BACKGROUND In hepatocellular carcinoma(HCC),detection and treatment prior to growth beyond 2 cm are important as a larger tumor size is more frequently associated with microvascular invasion and/or satellites.In the s...BACKGROUND In hepatocellular carcinoma(HCC),detection and treatment prior to growth beyond 2 cm are important as a larger tumor size is more frequently associated with microvascular invasion and/or satellites.In the surveillance of very small HCC nodules(≤2 cm in maximum diameter,Barcelona clinical stage 0),we demonstrated that the tumor markers alpha-fetoprotein and PIVKA-Ⅱare not so useful.Therefore,we must survey with imaging modalities.The superiority of magnetic resonance imaging(MRI)over ultrasound(US)to detect HCC was confirmed in many studies.Although enhanced MRI is now performed to accurately diagnose HCC,in conventional clinical practice for HCC surveillance in liver diseases,unenhanced MRI is widely performed throughout the world.While,MRI has made marked improvements in recent years.AIM To make a comparison of unenhanced MRI and US in detecting very small HCC that was examined in the last ten years in patients in whom MRI and US examinations were performed nearly simultaneously.METHODS In 394 patients with very small HCC nodules,those who underwent MRI and US at nearly the same time(on the same day whenever possible or at least within 14 days of one another)at the first diagnosis of HCC were selected.The detection rate of HCC with unenhanced MRI was investigated and compared with that of unenhanced US.RESULTS The sensitivity of unenhanced MRI for detecting very small HCC was 95.1%(97/102,95%confidence interval:90.9-99.3)and that of unenhanced US was 69.6%(71/102,95%confidence interval:60.7-78.5).The sensitivity of unenhanced MRI for detecting very small HCC was significantly higher than that of unenhanced US(P<0.001).Regarding the location of HCC in the liver in patients in whom detection by US was unsuccessful,S7-8 was identified in 51.7%.CONCLUSION Currently,unenhanced MRI is a very useful tool for the surveillance of very small HCC in conventional clinical follow-up practice.展开更多
BACKGROUND In hepatocellular carcinoma(HCC),detection and treatment prior to growth beyond 2 cm are relevant as a larger tumor size is more frequently associated with microvascular invasion and/or satellites.AIM To ex...BACKGROUND In hepatocellular carcinoma(HCC),detection and treatment prior to growth beyond 2 cm are relevant as a larger tumor size is more frequently associated with microvascular invasion and/or satellites.AIM To examine the impact of the tumor marker alpha-fetoprotein(AFP)or PIVKA-II in detecting very small HCC nodules(≤2 cm in maximum diameter,Barcelona stage 0)in the large number of very small HCC.The difference in the behavior of these tumor markers in HCC development was also examined.METHODS A total of 933 patients with single-nodule HCC were examined.They were subdivided into 394 patients with HCC nodules≤2 cm in maximum diameter and 539 patients whose nodules were>2 cm.The rates of patients whose AFP and PIVKA-II showed normal values were examined.RESULTS The positive ratio of the marker PIVKA-II was significantly different(P<0.0001)between patients with nodules≤2 cm in diameter and those with nodules>2 cm,but there was no significant difference in AFP(P=0.4254).In the patients whose tumor was≤2 cm,50.5%showed normal levels in AFP and 68.8%showed normal levels in PIVKA-II.In 36.4%of those patients,both AFP and PIVKA-II showed normal levels.The PIVKA-II-positive ratio was markedly increased with an increase in the tumor size.In contrast,the positivity in AFP was increased gradually and slowly.CONCLUSION In the surveillance of very small HCC nodules(≤2 cm in diameter,Barcelona clinical stage 0)the tumor markers AFP and PIVKA-II are not so useful.展开更多
BACKGROUND It is generally accepted that the incidence of hepatocellular carcinoma(HCC)in hepatitis C virus(HCV)-associated patients is higher than that in hepatitis B virus(HBV)-associated patients.The reason why thi...BACKGROUND It is generally accepted that the incidence of hepatocellular carcinoma(HCC)in hepatitis C virus(HCV)-associated patients is higher than that in hepatitis B virus(HBV)-associated patients.The reason why this difference in the incidence of HCC occurs in patients with HBV and HCV infections remains unclear.We report the possibility that the contributing power of inflammation,which is the main risk factor for developing HCC,may be different with HBV and HCV infections.AIM To investigate this,we surveyed the hazard ratio of inflammation for HCC development which was identified by serum alanine aminotransferase(ALT)levels between patients with HBV and HCV infections.METHODS The PubMed database was searched(2001-2021)for studies published in English regarding the incidence of HCC identifying 8924 HBV-and 7376 HCV-infected patients.From these studies,interferon-treated patients with both HBV and HCV infections were excluded.Furthermore,in HBV patients,those administered nucleos(t)ide analogues were excluded,and in HCV patients,those administered direct acting antivirals were also excluded.Studies citing hazard ratios of HCC regarding inflammation(serum elevated alanine aminotransferase levels)were selected.Finally,there were 14 studies of HBV-infected patients and 8 studies of HCV-infected patients.We calculated the hazard ratio in patients in an inflammatory state(serum ALT levels were above the normal range).RESULTS In the 14 studies of HBV patients,the average hazard ratio(HR)of elevated ALT for developing HCC was 2.74[1.98-3.77]and that in the 8 studies of HCV-infected patients was 5.51[3.08-9.83].The HR of inflammation for HCC development in HCV-associated liver diseases is about twice that in HBV-associated liver diseases.HR in HCV-infected patients was significantly(P=0.0391)higher than that in HBV-infected patients.In hepatitis B patients,the abnormal range adopted was 28-45 IU/L,and in hepatitis C patients,it was 20-50 IU/L.It was demonstrated that the abnormal ALT levels adopted in hepatitis B and C patients were very similar in this series.CONCLUSION The difference in the incidence of HCC development between HBV and HCV patients may depend on the difference in the hazard risk of ALT between HBV and HCV infections.展开更多
AIM To survey the efficacy and safety of dual therapy with daclatasvir and asunaprevir in the elderly hepatitis C virus(HCV) patients multicentricity.METHODS Interferon-ineligible/intolerant patients and non-responder...AIM To survey the efficacy and safety of dual therapy with daclatasvir and asunaprevir in the elderly hepatitis C virus(HCV) patients multicentricity.METHODS Interferon-ineligible/intolerant patients and non-responders to previous pegylated-interferon/ribavirin therapy with chronic HCV genotype 1b infection were enrolled. Child B, C cirrhotic patients were excluded.Patients received oral direct acting antiviral treatment consisting of 60 mg daclatasvir once daily plus 200 mg asunaprevir twice daily for 24 wk. We divided the patients into two groups of 56 elderly patients(≥ 75 years-old) and 141 non-elderly patients(< 75 years old) and compared the efficacy and safety. RESULTS Ninety-one point one percent of elderly patients and 90.1% of non-elderly patients achieved sustained virological response at 24 wk(SVR24). In the former, 1.8% experienced viral breakthrough, as compared with 3.5% in the latter(not significant). Adverse events occurred in 55.4% of the former and 56.0% of the latter. In the former, 7 cases(12.5%) were discontinued due to adverse events, and in the latter 9 cases were discontinued(6.4%, not significant). CONCLUSION Dual therapy with daclatasvir and asunaprevir achieved the same high rates of SVR24 in HCV elderly patients without more adverse events than in the non-elderly patients.展开更多
基金The study was reviewed and approved by the Ethics Committee of Yokohama Municipal Citizen's Hospital Institutional Review Board(Approval No.21-02-01).
文摘BACKGROUND In hepatocellular carcinoma(HCC),detection and treatment prior to growth beyond 2 cm are important as a larger tumor size is more frequently associated with microvascular invasion and/or satellites.In the surveillance of very small HCC nodules(≤2 cm in maximum diameter,Barcelona clinical stage 0),we demonstrated that the tumor markers alpha-fetoprotein and PIVKA-Ⅱare not so useful.Therefore,we must survey with imaging modalities.The superiority of magnetic resonance imaging(MRI)over ultrasound(US)to detect HCC was confirmed in many studies.Although enhanced MRI is now performed to accurately diagnose HCC,in conventional clinical practice for HCC surveillance in liver diseases,unenhanced MRI is widely performed throughout the world.While,MRI has made marked improvements in recent years.AIM To make a comparison of unenhanced MRI and US in detecting very small HCC that was examined in the last ten years in patients in whom MRI and US examinations were performed nearly simultaneously.METHODS In 394 patients with very small HCC nodules,those who underwent MRI and US at nearly the same time(on the same day whenever possible or at least within 14 days of one another)at the first diagnosis of HCC were selected.The detection rate of HCC with unenhanced MRI was investigated and compared with that of unenhanced US.RESULTS The sensitivity of unenhanced MRI for detecting very small HCC was 95.1%(97/102,95%confidence interval:90.9-99.3)and that of unenhanced US was 69.6%(71/102,95%confidence interval:60.7-78.5).The sensitivity of unenhanced MRI for detecting very small HCC was significantly higher than that of unenhanced US(P<0.001).Regarding the location of HCC in the liver in patients in whom detection by US was unsuccessful,S7-8 was identified in 51.7%.CONCLUSION Currently,unenhanced MRI is a very useful tool for the surveillance of very small HCC in conventional clinical follow-up practice.
文摘BACKGROUND In hepatocellular carcinoma(HCC),detection and treatment prior to growth beyond 2 cm are relevant as a larger tumor size is more frequently associated with microvascular invasion and/or satellites.AIM To examine the impact of the tumor marker alpha-fetoprotein(AFP)or PIVKA-II in detecting very small HCC nodules(≤2 cm in maximum diameter,Barcelona stage 0)in the large number of very small HCC.The difference in the behavior of these tumor markers in HCC development was also examined.METHODS A total of 933 patients with single-nodule HCC were examined.They were subdivided into 394 patients with HCC nodules≤2 cm in maximum diameter and 539 patients whose nodules were>2 cm.The rates of patients whose AFP and PIVKA-II showed normal values were examined.RESULTS The positive ratio of the marker PIVKA-II was significantly different(P<0.0001)between patients with nodules≤2 cm in diameter and those with nodules>2 cm,but there was no significant difference in AFP(P=0.4254).In the patients whose tumor was≤2 cm,50.5%showed normal levels in AFP and 68.8%showed normal levels in PIVKA-II.In 36.4%of those patients,both AFP and PIVKA-II showed normal levels.The PIVKA-II-positive ratio was markedly increased with an increase in the tumor size.In contrast,the positivity in AFP was increased gradually and slowly.CONCLUSION In the surveillance of very small HCC nodules(≤2 cm in diameter,Barcelona clinical stage 0)the tumor markers AFP and PIVKA-II are not so useful.
文摘BACKGROUND It is generally accepted that the incidence of hepatocellular carcinoma(HCC)in hepatitis C virus(HCV)-associated patients is higher than that in hepatitis B virus(HBV)-associated patients.The reason why this difference in the incidence of HCC occurs in patients with HBV and HCV infections remains unclear.We report the possibility that the contributing power of inflammation,which is the main risk factor for developing HCC,may be different with HBV and HCV infections.AIM To investigate this,we surveyed the hazard ratio of inflammation for HCC development which was identified by serum alanine aminotransferase(ALT)levels between patients with HBV and HCV infections.METHODS The PubMed database was searched(2001-2021)for studies published in English regarding the incidence of HCC identifying 8924 HBV-and 7376 HCV-infected patients.From these studies,interferon-treated patients with both HBV and HCV infections were excluded.Furthermore,in HBV patients,those administered nucleos(t)ide analogues were excluded,and in HCV patients,those administered direct acting antivirals were also excluded.Studies citing hazard ratios of HCC regarding inflammation(serum elevated alanine aminotransferase levels)were selected.Finally,there were 14 studies of HBV-infected patients and 8 studies of HCV-infected patients.We calculated the hazard ratio in patients in an inflammatory state(serum ALT levels were above the normal range).RESULTS In the 14 studies of HBV patients,the average hazard ratio(HR)of elevated ALT for developing HCC was 2.74[1.98-3.77]and that in the 8 studies of HCV-infected patients was 5.51[3.08-9.83].The HR of inflammation for HCC development in HCV-associated liver diseases is about twice that in HBV-associated liver diseases.HR in HCV-infected patients was significantly(P=0.0391)higher than that in HBV-infected patients.In hepatitis B patients,the abnormal range adopted was 28-45 IU/L,and in hepatitis C patients,it was 20-50 IU/L.It was demonstrated that the abnormal ALT levels adopted in hepatitis B and C patients were very similar in this series.CONCLUSION The difference in the incidence of HCC development between HBV and HCV patients may depend on the difference in the hazard risk of ALT between HBV and HCV infections.
文摘AIM To survey the efficacy and safety of dual therapy with daclatasvir and asunaprevir in the elderly hepatitis C virus(HCV) patients multicentricity.METHODS Interferon-ineligible/intolerant patients and non-responders to previous pegylated-interferon/ribavirin therapy with chronic HCV genotype 1b infection were enrolled. Child B, C cirrhotic patients were excluded.Patients received oral direct acting antiviral treatment consisting of 60 mg daclatasvir once daily plus 200 mg asunaprevir twice daily for 24 wk. We divided the patients into two groups of 56 elderly patients(≥ 75 years-old) and 141 non-elderly patients(< 75 years old) and compared the efficacy and safety. RESULTS Ninety-one point one percent of elderly patients and 90.1% of non-elderly patients achieved sustained virological response at 24 wk(SVR24). In the former, 1.8% experienced viral breakthrough, as compared with 3.5% in the latter(not significant). Adverse events occurred in 55.4% of the former and 56.0% of the latter. In the former, 7 cases(12.5%) were discontinued due to adverse events, and in the latter 9 cases were discontinued(6.4%, not significant). CONCLUSION Dual therapy with daclatasvir and asunaprevir achieved the same high rates of SVR24 in HCV elderly patients without more adverse events than in the non-elderly patients.
