AIM:To clarify the utility of using des-γ-carboxy prothrombin(DCP)andα-fetoprotein(AFP)levels to predict the prognosis of hepatocellular carcinoma(HCC)in patients with hepatitis B virus(HBV)and the hepatitis C virus...AIM:To clarify the utility of using des-γ-carboxy prothrombin(DCP)andα-fetoprotein(AFP)levels to predict the prognosis of hepatocellular carcinoma(HCC)in patients with hepatitis B virus(HBV)and the hepatitis C virus(HCV)infections.METHODS:A total of 205 patients with HCC(105patients with HBV infection 100 patients with HCV infection)who underwent primary hepatectomy between January 2004 and May 2012 were enrolled retrospectively.Preoperative AFP and DCP levels were used to create interactive dot diagrams to predict recurrence within 2 years after hepatectomy,and cutoff levels were calculated.Patients in the HBV and HCV groups were classified into three groups:a group with low AFP and DCP levels(LL group),a group in which one of the two parameters was high and the other was low(HL group),and a group with high AFP and DCP levels(HH group).Liver function parameters,the postoperative recurrence-free survival rate,and postoperative overall survival were compared between groups.The survival curves were compared by logrank test using the Kaplan-Meier method.Multivariate analysis using a Cox forward stepwise logistic regression model was conducted for a prognosis.RESULTS:The preoperative AFP cutoff levels for recurrence within 2 years after hepatectomy in the HBV and HCV groups were 529.8 ng/m L and 60 m AU/m L,respectively;for preoperative DCP levels,the cutoff levels were 21.0 ng/m L in the HBV group and 67 m AU/m L in the HCV group.The HBV group was significantly different from the other groups in terms of vascular invasion,major hepatectomy,volume of intraoperative blood loss,and surgical duration.Significant differences were found between the LL group,the HL group,and the HH group in terms of both mean disease-free survival time(MDFST)and mean overall survival time(MOST):64.81±7.47 vs 36.63±7.62 vs 18.98±6.17mo(P=0.001)and 85.30±6.55 vs 59.44±7.87 vs46.57±11.20 mo(P=0.018).In contrast,the HCV group exhibited a significant difference in tumor size,vascular invasion,volume of intraoperative blood loss,and surgical duration;however,no significant difference was observed between the three groups in liver function parameters except for albumin levels.In the LL group,the HL group,and the HH group,the MDFST was 50.09±5.90,31.01±7.21,and 14.81±3.08 mo(log-rank test,P<0.001),respectively,and the MOST was 79.45±8.30,58.82±7.56,and 32.87±6.31 mo(log-rank test,P<0.001),respectively.CONCLUSION:In the HBV group,the prognosis was poor when either AFP or DCP levels were high.In the HCV group,the prognosis was good when either or both levels were low;however,the prognosis was poor when both levels were high.High levels of both AFP and DCP were an independent risk factor associated with tumor recurrence in the HBV and HCV groups.The relationship between tumor marker levels and prognosis was characteristic to the type of viral hepatitis.展开更多
AIM: To compare the prognoses of hepatocellular carcinoma (HCC) patients that underwent anatomic liver resection (AR) or non-anatomic liver resection (NAR) using propensity score-matched populations.
Liver resection is the gold standard treatment for certain liver tumors such as hepatocellular carcinoma and metastatic liver tumors. Some patients with such tumors already have reduced liver function due to chronic h...Liver resection is the gold standard treatment for certain liver tumors such as hepatocellular carcinoma and metastatic liver tumors. Some patients with such tumors already have reduced liver function due to chronic hepatitis, liver cirrhosis, or chemotherapy-associated steatohepatitis before surgery. Therefore, complications due to poor liver function are inevitable after liver resection. Although the mortality rate of liver resection has been reduced to a few percent in recent case series, its overall morbidity rate is reported to range from 4.1% to 47.7%. The large degree of variation in the post-liver resection morbidity rates reported in previous studies might be due to the lack of consen-sus regarding the definitions and classification of postliver resection complications. The Clavien-Dindo(CD) classification of post-operative complications is widely accepted internationally. However, it is hard to apply to some major post-liver resection complications because the consensus definitions and grading systems for posthepatectomy liver failure and bile leakage established by the International Study Group of Liver Surgery are incompatible with the CD classification. Therefore, a unified classification of post-liver resection complications has to be established to allow comparisons between academic reports.展开更多
BACKGROUND Health utility assessments have been developed for various conditions,including chronic liver disease.Health utility scores are required for socio-economic evaluations,which can aid the distribution of nati...BACKGROUND Health utility assessments have been developed for various conditions,including chronic liver disease.Health utility scores are required for socio-economic evaluations,which can aid the distribution of national budgets.However,the standard health utility assessment scores for specific health conditions are largely unknown.AIM To summarize the health utility scores,including the EuroQOL 5-dimensions 5-levels(EQ-5D-5L),EuroQol-visual analogue scale,short from-36(SF-36),RAND-36,and Health Utilities Index(HUI)-Mark2/Mark3 scores,for the normal population and chronic liver disease patients.METHODS A systematic literature search of PubMed and MEDLINE,including the Cochrane Library,was performed.Meta-analysis was performed using the RevMan software.Multiple means and standard deviations were combined using the StatsToDo online web program.RESULTS The EQ-5D-5L and SF-36 can be used for health utility evaluations during antiviral therapy for hepatitis C.HUI-Mark2/Mark3 indicated that the health utility scores of hepatitis B patients are roughly 30% better than those of hepatitis C patients.CONCLUSION The EQ-5D-5L is the most popular questionnaire for health utility assessments.Health assessments that allow free registration would be useful for evaluating health utility in patients with liver disease.展开更多
BACKGROUND Mortality after hepatectomy has decreased,and the quality of various surgical approaches to hepatectomy have been evaluated.Various assessments of quality of life(QOL)after hepatectomy have been developed a...BACKGROUND Mortality after hepatectomy has decreased,and the quality of various surgical approaches to hepatectomy have been evaluated.Various assessments of quality of life(QOL)after hepatectomy have been developed and investigated in different clinical settings.AIM To conduct a systematic review and meta-analysis to examine two clinical topics:Laparoscopic hepatectomy vs open hepatectomy,and preoperative QOL status vs postoperative QOL status.METHODS A systematic literature search was performed using PubMed and MEDLINE,including the Cochrane Library Central.The following inclusion criteria were set for inclusion in this meta-analysis:(1)Studies comparing preoperative QOL and postoperative QOL;and(2)Studies comparing QOL between laparoscopic hepatectomy and open hepatectomy.RESULTS A total of 8 articles were included in this meta-analysis.QOL was better after laparoscopic hepatectomy than after open hepatectomy.CONCLUSION The outcomes of evaluations of QOL after hepatectomy can depend on the type of questionnaire used,the timing of the assessment,and the etiology of the hepatic disease.展开更多
AIM： To determine if liver regeneration （LR） could be dis- turbed following radiofrequency （RF） ablation and whe- ther modification of LR by steroid administration occurs.
BACKGROUND Minimally invasive hepatectomy techniques have developed rapidly since 2000.Pure laparoscopic liver resection(LLR)has become the primary approach for managing liver tumors and procuring donor organs for liv...BACKGROUND Minimally invasive hepatectomy techniques have developed rapidly since 2000.Pure laparoscopic liver resection(LLR)has become the primary approach for managing liver tumors and procuring donor organs for liver transplantation.Robotic liver resection(RLR)has emerged during the last decade.The technical status of RLR seems to be improving.AIM To conduct a systematic review and meta-analysis comparing the short-term clinical outcomes of LLR and RLR over two 5-year periods.METHODS A systematic literature search was performed using PubMed and Medline,including the Cochrane Library.The following inclusion criteria were set for the meta-analysis:(1)Studies comparing LLR vs RLR;and(2)Studies that described clinical outcomes,such as the operative time,intraoperative bleeding,intraoperative conversion rate,and postoperative complications.RESULTS A total of 25 articles were included in this meta-analysis after 40 articles had been subjected to full-text evaluations.The studies were divided into early(n=14)and recent(n=11)groups.In the recent group,the operative time did not differ significantly between LLR and RLR(P=0.70),whereas in the early group the operative time of LLR was significantly shorter than that of RLR(P<0.001).CONCLUSION The initial disadvantages of RLR,such as its long operation time,have been overcome during the last 5 years.The other clinical outcomes of RLR are comparable to those of LLR.The cost and quality-of-life outcomes of RLR should be evaluated in future studies to promote its routine clinical use.展开更多
基金Supported by Grant-in-Aid for Scientific Research from the Ministry of Education,Culture,Sports,Science and Technology,Japan,[Grant No.24791437 and No.26461920(to Meguro M),No.13377023(to Hirata K),and No.23591993(to Mizuguchi T)]A grant from the Yuasa Memorial Foundation was awarded to Mizuguchi T
文摘AIM:To clarify the utility of using des-γ-carboxy prothrombin(DCP)andα-fetoprotein(AFP)levels to predict the prognosis of hepatocellular carcinoma(HCC)in patients with hepatitis B virus(HBV)and the hepatitis C virus(HCV)infections.METHODS:A total of 205 patients with HCC(105patients with HBV infection 100 patients with HCV infection)who underwent primary hepatectomy between January 2004 and May 2012 were enrolled retrospectively.Preoperative AFP and DCP levels were used to create interactive dot diagrams to predict recurrence within 2 years after hepatectomy,and cutoff levels were calculated.Patients in the HBV and HCV groups were classified into three groups:a group with low AFP and DCP levels(LL group),a group in which one of the two parameters was high and the other was low(HL group),and a group with high AFP and DCP levels(HH group).Liver function parameters,the postoperative recurrence-free survival rate,and postoperative overall survival were compared between groups.The survival curves were compared by logrank test using the Kaplan-Meier method.Multivariate analysis using a Cox forward stepwise logistic regression model was conducted for a prognosis.RESULTS:The preoperative AFP cutoff levels for recurrence within 2 years after hepatectomy in the HBV and HCV groups were 529.8 ng/m L and 60 m AU/m L,respectively;for preoperative DCP levels,the cutoff levels were 21.0 ng/m L in the HBV group and 67 m AU/m L in the HCV group.The HBV group was significantly different from the other groups in terms of vascular invasion,major hepatectomy,volume of intraoperative blood loss,and surgical duration.Significant differences were found between the LL group,the HL group,and the HH group in terms of both mean disease-free survival time(MDFST)and mean overall survival time(MOST):64.81±7.47 vs 36.63±7.62 vs 18.98±6.17mo(P=0.001)and 85.30±6.55 vs 59.44±7.87 vs46.57±11.20 mo(P=0.018).In contrast,the HCV group exhibited a significant difference in tumor size,vascular invasion,volume of intraoperative blood loss,and surgical duration;however,no significant difference was observed between the three groups in liver function parameters except for albumin levels.In the LL group,the HL group,and the HH group,the MDFST was 50.09±5.90,31.01±7.21,and 14.81±3.08 mo(log-rank test,P<0.001),respectively,and the MOST was 79.45±8.30,58.82±7.56,and 32.87±6.31 mo(log-rank test,P<0.001),respectively.CONCLUSION:In the HBV group,the prognosis was poor when either AFP or DCP levels were high.In the HCV group,the prognosis was good when either or both levels were low;however,the prognosis was poor when both levels were high.High levels of both AFP and DCP were an independent risk factor associated with tumor recurrence in the HBV and HCV groups.The relationship between tumor marker levels and prognosis was characteristic to the type of viral hepatitis.
基金Supported by A Grant-in-Aid for Scientific Research from the Ministry of Education,Culture,Sports,Science,and Technology,No.23591993a Grant from the Yuasa Memorial Foundation
文摘AIM: To compare the prognoses of hepatocellular carcinoma (HCC) patients that underwent anatomic liver resection (AR) or non-anatomic liver resection (NAR) using propensity score-matched populations.
基金Supported by A Grant-in-Aid for Scientific Research from the Ministry of Education,Culture,Sports,Science,and Technology(No.26461921)to T.Mizuguchi,(No.26461920)to M,Meguro and(No.25861207)to S.Ota
文摘Liver resection is the gold standard treatment for certain liver tumors such as hepatocellular carcinoma and metastatic liver tumors. Some patients with such tumors already have reduced liver function due to chronic hepatitis, liver cirrhosis, or chemotherapy-associated steatohepatitis before surgery. Therefore, complications due to poor liver function are inevitable after liver resection. Although the mortality rate of liver resection has been reduced to a few percent in recent case series, its overall morbidity rate is reported to range from 4.1% to 47.7%. The large degree of variation in the post-liver resection morbidity rates reported in previous studies might be due to the lack of consen-sus regarding the definitions and classification of postliver resection complications. The Clavien-Dindo(CD) classification of post-operative complications is widely accepted internationally. However, it is hard to apply to some major post-liver resection complications because the consensus definitions and grading systems for posthepatectomy liver failure and bile leakage established by the International Study Group of Liver Surgery are incompatible with the CD classification. Therefore, a unified classification of post-liver resection complications has to be established to allow comparisons between academic reports.
基金Supported by Grants-in-Aid from JSPS KAKENHI,No.JP 20K10404(to Mizuguchi T)and No.JP 21K10715(to Ishinuki T)the Hokkaido Hepatitis B Litigation Orange Fund,No.2059198(to Mizuguchi T)and No.2136589(to Harada K)+14 种基金Terumo Life Science Foundation,No.2000666Pfizer Health Research Foundation,No.2000777the Viral Hepatitis Research Foundation of Japan,No.3039838Project Mirai Cancer Research Grants,No.202110251Takahashi Industrial and Economic Research Foundation,No.12-003-106Daiichi Sankyo Company,No.2109540Shionogi and Co.,No.2109493MSD,No.2099412Takeda Pharmaceutical Company,No.2000555Sapporo Doto Hospital,No.2039118Noguchi Hospital,No.2029083Doki-kai Tomakomai Hospital,No.2059203Tsuchida Hospital,No.2000092Shinyu-kai Noguchi Hospital,No.2029083(to Mizuguchi T)the Yasuda Medical Foundation,No.28-1(to Ishinuki T).
文摘BACKGROUND Health utility assessments have been developed for various conditions,including chronic liver disease.Health utility scores are required for socio-economic evaluations,which can aid the distribution of national budgets.However,the standard health utility assessment scores for specific health conditions are largely unknown.AIM To summarize the health utility scores,including the EuroQOL 5-dimensions 5-levels(EQ-5D-5L),EuroQol-visual analogue scale,short from-36(SF-36),RAND-36,and Health Utilities Index(HUI)-Mark2/Mark3 scores,for the normal population and chronic liver disease patients.METHODS A systematic literature search of PubMed and MEDLINE,including the Cochrane Library,was performed.Meta-analysis was performed using the RevMan software.Multiple means and standard deviations were combined using the StatsToDo online web program.RESULTS The EQ-5D-5L and SF-36 can be used for health utility evaluations during antiviral therapy for hepatitis C.HUI-Mark2/Mark3 indicated that the health utility scores of hepatitis B patients are roughly 30% better than those of hepatitis C patients.CONCLUSION The EQ-5D-5L is the most popular questionnaire for health utility assessments.Health assessments that allow free registration would be useful for evaluating health utility in patients with liver disease.
基金Supported by Grant-in-Aid from JSPS KAKENHI,No.JP 20K10404(to Mizuguchi T)the Hokkaido Hepatitis B Litigation Orange Fund,No.2059198+9 种基金Terumo Life Science Foundation,No.2000666Pfizer Health Research Foundation,No.2000777Daiichi Sankyo Company,No.2109540Shionogi and Co.,No.2109493MSD,No.2099412Takeda,No,2000555Sapporo Doto Hospital,No.2039118Noguchi Hospital,No.2029083Doki-kai Tomakomai Hospital,No.2059203and Tsuchida Hospital,No.2069231.
文摘BACKGROUND Mortality after hepatectomy has decreased,and the quality of various surgical approaches to hepatectomy have been evaluated.Various assessments of quality of life(QOL)after hepatectomy have been developed and investigated in different clinical settings.AIM To conduct a systematic review and meta-analysis to examine two clinical topics:Laparoscopic hepatectomy vs open hepatectomy,and preoperative QOL status vs postoperative QOL status.METHODS A systematic literature search was performed using PubMed and MEDLINE,including the Cochrane Library Central.The following inclusion criteria were set for inclusion in this meta-analysis:(1)Studies comparing preoperative QOL and postoperative QOL;and(2)Studies comparing QOL between laparoscopic hepatectomy and open hepatectomy.RESULTS A total of 8 articles were included in this meta-analysis.QOL was better after laparoscopic hepatectomy than after open hepatectomy.CONCLUSION The outcomes of evaluations of QOL after hepatectomy can depend on the type of questionnaire used,the timing of the assessment,and the etiology of the hepatic disease.
基金Supported by Grant-in-Aid for Scientific Research from Ministry of Education,Culture,Sports,Science and Technology,No.23791489 (to Nakamura Y),No.23591993 (to Mizuguchi T),No.21390365 (to Mitaka T) and No.22390259 (Hirata K)a grant from Yuasa memorial foundation (to Mizuguchi T)
文摘AIM： To determine if liver regeneration （LR） could be dis- turbed following radiofrequency （RF） ablation and whe- ther modification of LR by steroid administration occurs.
基金Supported by Grants-in-Aid from JSPS KAKENHI,No.JP 20K10404(to Mizuguchi T)the Hokkaido Hepatitis B Litigation Orange Fund,No.2059198+10 种基金Terumo Life Science Foundation,No.2000666Pfizer Health Research Foundation,No.2000777the Viral Hepatitis Research Foundation of Japan,No.2000638Daiichi Sankyo Company,No.2109540Shionogi and Co.,No.2109493MSD,No.2099412Takeda,No.2000555Sapporo Doto Hospital,No.2039118Noguchi Hospital,No.2029083Doki-kai Tomakomai Hospital,No.2059203Tsuchida Hospital,No.2069231.
文摘BACKGROUND Minimally invasive hepatectomy techniques have developed rapidly since 2000.Pure laparoscopic liver resection(LLR)has become the primary approach for managing liver tumors and procuring donor organs for liver transplantation.Robotic liver resection(RLR)has emerged during the last decade.The technical status of RLR seems to be improving.AIM To conduct a systematic review and meta-analysis comparing the short-term clinical outcomes of LLR and RLR over two 5-year periods.METHODS A systematic literature search was performed using PubMed and Medline,including the Cochrane Library.The following inclusion criteria were set for the meta-analysis:(1)Studies comparing LLR vs RLR;and(2)Studies that described clinical outcomes,such as the operative time,intraoperative bleeding,intraoperative conversion rate,and postoperative complications.RESULTS A total of 25 articles were included in this meta-analysis after 40 articles had been subjected to full-text evaluations.The studies were divided into early(n=14)and recent(n=11)groups.In the recent group,the operative time did not differ significantly between LLR and RLR(P=0.70),whereas in the early group the operative time of LLR was significantly shorter than that of RLR(P<0.001).CONCLUSION The initial disadvantages of RLR,such as its long operation time,have been overcome during the last 5 years.The other clinical outcomes of RLR are comparable to those of LLR.The cost and quality-of-life outcomes of RLR should be evaluated in future studies to promote its routine clinical use.
