Long‐term suppression of hepatitis B virus with tenofovir (TDF) induces fibrosis regression, and repeated liver stiffness (LS) measurement can indicate the improvement of fibrosis. We aimed to ...investigate predictors for LS improvement assessed by changes in patients receiving long‐term TDF therapy in chronic hepatitis B (CHB) with liver cirrhosis. CHB patients with histologically proven liver cirrhosis who received TDF as the first‐line therapy from 2012 to 2015 were recruited. LS and controlled attenuation parameter (CAP) measurements were repeated at baseline and 3 years after therapy. Liver stiffness improvement was defined as a drop of LS value ≥30% from the baseline. A total of 131 patients were enrolled (mean age 51.4% and male 64.9%). After 3 years of TDF therapy, the mean LS value significantly improved (from 14.7 to 8.6 kPa, P < .001), and 96 (73.3%) patients have achieved LS improvement. Predictors associated with improvement of LS were low body mass index (BMI), HBeAg positivity, and low CAP value at baseline. In multivariate analysis, low BMI was a single factor independently associated with LS improvement (odds ratio 0.680, 95% CI 0.560‐0.825, P < .001). Patients with BMI < 23.5, had a 1.96 times more chance of achieving LS improvement compared to those with BMI ≥ 23.5 (90.1% vs. 46.0%, P = .001). High BMI was a single significant factor hindering the fibrosis improvement in patients receiving long‐term TDF therapy in CHB with liver cirrhosis. Life style modification and BMI reduction should be encouraged to enhance fibrosis improvement.
Background and Aim
To identify factors associated with non‐alcoholic fatty liver disease (NAFLD) in healthy Asian subjects.
Methods
A propensity score‐matched case‐control study was designed. To ...investigate the effects of demographic and clinical factors on the presence of NAFLD, a baseline‐category logit model was used. Potential living liver donors with no hepatic steatosis (< 5%: n = 1353, group 1) were considered the baseline category, and subjects with mild (5–33%: n = 724, group 2) and moderate/severe (> 33%: n = 116, group 3) hepatic steatosis were defined as cases. Age and gender were matched between cases and controls, which resulted in 83 matched subjects in each of the three groups. The area of abdominal (visceral and subcutaneous) fat was directly measured in all subjects by unenhanced computed tomography.
Results
Serum aspartate aminotransferase, alanine aminotransferase (ALT), gamma‐glutamyltranspeptidase, total cholesterol and triglyceride levels, and visceral fat amount were directly correlated with the grade of hepatic steatosis, and high‐density lipoprotein cholesterol levels were inversely correlated with it (all P values < 0.05). In a multivariate model, visceral fat amount was significantly correlated with both mild (group 2) and moderate to severe (group 3) NAFLD, with respective odds ratios (ORs) of 1.03 relative to group 1 (Ps < 0.05). Body mass index (BMI), ALT, and subcutaneous fat were significant predictors of only moderate to severe NAFLD (ORs of 0.54, 1.20, and 1.02, respectively, for group 3 vs group 1; Ps < 0.05).
Conclusions
Our results indicate that visceral adiposity makes non‐obese subjects more susceptible to NAFLD, compared with subcutaneous fat and BMI.
Due to the various changes caused by the COVID-19 pandemic, some infectious diseases showed different epidemiology and prevalence during the pandemic. However, there is a lack of comprehensive ...studies on trends in the prevalence of hepatitis B and C related to the pandemic. Thus, we compared the prevalence of hepatitis B and C before and during the COVID-19 pandemic in South Korea.
We conducted a comprehensive trend analysis with a nationwide serial cross-sectional survey from 2007 to 2021 (n=86,931) using the Korea National Health and Nutrition Examination Survey (KNHANES). The changes in the prevalence of hepatitis B and C were evaluated using a weighted regression model to assess the impact of the COVID-19 pandemic.
From 2007 to 2021, 86,931 Korean adults aged 19 or older were included in the KNHANES data. The prevalence of hepatitis B showed a declining trend until the onset of the pandemic (1.80% in 2007-2009; 1.08% in 2016-2019; and 1.01% in 2020), at which point this trend reversed (1.39% in 2021). The prevalence of hepatitis C remained stable (0.14% in 2007-2009 and 0.18% in 2016-2019), with no particular surge related to the COVID-19 pandemic (βdiff, -0.002; 95% CI, -0.761 to 0.756). For hepatitis B, old age was identified as a pandemic-related vulnerable factor (ratio of odds ratio, 1.68; 95% CI, 1.05-2.70).
In this study, unlike other infectious diseases, hepatitis B and C did not show a decreasing trend during the pandemic. In particular, hepatitis B showed a rebound trend during the pandemic, which was noticeable in those aged 60 or older. Further studies are needed to support these findings.
Objectives
To validate and reappraise the Assessment for Retreatment with Transarterial chemoembolization (ART) score comprising three parameters (>25 % increase in aspartate aminotransferase AST, ...increase in Child-Pugh score and tumour response), determined prior to subsequent transarterial chemoembolization (TACE).
Methods
Enrolled patients were diagnosed with unresectable non-metastatic hepatocellular carcinoma and underwent multiple TACEs between June 2006 and December 2007 (
N
= 153). Subgroupings were classified according to the established cut-off (≤1.5 vs. ≥2.5). Survival analysis using the Kaplan-Meier curve was performed.
Results
The original ART score dichotomized patients according to their overall survival (
P
= 0.004). We found several patients who actually survived longer than others were assigned to a poor prognostic group due to the AST component. Parameter estimates for AST obtained from our analysis were much lower than the original version (0.5 vs. 2.1). We adjusted the component according to the value of our parameter estimates, and patients with >25 % AST increase received 1.0 point. After this modification, patients assigned to the favourable prognostic group were more likely to have a better survival outcome (median 23.9 vs. 12.2 months,
P
< 0.001).
Conclusions
In hepatitis B virus-endemic regions, the ART score is valid and can better predict post-TACE survival after the AST component is modified.
Key Points
•
The ART score was validated in a HBV-endemic region.
•
The modified ART score improved prognostic performance by reappraising the AST component.
•
The modified ART score helps physicians make decisions for further TACE.
Although sorafenib is considered standard therapy for advanced hepatocellular carcinoma (HCC), actual treatments vary. We evaluated the effects of different treatment strategies on overall survival.
...A retrospective study of sorafenib-treated patients with advanced HCC was conducted. The primary outcome was overall survival. Prognostic factors were analyzed using multivariate Cox-proportional hazards model.
A total of 658 patients (mean age, 54.5 years; 83.3% male) were analyzed; 293, 129, and 236 patients were treated with sorafenib, a combination therapy of sorafenib and transarterial chemoembolization (TACE), and TACE followed by sorafenib, respectively. Overall, 51.2% of patients treated under the combination strategy had portal vein invasion, whereas 89.9% of patients receiving sorafenib monotherapy had distant metastasis. Median overall survival durations were comparable (11.8 months for sorafenib, 16.2 months for the combination therapy, and 13.5 months for TACE followed by sorafenib; P = 0.13). However, among portal vein invasion cases, combination (25.7 months, P = 0.002) and TACE followed by sorafenib (14.0 months, P = 0.030) treatments were associated with longer overall survival duration compared with than sorafenib monotherapy (5.5 months). In a multivariate model, sorafenib duration (hazard ratio HR, 0.96, P < 0.001) and TACE (HR, 0.24, P < 0.001) along with Child-Pugh stage (HR, 1.83, P = 0.005) were associated with better survival.
In patients with portal vein invasion, TACE performed concurrently with or before sorafenib administration is associated with better survival.
Alpha-fetoprotein (AFP) is a prognostic marker for hepatocellular carcinoma (HCC). We investigated the prognostic value of AFP levels in patients who achieved complete response (CR) to transarterial ...chemoembolization (TACE) for HCC.
Between 2005 and 2018, 890 patients with HCC who achieved a CR to TACE were recruited. An AFP responder was defined as a patient who showed elevated levels of AFP (>10 ng/mL) during TACE, but showed normalization or a >50% reduction in AFP levels after achieving a CR.
Among the recruited patients, 569 (63.9%) with naïve HCC and 321 (36.1%) with recurrent HCC after complete resection were treated. Before TACE, 305 (34.3%) patients had multiple tumors, 219 (24.6%) had a maximal tumor size >3 cm, and 22 (2.5%) had portal vein tumor thrombosis. The median AFP level after achieving a CR was 6.36 ng/mL. After a CR, 473 (53.1%) patients experienced recurrence, and 417 (46.9%) died median progression-free survival (PFS) and overall survival (OS) of 16.3 and 62.8 months, respectively. High AFP levels at CR (>20 ng/mL) were independently associated with a shorter PFS hazard ratio (HR)=1.403 and OS (HR=1.284), together with tumor multiplicity at TACE (HR=1.518 and 1.666, respectively). AFP non-responders at CR (76.2%, n=359 of 471) showed a shorter PFS (median 10.5 months vs. 15.5 months, HR=1.375) and OS (median 41.4 months vs. 61.8 months, HR=1.424) than AFP responders (all
=0.001).
High AFP levels and AFP non-responders were independently associated with poor outcomes after TACE. AFP holds clinical implications for detailed risk stratification upon achieving a CR after TACE.
Abstract
Background and Aim
To evaluate the usefulness of
B
arcelona
C
linic
L
iver
C
ancer
B
subclassification (
B
1–
B
4) proposed by
B
olondi
et al
. in subjects with hepatocellular carcinoma ...treated with transarterial chemoembolization according to the current
B
arcelona
C
linic
L
iver
C
ancer policy.
Methods
A total of 466
B
arcelona
C
linic
L
iver
C
ancer
B
patients initially treated with transarterial chemoembolization were included. The subclassification system was tested and modified on the basis of correlation with survival outcomes, which were examined by
K
aplan–
M
eier method and log–rank test.
Results
There were 101 (21.7%), 232 (49.8%), 35 (7.5%), and 98 (21.0%) patients in
B
1,
B
2,
B
3, and
B
4, respectively. There was a significant difference in median survival time between
B
1 and
B
2 (41.0
vs
22.1 months,
P
≤ 0.001), and
B
2 and
B
3 (22.1
vs
14.1 months,
P
= 0.004), but not between
B
3 and
B
4 (14.1
vs
17.2 months,
P
= 0.48). We, therefore, developed a modified subclassification, in which
B
3 subclass was merged with
B
4 as
BIII
, and
BI
and
BII
corresponded to
B
1 and
B
2. The median survival times differed between all three modified subclasses (41.0
vs
22.1
vs
16.6 months,
P
≤ 0.001), and multivariate
C
ox analysis revealed that the modified
B
arcelona
C
linic
L
iver
C
ancer
B
subclasses independently predicted overall survival (hazard ratios, 1.92 and 2.78 for
BII
and
BIII
vs
BI
;
P
< 0.001 for each).
Conclusions
The modified subclassification, which divides the
B
arcelona
C
linic
L
iver
C
ancer
B
stage into three substages, would be an effective tool for stratifying this heterogeneous population and facilitating per‐subclass‐based treatment options.
PDF
