦40 IU/l (group A) and 212 with either or both levels ≥41 (group B) and followed-up for 3 years or longer without antiviral treatment. Results. Cirrhosis and HCC developed more frequently in group B than in group A (p<0.001 for both). In particular, of the patients aged 65-69 years at entry, cirrhosis and HCC developed more frequently in group B than in group A (p<0.001 and p=0.001, respectively). Liver-related causes of death were more common in group B than in group A (20/34 (59%) versus 1/9 (11%), p=0.021). HCC developed more frequently in men than in women (p=0.033). Conclusions . In elderly patients with chronic hepatitis C, cirrhosis and HCC develop more frequently in those with elevated transaminase levels than in those without elevated transaminase levels. Therefore, transaminase levels need to be suppressed below ≦40 IU/l, using antiviral treatments or other agents, in order to prevent cirrhosis and HCC arising in these patients. In view of rare liver-related deaths, aggressive antiviral treatment would not be necessary in the elderly with chronic hepatitis C who have normal transaminase levels. [ABSTRACT FROM AUTHOR] more...
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- 2009
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26. Predictive factors of advanced recurrence after curative resection of small hepatocellular carcinoma.
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Hosaka, Tetsuya, Ikeda, Kenji, Kobayashi, Masahiro, Hirakawa, Miharu, Kawamura, Yusuke, Yatsuji, Hiromi, Sezaki, Hitomi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Saitoh, Satoshi, Arase, Yasuji, and Kumada, Hiromitsu more...
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LIVER cancer ,TUMORS ,PATIENTS ,METASTASIS ,PROGNOSIS - Abstract
Background: The tumour recurrence rate after resection is still high even in patients with small hepatocellular carcinoma (HCC). The advanced patterns of recurrence occasionally occur after resection. In this study, we analysed the clinical and histological characteristics of small HCC and evaluated the predictive factors of advanced tumour recurrence. Methods: One hundred and sixty-five patients underwent resection of small HCC measuring 3 cm or less in greatest dimension. Patterns of tumour recurrences were classified into advanced recurrence and minor recurrence based on size, number, vascular invasion and extrahepatic metastasis of recurrent tumour. We created a simple index to closely evaluate the malignant potential of small HCC, named α-foetoprotein–size ratio index (ASRI). Results: Overall tumour recurrence was significantly associated with tumour multiplicity ( P<0.001) and ASRI ( P=0.001). Tumour multiplicity, ASRI and tumour differentiation were independent and significant predictive factors of advanced recurrences. The overall survival rates were lower in the advanced recurrence group than the minor recurrence or the no recurrence group. Conclusions: Patients with advanced recurrences have a poor prognosis, although they have undergone curative resection of small HCC. On the other hand, patients with minor recurrences have a relatively good prognosis. ASRI was a useful index to predict advanced recurrence after curative resection of small HCC. The therapeutic management to prevent advanced recurrences is needed. [ABSTRACT FROM AUTHOR] more...
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- 2009
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27. Efficacy of platinum analogue for advanced hepatocellular carcinoma unresponsive to transcatheter arterial chemoembolization with epirubicin.
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Kawamura, Yusuke, Ikeda, Kenji, Hirakawa, Miharu, Hosaka, Tetsuya, Kobayashi, Masahiro, Saitoh, Satoshi, Yatsuji, Hiromi, Sezaki, Hitomi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu more...
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LIVER cancer ,THERAPEUTICS ,CANCER patients ,CANCER treatment ,TOMOGRAPHY - Abstract
Aim: Hepatocellular carcinoma (HCC) often shows resistance to transcatheter arterial chemoembolization (TACE). Such patients often have a poor prognosis and are unresponsive to other forms of therapy. The aim of this retrospective study was to determine the response to TACE using platinum analogues in patients deemed resistant to TACE using epirubicin. Methods: We studied 152 consecutive patients with advanced HCC resistant to TACE using epirubicin. All cases were treated with platinum analogue using transcatheter arterial chemotherapy with or without embolization. Results: Computed tomography at 3 months after therapy showed complete response (CR) in 6 patients (4.0%), partial response (PR) in 28 (18%), stable disease (SD) in 35 (23%), and progressive disease (PD) in 83 (55%). The cumulative survival rates for PR/CR patients who received platinum analogue-transcatheter arterial chemotherapy with or without embolization (81.8% at first year, 53.9% at second year, and 33.1% at third year) were significantly higher than those of SD/PD patients (36.6%, 17.5% and 7.4%, respectively) ( P < 0.001). The 50% survival period was extended almost 1.4 year in PR/CR patients who received platinum analogue-transcatheter arterial chemotherapy with or without embolization. Conclusion: Our retrospective study is the first to report the efficacy of platinum analogues for advanced HCC unresponsive to TACE using epirubicin. [ABSTRACT FROM AUTHOR] more...
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- 2009
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28. High Serum Des-gamma-carboxy Prothrombin Level Predicts Poor Prognosis After Radiofrequency Ablation of Hepatocellular Carcinoma.
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Kobayashi, Masahiro, Ikeda, Kenji, Kawamura, Yusuke, Yatsuji, Hiromi, Hosaka, Tetsuya, Sezaki, Hitomi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Saitoh, Satoshi, Arase, Yasuji, and Kumada, Hiromitsu more...
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LIVER cancer ,CANCER patients ,CATHETER ablation ,TUMORS ,ONCOLOGY - Abstract
The article reports on a study analyzing treatment strategies for small hepatocellular carcinoma (HCC) measuring less than or equal to 13 cm by comparing the long-term outcome of patients treated with either hepatectomy or radiofrequency ablation (RFA) as the first-line treatment for HCC. In the study, 199 patients who underwent surgery and 209 patients who underwent RFA for HCC were analysed. It was found that high DCP levels reflect the biologic aggressiveness and progression of HCC tumors. more...
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- 2009
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29. Clinicopathological features, background liver disease, and survival analysis of HCV-positive patients with hepatocellular carcinoma: differences between young and elderly patients.
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Saneto, Hiromi, Kobayashi, Masahiro, Kawamura, Yusuke, Yatsuji, Hiromi, Sezaki, Hitomi, Hosaka, Tetsuya, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, Ikeda, Kenji, and Kumada, Hiromitsu more...
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LIVER diseases ,HEPATITIS C ,LIVER cancer ,TUMORS ,VIRAL hepatitis - Abstract
The aim of this retrospective study was to determine the incidence and characteristics of hepatocellular carcinoma (HCC) in hepatitis C virus (HCV) antibody-positive elderly patients with chronic hepatitis without cirrhosis. The study included 65 patients who developed HCC at ≥75 years of age and who received their first HCC therapy at Toranomon Hospital between 1985 and 2005. Their clinicopathological and laboratory data were analyzed and compared with those of 33 patients who developed HCC at ≤50 years of age during the same period. The ratio of women patients in the elderly group (M: F = 1.1: 1) was higher than in the younger group (M: F = 5.6: 1). Also, patients in the elderly group had better liver function and prothrombin activity ( P = 0.001), and lower total bilirubin ( P = 0.002) than the young group. Only 11 of 65 elderly patients were diagnosed with liver cirrhosis by biopsy or peritoneoscopy before or at the time of development of HCC. Based on a discriminate score using γ-globulin, hyaluronate level, platelet count, and sex, 27 (41.5%) elderly patients were considered to have chronic hepatitis, compared with six of 33 (18.1%) patients in the young group ( P = 0.025). There were no differences in tumor number or size or tumor markers between the two groups. Survival rate was higher in the younger patients ( P = 0.002), who were more likely to receive radical treatment. Our results showed distinct differences in HCV-related HCC between elderly and young patients and suggested that elderly patients (especially women) could develop HCC even when liver histology shows chronic hepatitis and lack of cirrhosis. [ABSTRACT FROM AUTHOR] more...
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- 2008
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30. Virological Response and Hepatocarcinogenesis in Lamivudine-Resistant Hepatitis B Virus Genotype C Patients Treated with Lamivudine plus Adefovir Dipivoxil.
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Akuta, Norio, Suzuki, Fumitaka, Kawamura, Yusuke, Yatsuji, Hiromi, Sezaki, Hitomi, Suzuki, Yoshiyuki, Hosaka, Tetsuya, Kobayashi, Masahiro, Kobayashi, Mariko, Arase, Yasuji, Ikeda, Kenji, and Kumada, Hiromitsu more...
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VIROLOGY ,MICROBIOLOGY ,LIVER cancer ,LIVER metastasis ,HEPATITIS B virus - Abstract
Aims: The long-term efficacy of adefovir dipivoxil in combination with lamivudine to chronic hepatitis B virus (HBV) infection is still unclear. Methods: Virological response and hepatocarcinogenesis during lamivudine + adefovir were investigated in 183 lamivudine-resistant Japanese patients with chronic genotype C-dominant HBV infection. As the predictors of virological response, an assessment of clinical parameters and a nucleotide (nt) sequence analysis of the negative regulatory element to core gene (nt 1611–2450) were performed at the start of adefovir. Results: The cumulative HBV-DNA non-detectable and ALT normalization rates were 93.6 and 97.6% at the end of 3 years, respectively. Multivariate analysis identified total bilirubin, AST, and nt substitutions (nt 1762, 1768, 1846, 1896, 2134, 2288, 2441) as determinants of early non-detectable HBV-DNA. The yearly incidence of hepatocellular carcinoma (HCC) during the first 3 years was 2.7%. At the diagnosis of HCC, ALT normalization, HBV-DNA non-detectable, and HBeAg-seronegative conversion rates were 75.0, 83.3, and 57.1%, respectively. Furthermore, the cumulative HBV-DNA non-detectable and ALT normalization rates were not significantly different according to the development of HCC or not. Conclusions: Lamivudine-resistant patients treated with lamivudine + adefovir could achieve the excellent virological response and biochemical response, but the low hepatitis activity was not enough to suppress hepatocarcinogenesis. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR] more...
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- 2008
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31. Diabetes mellitus worsens the recurrence rate after potentially curative therapy in patients with hepatocellular carcinoma associated with nonviral hepatitis.
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Kawamura, Yusuke, Ikeda, Kenji, Arase, Yasuji, Yatsuji, Hiromi, Sezaki, Hitomi, Hosaka, Tetsuya, Akuta, Norio, Kobayashi, Masahiro, Saitoh, Satoshi, Suzuki, Fumitaka, Suzuki, Yoshiyuki, and Kumada, Hiromitsu more...
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LIVER cancer ,HEPATITIS ,DIABETES complications ,PEOPLE with diabetes ,CANCER relapse ,AGE factors in disease ,RADIO frequency - Abstract
Background and Aim: The aim of this retrospective study was to examine the relationship between diabetes mellitus and recurrence of hepatocellular carcinoma after potentially curative therapy for hepatocellular carcinoma with nonviral hepatitis. Methods: We studied 40 consecutive hepatocellular carcinoma patients who were diagnosed between 1980 and 2006 with hepatocellular carcinoma associated with non-B, non-C hepatitis, and later underwent surgical resection or radiofrequency ablation. Results: Twenty-two out of the 40 patients developed hepatocellular carcinoma recurrence within a median of 3.7 years. In the 18 patients with diabetes mellitus, the cumulative rates of hepatocellular carcinoma recurrence were 22.2% at the first year, 55.6% at the second year, 61.1% at the third year, 61.1% at the fourth year, and 80.6% at the fifth year. The cumulative rates of hepatocellular carcinoma recurrence in 22 nondiabetic patients were 24.6% at the first year, 24.6% at the second year, 31.5% at the third year, 31.5% at the fourth year, and 31.5% at the fifth year. The hepatocellular carcinoma recurrence rate was significantly higher in diabetic patients than in nondiabetics ( P = 0.026). The multivariate Cox proportional model identified old age and diabetes as the only significant predictors for recurrence. The hazard ratio of hepatocellular carcinoma recurrence in diabetic patients was 4.61 ( P = 0.007). There was no significant difference in overall survival rate between diabetic and nondiabetic patients ( P = 0.392). Conclusion: Diabetes is a significant predictor of tumor recurrence after potentially curative therapy for hepatocellular carcinoma in patients with nonviral hepatitis. [ABSTRACT FROM AUTHOR] more...
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- 2008
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32. Lipiodol and Dye at the Site of Ablation Decreases during RFA.
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Hirakawa, Miharu, Ikeda, Kenji, Kawamura, Yusuke, Kobayashi, Masahiro, Hosaka, Tetsuya, Yatsuji, Hiromi, Sezaki, Hitomi, Akuta, Norio, Saitoh, Satoshi, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu more...
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RADIO frequency therapy ,RADIOTHERAPY ,LIVER cancer ,CANCER cells ,METASTASIS - Abstract
Objectives: Intrahepatic metastasis is one of the serious complications of radiofrequency ablation (RFA) therapy for hepatocellular carcinoma. The aim of this study was to investigate how liver tissue could be disseminated during the RFA procedure with different devices and protocols in an in vivo porcine model. Methods: Three pigs underwent RFA procedures using 2 different devices: needles that could be expanded (LeVeen needle) and those that could not (cool-tip needle). A LeVeen needle was used with a single-step full extension method or a stepwise extension method. Before RFA, a mixture of lipiodol and blue dye was injected intrahepatically into a precoagulated area. After the ablation procedure, the specimen was cut to evaluate the amount of dye remaining in the ablated region and the distribution of the dye outside the ablated area. Results: The stepwise extension method resulted in the disappearance of the smallest amount of the dye and lipiodol at the ablation site, compared with the full extension method and cool-tip needle. Dye was found at sites distant from the ablated area in all cases using the cool-tip needle, but in none with the stepwise extension method. Conclusions: The stepwise procedure using the expandable needle can reduce tumor cell scattering, which can cause intrahepatic metastasis, compared with other methods. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR] more...
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- 2008
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33. New ablation procedure for a radiofrequency liver tissue coagulation system using an expandable needle.
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Hirakawa, Miharu, Ikeda, Kenji, Kawamura, Yusuke, Kobayashi, Masahiro, Hosaka, Tetsuya, Yatsuji, Hiromi, Sezaki, Hitomi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Saitoh, Satoshi, Arase, Yasuji, and Kumada, Hiromitsu more...
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CATHETER ablation ,LIVER ,NEEDLES & pins ,ELECTRODES ,ELECTROSURGERY - Abstract
Objective: The stepwise hook extension technique for an expandable needle, which we reported previously, allowed roll-off in short time with low power. The aim of this study was to investigate experimentally the efficacy of a modified extension procedure. Methods: Three pigs underwent 10 radiofrequency ablation (RFA) procedures using the 10-hook electrode of LeVeen needle. The conventional technique was used in five RFA (group 1; the electrode was deployed in four steps to full extension), while the new technique was used in the other five RFA (group 2; the electrode was closed after the same three steps as group 1 and then fully extended). Results: The shape of the RFA-induced zone was cone-like or irregular in group 1 and oval-like in group 2. The diameter vertical to the shaft was larger in group 2 (37, range 33–42 mm) than in group 1 (23, range 20–29 mm). The median ablation time was longer in group 2 (10 min 13 s) than in group 1 (3 min 56 s). Although the required energy was higher in group 2 than in group 1, that per volume was comparable between the groups (median 0.9 vs. 1.4 kJ/mm
3 ). Conclusions: Our new procedure requires a longer session but produces larger necrosis of a uniform ellipsoid volume, making it potentially suitable for tumours more than 3 cm in diameter. [ABSTRACT FROM AUTHOR] more...- Published
- 2008
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34. Efficacy and anticarcinogenic activity of interferon for hepatitis C virus-related compensated cirrhosis in patients with genotype 1b low viral load or genotype 2.
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Hasegawa, Eiko, Kobayashi, Masahiro, Kawamura, Yusuke, Yatsuji, Hiromi, Sezaki, Hitomi, Hosaka, Tetsuya, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, Ikeda, Kenji, and Kumada, Hiromitsu more...
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ANTINEOPLASTIC agents ,INTERFERONS ,HEPATITIS C virus ,CIRRHOSIS of the liver ,LIVER cancer - Abstract
Background: We assessed the efficacy and anticarcinogenic effects of interferon (IFN) therapy in patients with hepatitis C virus (HCV)-related cirrhosis. Methods: The study subjects were 123 Japanese patients with HCV-related cirrhosis with genotype 1b low viral load or genotype 2 who received IFN from 1989 to 2005 (18 patients continue to receive IFN therapy). They included 81 men and 42 women aged 29–74 years (median, 56 years). Results: Univariate analysis identified four parameters that significantly influenced SVR; viral load (low HCV concentration, P < 0.001), duration of IFN therapy (≥ 52 weeks, P = 0.029), daily dose of IFN (≥ 6 million units, P = 0.018), induction therapy (presence, P = 0.010) and choline esterase (> 1.0 ΔpH, P = 0.037). Multivariate analysis identified viral load (risk ratio = 6.329, P < 0.001) and daily dose of IFN (risk ratio = 2.62, P = 0.042) as two independent parameters thatinfluenced SVR. During the observation period, newly developed hepatocellular carcinoma (HCC) was detected in 22 patients. The rates of development of HCC in patients with SVR were 5.8% at the fifth year and 10.3% at the 10th year, compared with 25.8% at the fifth year and 42.5% at the 10th year in non-SVR patients. Multivariate analysis showed that IFN efficacy (SVR) was the only independent factor of hepatocarcinogenesis (hazard ratio: 0.185, 95% confidence interval: 0.042–0.810, P = 0.025) Conclusion: Among patients with HCV-related cirrhosis, the rate of development of HCC is significantly less in patients with SVR. [ABSTRACT FROM AUTHOR] more...
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- 2007
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35. Diabetes mellitus increases the risk of hepatocarcinogenesis in patients with alcoholic cirrhosis: A preliminary report.
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Torisu, Yuichi, Ikeda, Kenji, Kobayashi, Masahiro, Hosaka, Tetsuya, Sezaki, Hitomi, Akuta, Norio, Kawamura, Yusuke, Yatsuji, Hiromi, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu more...
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DIABETES ,CARBOHYDRATE intolerance ,LIVER cancer ,LIVER metastasis ,CIRRHOSIS of the liver - Abstract
Aim: Diabetes mellitus (DM) has been reported to increase the risk of hepatocellular carcinogenesis in chronic liver diseases. This study aims to elucidate whether DM is an independent risk factor for the appearance of hepatocellular carcinoma (HCC) in patients with alcoholic cirrhosis. Methods: Forty-seven patients with alcoholic cirrhosis were retrospectively observed for a median of 6.8 years. The patients showed a history of heavy alcohol intake of 500 kg or more until the diagnosis of cirrhosis, and no patients had hepatitis B surface antigen, hepatitis B virus DNA measured by nested polymerase chain reaction, or antihepatitis C virus. Results: During the observation period, HCC developed in nine patients (19.1%). Cumulative appearance rates of HCC were 10.5%, 23.8% and 33.3% at the end of the fifth, 10th and 15th years, respectively. When they were divided into two groups according to the association of diabetes, carcinogenesis rates in patients with ( n = 11) and without ( n = 36) DM, cumulative carcinogenesis rates were 32.7% and 3.2% at the end of fifth year, 32.7% and 20.2% at the tenth year, and 66.3% and 20.2% at the 15th year, respectively. Crude carcinogenesis rate in the patient with DM was significantly higher than that of patients without DM ( P = 0.0034). Multivariate analysis disclosed a higher age (hazard ratio 28.1, P = 0.007), and association of DM (hazard ratio 21.7, P = 0.006) significantly affected future carcinogenesis rate. Conclusion: DM seemed to be an independent risk factor for hepatocarcinogenesis in the cohort study of patients with alcoholic cirrhosis. [ABSTRACT FROM AUTHOR] more...
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- 2007
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36. Randomized controlled trial for the efficacy of hepatic arterial occlusion during radiofrequency ablation for small hepatocellular carcinoma – direct ablative effects and a long-term outcome.
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Kobayashi, Masahiro, Ikeda, Kenji, Kawamura, Yusuke, Hosaka, Tetsuya, Sezaki, Hitomi, Yatsuji, Hiromi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu
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ARTERIAL occlusions ,TRANSLUMINAL angioplasty ,RANDOMIZED controlled trials ,CATHETER ablation ,LIVER cancer ,ELECTROSURGERY - Abstract
Objective: To evaluate the efficacy of temporary balloon arterial occlusion during radiofrequency ablation (RFA), randomized controlled trial was performed. Methods: Twenty patients with hypervascular hepatocellular carcinoma measuring ≤30 mm were randomly treated with RFA combined with arterial occlusion (group A), or RFA alone (group B). Tumour ablation was performed in both groups using our ‘stepwise hook extension technique.’ Results: Median diameters of the longer and shorter axis of RF-induced area measured on computer tomography were 38 mm (range, 31–52) and 36 mm (25–40) in group A, and 34 mm (26–45) and 26 mm (22–32) in group B respectively. Although the longer axis was not statistically significant, the shorter axis of group A was significantly larger than in group B ( P=0.003). The median volume of the ablated lesion was 25.3 cm
3 (15.6–48.7) in group A and 16.1 cm3 (9.3–23.8) in group B. The lesion volume was significantly larger in group A than in group B ( P=0.005). The time and energy requirement of RFA of both groups were not significantly different. In addition, no serious adverse effects were observed in both groups. Intrasubsegmental tumour recurrence was found in 0% in group A and 30% in group B at the end of the third year ( P=0.082). Conclusions: Hepatic arterial balloon occlusion during RFA is useful for extending the area of ablation in RF-induced lesions, and the procedure tended to decrease tumour recurrence from the same subsegment of ablated tumour. [ABSTRACT FROM AUTHOR] more...- Published
- 2007
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37. Long-Term Outcome after Interferon Therapy in Elderly Patients with Chronic Hepatitis C.
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Arase, Yasuji, Ikeda, Kenji, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Saitoh, Satoshi, Kobayashi, Masahiro, Akuta, Norio, Someya, Takashi, Koyama, Rikako, Hosaka, Tetsuya, Sezaki, Hitomi, Kobayashi, Mariko, and Kumada, Hiromitsu more...
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HEPATITIS C ,INTERFERONS ,LIVER cancer ,DISEASES in older people ,HEALTH outcome assessment ,JAPANESE people - Abstract
Objective: The purpose of this study was to elucidate the long-term outcome after interferon (IFN) therapy in chronic hepatitis C elderly patients. Methods: We studied the incidence of hepatocellular carcinoma (HCC) and survival probability after the initiation of IFN therapy in 500 Japanese chronic hepatitis C patients >60 years. The mean age of initiation of IFN was 63 years and the mean follow-up period was 7.4 years. Cox proportional hazard regression analysis was used to evaluate the long-term outcome after initiation of IFN therapy.Sustained virological response (SVR) was defined as negative HCV-RNA by RT-nested PCR 6 months after the completion of long-term IFN therapy. Non-response (NR) was applied to patients who did not show SVR. Hepatic fibrosis was defined as the fibrosis score (score 0–4) according to Knodell et al. Results: 140 patients (28%) had an SVR and 360 patients (72%) had an NR. 71 of 500 patients developed HCC during follow-up. The cumulative incidence of HCC was 9.6% at the 5th year, 17.4% at the 10th year, and 31.3% at the 15th year. HCC developed with significance when: (1) HCV was not cleared after IFN therapy (p < 0.0001), (2) sex was male (p < 0.0001), and (3) staging of liver fibrosis was >2 (p = 0.008). 53 of the patients died. The cumulative survival probability was 95.7% at the 5th year, 86.4% at the 10th year, and 78% at the 15th year. Patients achieved a long survival with significance when: (1) staging of liver fibrosis was 1 (p < 0.0001), (2) HCV was cleared after IFN therapy (p = 0.034), and (3) sex was female (p = 0.015). Conclusion: Chronic hepatitis C patients with clearance of HCV after IFN therapy had a significantly reduced risk of HCC appearance and achieved prolonged survival even if they are ≥60 years. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR] more...
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- 2007
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38. Interferon lowers tumor recurrence rate after surgical resection or ablation of hepatocellular carcinoma: a pilot study of patients with hepatitis B virus-related cirrhosis.
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Someya, Takashi, Ikeda, Kenji, Saitoh, Satoshi, Kobayashi, Masahiro, Hosaka, Tetsuya, Sezaki, Hitomi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu
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LIVER cancer ,INTERFERONS ,HEPATITIS B virus ,CIRRHOSIS of the liver ,ASPARTATE aminotransferase - Abstract
Hepatocellular carcinoma (HCC) caused by hepatitis B virus (HBV) often recurs after surgical or medical treatment. Eighty consecutive patients with HBV-positive cirrhosis and HCC who underwent potentially curative ablation for HCC were analyzed. Eleven patients received long-term interferon (IFN) therapy. HBV DNA was quantified at the time of HCC treatment. A DNA value of <6.0 log copies/ml was considered low. Initial DNA was low in 39 and high in 41 patients. HCC recurrence rates in the low DNA group and high DNA group were 46.9% and 82.6% at the fifth year, and 73.5% and 91.3% at the tenth year, respectively ( P = 0.0103). Similarly, recurrence rates after treatment of HCC in the normal aspartate aminotransferase (AST) group (<38 IU/l, n = 42) and abnormal AST group ( n = 38) were 50.6% and 84.0% at the fifth year, and 71.3% and 100% at the tenth year, respectively ( P = 0.0003). Six of the 38 patients with abnormal AST, and 5 of 42 patients with normal AST, received IFN after confirmation of tumor ablation. In the subgroup of abnormal AST, tumor recurrence rates in the IFN and untreated groups were 16.7% and 37.9% at the end of the first year, 16.7% and 60.1% at the second year, and 16.7% and 83.4% at the third year, respectively ( P = 0.0139). Multivariate analysis revealed that IFN significantly reduced the recurrence rate (hazard ratio = 0.21, P = 0.037) even after adjusting for background characteristics. IFN was inferred to decrease tumor recurrence after treatment of HCC in patients with HBV-related cirrhosis, especially in the subgroup with high AST. [ABSTRACT FROM AUTHOR] more...
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- 2006
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39. Efficacy of interferon monotherapy in young adult patients with chronic hepatitis C virus infection.
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Uka, Kiminori, Suzuki, Fumitaka, Akuta, Norio, Sezaki, Hitomi, Suzuki, Yoshiyuki, Hosaka, Tetsuya, Someya, Takashi, Kobayashi, Masahiro, Saitoh, Satoshi, Arase, Yasuji, Ikeda, Kenji, and Kumada, Hiromitsu more...
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LIVER cancer ,HEPATITIS C virus ,LIVER diseases ,CANCER patients ,INTERFERONS ,BLOOD transfusion ,RNA - Abstract
Background. Suppression of the progression to cirrhosis and hepatocellular carcinoma is important, especially for young hepatitis C virus (HCV)-infected patients. The aim of this study was to analyze the response to interferon (IFN) monotherapy in young HCV patients. Methods. Between 1989 and 2002, 1021 anti-HCV-positive patients hospitalized at Toranomon Hospital received IFN monotherapy. Among these patients, 144 were ≤35 years of age, while the remaining 877 were 36–73 years old. We retrospectively identified 209 patients with known dates of blood transfusion (i.e., start of HCV infection) among the 1021 patients. IFN treatment lasted 6 months. Results. HCV RNA level (P < 0.001), HCV genotype (P < 0.001), age (P < 0.001), and liver histology (P = 0.01) were identified as determinants of the response to IFN monotherapy in 1021 patients. Moreover, in patients with high viral load and genotype 1b, the sustained virological response (SVR) rate was significantly higher in those aged ≤35 years than in older patients (P < 0.001). In patients with genotype 1b with known date of blood transfusion, a longer duration of infection negatively influenced the SVR rate. In the 209 patients, multivariate analysis identified HCV RNA level (P < 0.001), age (P = 0.002), and duration of infection (P = 0.049) as determinants of SVR. Conclusions. The response of IFN monotherapy is better in patients aged ≤35 years than in older patients, probably because of mild stage histology, the effect of host-related factors, and shorter period of infection. Long-term IFN monotherapy may be suitable for young women who desire to become pregnant or those with anemia. [ABSTRACT FROM AUTHOR] more...
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- 2006
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40. Cost-effectiveness of radiofrequency ablation and surgical therapy for small hepatocellular carcinoma of 3cm or less in diameter
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Ikeda, Kenji, Kobayashi, Masahiro, Saitoh, Satoshi, Someya, Takashi, Hosaka, Tetsuya, Sezaki, Hitomi, Suzuki, Yoshiyuki, Suzuki, Fumitaka, Akuta, Norio, Arase, Yasuji, Kumada, Hiromitsu, Matsuda, Masamichi, Hashimoto, Masaji, and Watanabe, Goro more...
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LIVER cancer ,CATHETER ablation ,SURGERY ,CANCER relapse ,COST effectiveness - Abstract
Abstract: Background: Cost-effectiveness of radiofrequency ablation (RFA) was assessed in treatment of hepatocellular carcinoma (HCC). Patients and methods: During 5 years, 153 patients with HCC of 3cm or less received RFA, and 60 underwent surgery. Judgment after RFA therapy was classified into three grades: residual tumor (grade 1), necrotic area with a less safety margin of 5mm (grade 2), and necrosis with a safety margin of 5mm in all directions (grade 3). Results: Local recurrence rates after RFA and surgery were 7.9% and 0% at the third year. The rates in patients with grades 2 and 3 after RFA were 18.7% and 1.2% at the third year, respectively (P =0.0005). Among 91 patients with grades 1 and 2 necrosis after initial therapy, 52 received additional ablation. Although local recurrence rate was 24.9% in 39 patients without additional therapy, the rates after therapy repetition were 10.9% in 21 patients with eventual grade 2 necrosis, and 0% in 31 patients with grade 3 (P =0.038). Median costs of single RFA, repeated RFA, and surgery were ¥849,900, ¥1,086,000, and ¥1,745,100, respectively. Additional ablation reduced local recurrence by 20.7% at the cost of ¥236,100. Conclusion: Cost-effectiveness of RFA in the treatment of small HCC was superior to that of surgery. [Copyright &y& Elsevier] more...
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- 2005
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41. Long-term follow-up of interferon monotherapy in 454 consecutive naive patients infected with hepatitis C virus: Multi-course interferon therapy may reduce the risk of hepatocellular carcinoma and increase survival.
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Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, Sezaki, Hitomi, Hosaka, Tetsuya, Someya, Takashi, Kobayashi, Masahiro, Saitoh, Satoshi, Arase, Yasuji, Ikeda, Kenji, Kobayashi, Mariko, and Kumada, Hiromitsu more...
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INTERFERONS ,ANTINEOPLASTIC agents ,HEPATITIS C virus ,LIVER cancer ,SURVIVAL analysis (Biometry) ,FAILURE time data analysis - Abstract
Objective The long-term effects of multi-course interferon (IFN) monotherapy in patients infected with hepatitis C virus (HCV) are still unclear. Material and methods To evaluate the effects of multi-course IFN on hepatocarcinogenesis and survival, a follow-up study was conducted comprising 454 consecutively recruited non-cirrhotic naive patients infected with HCV, who had received IFN monotherapy between 1987 and 1992. The median follow-up was 11.3 years. Results A sustained response (SR) after the first IFN was achieved by 152 patients (33.5%) (Group A). Of 302 patients (66.5%) with non-SR after the first IFN, 130 patients (28.6%) did not receive additional IFN (Group B), and the remaining 172 patients (37.9%) received multi-course IFN monotherapy (Group C). With regard to hepatocarcinogenesis and survival rates for liver-related deaths, Groups A and C both showed significantly better long-term clinical outcome than Group B ( p <0.001; log-rank test). Three independent factors were identified by multivariate analyses (fibrosis stage 3, Group B, and age?50) for all patients and two factors (fibrosis stage 3 and age?50) for Group C associated with hepatocarcinogenesis. With regard to hepatocarcinogenesis rates according to the mean alanine aminotransferase (ALAT) levels during the IFN-free period in Group C, significantly higher rates were noted in patients with ALAT levels above 1.5×the upper normal limit (17.6%) than those below the limit (0%) ( p <0.05). Conclusions Multi-course IFN monotherapy reduces the risk of hepatocarcinogenesis and increases survival, and low ALAT levels during the IFN-free period are associated with lower hepatocarcinogenesis rates in multi-course IFN. [ABSTRACT FROM AUTHOR] more...
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- 2005
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42. Hepatitis B Virus-Related Hepatocellular Carcinogenesis and Its Prevention.
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Ikeda, Kenji, Arase, Yasuji, Kobayashi, Masahiro, Someya, Takashi, Hosaka, Tetsuya, Saitoh, Satoshi, Sezaki, Hitomi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, and Kumada, Hiromitsu
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LIVER cancer ,HEPATITIS B virus ,HEPATITIS viruses ,ANTIVIRAL agents ,CANCER prevention - Abstract
To elucidate the influence of serum hepatitis B virus (HBV) load on hepatocellular carcinogenesis in cirrhotic patients, HBV-DNA was sequentially measured. In a nested, case-control study using 96 patients without antiviral therapy, high HBV-DNA (≥10
3.7 copies/ml) in the last 3 years was significantly associated with carcinogenesis (a patient group without hepatocellular carcinoma (HCC) development; 0/48 vs. a patient group with eventual HCC development; 22/48, p < 0.0001). No patient with a continuously low HBV-DNA for the last 3 years developed HCC. Persistence of high HBV-DNA concentration suggested an increased risk of carcinogenesis. In a retrospective cohort study using 57 patients with interferon therapy, HCC developed in 2 (8.0%) of the 25 patients with HBV-DNA loss, while carcinogenesis was found in 11 (34.4%) of 32 patients without HBV-DNA loss (Fisher’s exact test, p = 0.026). A significant decrease or loss of serum HBV-DNA stops HCC development, and its sequential analysis could be very useful both in the prediction and early detection of small HCC. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR] more...- Published
- 2005
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43. Significance of hepatitis B virus DNA clearance and early prediction of hepatocellular carcinogenesis in patients with cirrhosis undergoing interferon therapy: Long-term follow up of a pilot study.
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Ikeda, Kenji, Kobayashi, Masahiro, Saitoh, Satoshi, Someya, Takashi, Hosaka, Tetsuya, Akuta, Norio, Suzuki, Yoshiyuki, Suzuki, Fumitaka, Tsubota, Akihito, Arase, Yasuji, and Kumada, Hiromitsu
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HEPATITIS B virus ,LIVER cancer ,CARCINOGENESIS ,CIRRHOSIS of the liver ,INTERFERONS ,DNA ,GENETIC transcription - Abstract
Because the anti-carcinogenic effect and mechanism of interferon (IFN) in patients with hepatitis B virus (HBV)-related cirrhosis have not been elucidated, quantitative analysis of HBV-DNA concentration was carried out sequentially.Of 60 consecutive patients with cirrhosis who began IFN therapy between 1986 and 1990, 57 patients were completely observed for the appearance of hepatocellular carcinoma (HCC). All patients underwent intermittent administration of IFN for a median period of 18 months. HBV-DNA was quantified using transcription mediated amplification and hybridization protection assay. A HBV-DNA count<3.7 log-genome equivalent (LGE)/mL (equivalent to 10
3.7 or 5000 copies/mL) was considered to be a negative value.Of 25 patients who had HBV-DNA loss after IFN therapy, nine lost HBV-DNA during the therapy and 16 lost HBV-DNA after cessation of the therapy. The other nine patients showed a transient loss of HBV-DNA, and the remaining 23 retained persistently positive HBV-DNA during and after therapy. Although HCC developed in two (8.0%) of the 25 patients with HBV-DNA loss, carcinogenesis was found in 11 (34.4%) of 32 patients without HBV-DNA loss (Fisher's exact test,P = 0.026). In the two exceptional patients, HCC was detected at 1.2 and 3.6 years after loss of HBV-DNA, respectively. When the HBV-DNA concentration decreased by 2 LGE/mL (decrease to 1/100) at 6 months after initiation of interferon, HBV-DNA became negative eventually in 15 (60.0%) of 25 patients.A significant decrease or loss of serum HBV-DNA prevents development of HCC, and sequential analysis of HBV-DNA could be very useful in both the prediction and the early detection of small HCC. [ABSTRACT FROM AUTHOR] more...- Published
- 2005
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44. Hepatocellular carcinoma in noncirrhotic young adult patients with chronic hepatitis B viral infection.
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Sezaki, Hitomi, Kobayashi, Masahiro, Hosaka, Tetsuya, Someya, Takashi, Akuta, Norio, Suzuki, Fumitaka, Tsubota, Akihito, Suzuki, Yoshiyuki, Saitoh, Satoshi, Arase, Yasuji, Ikeda, Kenji, Kobayashi, Mariko, Matsuda, Marie, Takagi, Kimiko, Sato, Junko, and Kumada, Hiromitsu more...
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LIVER cancer ,YOUNG adults ,VIRUS diseases ,ANTIVIRAL agents ,ANTINEOPLASTIC agents ,DNA - Abstract
Background. The aims of this study were to define the clinical characteristics of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) in young adult patients without cirrhosis and to evaluate the efficacy of interferon (IFN) therapy on HCC recurrence. Methods. Of 187 patients with HBV-related HCC treated at our hospital, 4 had no liver cirrhosis and were less than 30 years of age (10, 22, 23, and 26 years). Results. At the time of diagnosis of HCC, all cases had antibody to hepatitis B e antigen (anti-HBe) and histological staging of nontumorous liver was F0 or F1, i.e., low-grade hepatitis. The mothers of all 4 young adult patients with HCC had HBV-related liver disease. Three cases developed recurrence of HCC. In these patients, long-term intermittent IFN therapy after reresection of HCC resulted in long-term survival without recurrence for more than 3 years of follow-up. Conclusions. (1) Young adult patients with HCC are positive for anti-HBe, lack cirrhosis, and the route of infection seems to be mother-to-infant transmission. Transplacental transmission of HBV and HBV DNA integration into the cellular genomic DNA during fetal life is a possible explanation of HBV-related hepatocarcinogenesis in young adults; and (2) long-term IFN therapy seems to be useful for prevention of tumor recurrence after radical operation for HBV-related HCC. [ABSTRACT FROM AUTHOR] more...
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- 2004
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45. Recurrence Rate and Prognosis of Patients with Hepatocellular Carcinoma That Developed after Elimination of Hepatitis C Virus RNA by Interferon Therapy.
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Ikeda, Kenji, Kobayashi, Masahiro, Saitoh, Satoshi, Someya, Takashi, Hosaka, Tetsuya, Akuta, Norio, Suzuki, Fumitaka, Tsubota, Akihito, Suzuki, Yoshiyuki, Arase, Yasuji, and Kumada, Hiromitsu
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LIVER cancer ,INTERFERONS ,CANCER patients ,HEPATITIS C ,HEPATITIS C virus - Abstract
Background: Although hepatocellular carcinoma does develop after sustained response to interferon (IFN) in patients with chronic hepatitis C, details on the clinical prognosis have not been elucidated yet. Patients and Methods: Among 12 patients with liver cancer arising after hepatitis C virus (HCV) elimination, 10 patients with potentially curative ablation were prospectively analyzed. Matched control patients were chosen from a patient list of surgical resection on the basis of age, sex, cancer stage, and severity of liver disease. Control patients were recruited with a ratio of 1:4, and all the control patients had positive HCV-RNA. Results: One (10.0%) of 10 patients with virus elimination and 31 (77.5%) of 40 control patients eventually developed cancer recurrence during the same follow-up period. Cancer recurrence rates of the 10 cases and 40 controls were 10.0 and 55.3% at the 3rd year, and 10.0 and 72.2% at the 5th year, respectively. The recurrence rate in the 10 cases of virus elimination was significantly lower than that of control patients (p = 0.012). Conclusion: Although hepatocellular carcinogenesis after elimination of HCV-RNA by IFN treatment did rarely occur, the recurrence rate after radical therapy was significantly lower than that of untreated or non-responsive patients.Copyright © 2003 S. Karger AG, Basel [ABSTRACT FROM AUTHOR] more...
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- 2003
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46. Stepwise Hook Extension Technique for Radiofrequency Ablation Therapy of Hepatocellular Carcinoma.
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Kobayashi, Masahiro, Ikeda, Kenji, Someya, Takashi, Akuta, Norio, Suzuki, Fumitaka, Tsubota, Akihito, Suzuki, Yoshiyuki, Saitoh, Satoshi, Arase, Yasuji, and Kumada, Hiromitsu
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LIVER cancer ,MEDICAL lasers ,RADIOTHERAPY ,CANCER treatment ,THERAPEUTICS - Abstract
Objective: Our study was designed to examine the efficacy of stepwise hook extension technique for radiofrequency ablation (RFA) therapy of hepatocellular carcinoma in a randomized controlled study. Method: Twenty patients with hepatocellular carcinoma measuring <25 mm were divided randomly into two equal groups. RFA was applied using our new stepwise hook extension technique in patients of group 1, and the full extension method in group 2. The 10-hook electrode of LeVeen needle was deployed in four steps to full extension during ablation in group 1, and full extension at start of treatment in group 2. Results: Roll-off was achieved in all 10 patients of group 1, indicative of sufficient tumor coagulation, but only in 3 of 10 patients of group 2. The median time to completion of treatment was 6 min and 55 s (range 3 min to 14 min and 3 s) and 15 min (6–15 min), respectively. The total power output used for RF was lower in group 1 than in group 2 (median 271 vs. 1,045 W·m). The diameters of RFA-induced lesions were not significantly different between the groups (group 1: 27, range 23–37 mm; group 2: 23, 0–42 mm). Conclusions: Application of RFA using stepwise hook extension technique is superior to the full extension method since it produces the same therapeutic effects within a short period using a lower energy.Copyright © 2002 S. Karger AG, Basel [ABSTRACT FROM AUTHOR] more...
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- 2002
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47. Hepatic vascular side effects of styrene maleic acid neocarzinostatin in the treatment of hepatocellular carcinoma.
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Ikeda, Kenji, Saitoh, Satoshi, Kobayashi, Masahiro, Suzuki, Yoshiyuki, Suzuki, Fumitaka, Tsubota, Akihito, Arase, Yasuji, Chayama, Kazuaki, Murashima, Naoya, Kumada, Hiromitsu, Ikeda, K, Saitoh, S, Kobayashi, M, Suzuki, Y, Suzuki, F, Tsubota, A, Arase, Y, Chayama, K, Murashima, N, and Kumada, H more...
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ZINOSTATIN ,LIVER cancer ,HEPATIC artery - Abstract
Styrene-maleic acid neocarzinostatin (SMANCS) sometimes causes hepatic vascular side effects, including arterial stricture, obstruction, and arterio-portal shunt. A total of 128 intra-arterial SMANCS injection treatments, performed for 89 patients with hepatocellular carcinoma, were analyzed to determine the relationship between angiographic findings and subsequent hepatic vascular injuries. After SMANCS therapy, hepatic arterial stricture or obstruction occurred in 5 patients (5/128; 3.9%), arterio-portal shunting in 12 (12/128; 9.4%), liver shrinkage in 4 (4/128; 3.1%), and cholangitis or biloma in 2 (2/128; 1.6%). Among 23 patients whose plain abdominal X-ray films just after SMANCS injection showed Lipiodol retention in the hepatic artery, 5 patients developed arterial obstruction, 10 developed arterio-portal shunt, and 2, cholangitis or biloma. Among 26 patients with Lipiodol retention in the portal vein, 4 developed hepatic lobe atrophy with aggravation of liver function. Among 3 patients with Lipiodol retention in both the hepatic artery and the portal vein, 1 developed arterio-portal shunt. In 76 treatments without excessive Lipiodol retention, only 1 of the patients developed arterio-portal shunt. Excessive retention of Lipiodol in hepatic vascular beds just after SMANCS therapy was significantly associated with future vascular side effects (22/52 vs 1/76; P < 0.0001). Lipiodol retention in arteries just after SMANCS injection was closely associated with subsequent arterial obstruction or arterio-portal shunt, and Lipiodol retention in the portal vein was related to subsequent hepatic lobe atrophy. [ABSTRACT FROM AUTHOR] more...
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- 2000
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48. Hepatocellular carcinoma is the most common liver-related complication in patients with histopathologically-confirmed NAFLD in Japan.
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Akuta, Norio, Kawamura, Yusuke, Arase, Yasuji, Saitoh, Satoshi, Fujiyama, Shunichiro, Sezaki, Hitomi, Hosaka, Tetsuya, Kobayashi, Masahiro, Kobayashi, Mariko, Suzuki, Yoshiyuki, Suzuki, Fumitaka, Ikeda, Kenji, and Kumada, Hiromitsu more...
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LIVER cancer ,HISTOPATHOLOGY ,TYPE 2 diabetes ,FERRITIN ,FATTY liver - Abstract
Background: The incidence of liver-related events, cardiovascular events and type 2 diabetes mellitus in patients with histopathologically confirmed NAFLD remains unclear.Methods: We retrospectively investigated the incidence of liver events, cardiovascular events, malignancy, and type 2 diabetes mellitus in 402 Japanese patients with histopathologically confirmed NAFLD for a median follow-up of 4.2 years. We also investigated predictors of the development of hepatocellular carcinoma and type 2 diabetes mellitus in these patients.Results: The rate of liver-related events per 1000 person years was 4.17 (hepatocellular carcinoma, 3.67; hepatic encephalopathy, 1.60; esophago-gastric varices, 2.43; ascites, 0.80; and jaundice, 0.40). The rate of cardiovascular events and type 2 diabetes mellitus was 5.73 and 9.95, respectively. Overall mortality was 3.33 (liver-related events, 1.25; cardiovascular events, 0.42; and malignancies other than hepatocellular carcinoma, 0.83), in patients free of previous or current malignancies. Multivariate analyses identified old age (≥70 years) and advanced fibrosis stage 4 as significant determinants of hepatocellular carcinoma development, and hepatocyte steatosis (> 33%), female sex, and serum ferritin (≤80 μg/l) as significant determinants of type 2 diabetes mellitus development in these patients.Conclusions: Our results highlighted the importance of cardiovascular and liver-related events in Japanese patients with histopathologically-confirmed NAFLD. Hepatocellular carcinoma was the most common liver-related event, and the incidence of hepatocellular carcinoma was more than half of that of cardiovascular events. [ABSTRACT FROM AUTHOR] more...- Published
- 2018
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49. Data mining model using simple and readily available factors could identify patients at high risk for hepatocellular carcinoma in chronic hepatitis C
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Kurosaki, Masayuki, Hiramatsu, Naoki, Sakamoto, Minoru, Suzuki, Yoshiyuki, Iwasaki, Manabu, Tamori, Akihiro, Matsuura, Kentaro, Kakinuma, Sei, Sugauchi, Fuminaka, Sakamoto, Naoya, Nakagawa, Mina, and Izumi, Namiki more...
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DATA mining , *LIVER cancer , *CANCER risk factors , *HEPATITIS C , *COHORT analysis , *ANTIVIRAL agents , *MEDICAL statistics , *PATIENTS - Abstract
Background & Aims: Assessment of the risk of hepatocellular carcinoma (HCC) development is essential for formulating personalized surveillance or antiviral treatment plan for chronic hepatitis C. We aimed to build a simple model for the identification of patients at high risk of developing HCC. Methods: Chronic hepatitis C patients followed for at least 5years (n=1003) were analyzed by data mining to build a predictive model for HCC development. The model was externally validated using a cohort of 1072 patients (472 with sustained virological response (SVR) and 600 with nonSVR to PEG-interferon plus ribavirin therapy). Results: On the basis of factors such as age, platelet, albumin, and aspartate aminotransferase, the HCC risk prediction model identified subgroups with high-, intermediate-, and low-risk of HCC with a 5-year HCC development rate of 20.9%, 6.3–7.3%, and 0–1.5%, respectively. The reproducibility of the model was confirmed through external validation (r 2 =0.981). The 10-year HCC development rate was also significantly higher in the high-and intermediate-risk group than in the low-risk group (24.5% vs. 4.8%; p <0.0001). In the high-and intermediate-risk group, the incidence of HCC development was significantly reduced in patients with SVR compared to those with nonSVR (5-year rate, 9.5% vs. 4.5%; p =0.040). Conclusions: The HCC risk prediction model uses simple and readily available factors and identifies patients at a high risk of HCC development. The model allows physicians to identify patients requiring HCC surveillance and those who benefit from IFN therapy to prevent HCC. [Copyright &y& Elsevier] more...
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- 2012
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50. Diabetes Enhances Hepatocarcinogenesis in Noncirrhotic, Interferon-treated Hepatitis C Patients
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Kawamura, Yusuke, Arase, Yasuji, Ikeda, Kenji, Hirakawa, Miharu, Hosaka, Tetsuya, Kobayashi, Masahiro, Saitoh, Satoshi, Yatsuji, Hiromi, Sezaki, Hitomi, Akuta, Norio, Suzuki, Fumitaka, Suzuki, Yoshiyuki, and Kumada, Hiromitsu more...
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DIABETES , *CARCINOGENESIS , *COHORT analysis , *FOLLOW-up studies (Medicine) , *LIVER cancer , *INTERFERONS , *HEPATITIS C treatment - Abstract
Abstract: Background: This retrospective cohort study assessed the impact of diabetes mellitus on hepatocarcinogenesis and determined the predictors of hepatocarcinogenesis in noncirrhotic, interferon-treated patients with hepatitis C virus infection. Methods: A total of 2058 hepatitis C virus-positive, noncirrhotic patients treated with interferon were enrolled. The median follow-up period was 6.7 years. The primary end point was the onset of hepatocellular carcinoma. The cumulative rate of new hepatocellular carcinoma cases was computed by the Kaplan–Meier method and Cox proportional hazard analysis according to diabetic state and response to interferon therapy. Results: The cumulative rates of hepatocellular carcinoma in diabetic patients (3.2% at 4 years, 8.5% at 8 years, and 24.4% at 12 years) were significantly higher than those of nondiabetic patients (1.3% at 4 years, 2.2% at 8 years, and 5.6% at 12 years, P <.001). In patients with a sustained virologic response, diabetes had no significant effect on the rate of hepatocarcinogenesis. In contrast, the rate in patients with a nonsustained virologic response was significantly higher in diabetic than in nondiabetic patients. Multivariate analysis identified lack of sustained virologic response (hazard ratio [HR] 7.28; 95% confidence interval [CI], 3.28-16.15; P <.001) and diabetes as independent risk factors for hepatocarcinogenesis (HR 2.00; 95% CI, 1.05-3.84; P =.036). Conclusions: Our results highlight the enhancing effect of diabetes mellitus on hepatocarcinogenesis in noncirrhotic, interferon-treated patients with hepatitis C virus. The sustained virologic response induced by interferon therapy eliminates the influence of diabetes and markedly reduces the rate of hepatocarcinogenesis in such patients. [ABSTRACT FROM AUTHOR] more...
- Published
- 2010
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