1
|
Rahadiani N, Stephanie M, Perkasa AG, Handjari DR, Krisnuhoni E. p53 expression is associated with tumor stage, grade and subtype in patients with hepatocellular carcinoma. Mol Clin Oncol 2023; 19:54. [PMID: 37323246 PMCID: PMC10265582 DOI: 10.3892/mco.2023.2650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
The present study aimed to determine the expression levels of p53 in patients with hepatocellular carcinoma (HCC) and to evaluate its association with several HCC-related prognostic factors and in particular, with tumor stage, grade and subtype. Therefore, a cross-sectional study, involving 41 patients with HCC, who underwent surgical resection between January, 2013 and December, 2020 was conducted. To assess the expression levels of p53 in all patients with HCC, immunohistochemical staining was performed. In addition, the association between p53 expression and the clinicopathological characteristics of patients with HCC, including prognostic factors, was evaluated by applying the appropriate statistical analysis methods. The results revealed that among the 41 patients enrolled, 35 patients (85.4%) were positive for p53 expression. A higher percentage of positive p53 expression was observed in male patients >60 years old, with single HCC nodules >5 cm in diameter and vascular invasion, compared with their counterparts. A positive p53 expression was associated with well- and poorly differentiated HCC, but not with tumor stage and subtype. No differences in p53 expression were observed across different tumor stages and subtypes. Additionally, patients with moderately and poorly differentiated HCC exhibited significantly higher p53 expression levels compared with those suffering from well-differentiated HCC. Overall, the results demonstrated that the rate of p53 immuno-positive cells was increased in patients with HCC. In addition, p53 expression was associated with well- and poorly differentiated HCC, thus suggesting its association with a poorer prognosis.
Collapse
Affiliation(s)
- Nur Rahadiani
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
| | - Marini Stephanie
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
| | - Alif Gilang Perkasa
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
| | - Diah Rini Handjari
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
| | - Ening Krisnuhoni
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
| |
Collapse
|
2
|
Hasan I, Lutfie L, Rinaldi I, Kurniawan J, Loho IM. Comparison Between Neutrophil-Lymphocyte Ratio and Systemic Immune-Inflammation Index as Predictors of One-Year Survival in Patients with Untreated Advanced Hepatocellular Carcinoma. J Gastrointest Cancer 2022; 54:135-146. [PMID: 35099753 DOI: 10.1007/s12029-021-00796-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patients with hepatocellular carcinoma (HCC) generally only come for treatment when cancer has reached an advanced stage, with very limited treatment options. There has not been an accurate predictor marker to be able to identify which group of patients may have better survival. This study wanted to analyze the role of the inflammatory status indices as predictors of 1-year survival in patients with advanced HCC who did not undergo therapy. METHODS This study has a retrospective cohort design using secondary data on subjects with advanced HCC who did not undergo therapy at Cipto Mangunkusumo Hospital and Dharmais Hospital. The neutrophil-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) were evaluated for their role as predictors of 1-year survival based on the area under receiving operator curve (AUROC). The best optimal cut-off for NLR and SII was decided based on the Youden index, followed by survival analysis based on those cut-offs. Confounding factors were analyzed with multivariate cox regression analysis. RESULTS A total of 196 subjects were included in the data analysis. One-year survival was 6.6%, with a median survival of 56 days (95% CI: 46-67). The NLR had a discriminatory ability based on AUROC of 0.667 (95% CI: 0.536-0.798; p = 0.044), with the optimal cut-off point to differentiate survival was 3.7513. The SII has a discriminatory ability based on AUROC of 0.766 (95% CI: 0.643-0.889; p = 0.001), with the optimal cut-off point to distinguish survival was 954.4782. SII had superiority in discriminatory ability (p = 0.0415). CONCLUSIONS The discriminatory ability based on AUROC of SII was better than that of NLR in predicting 1-year survival in patients with advanced HCC who did not undergo therapy.
Collapse
Affiliation(s)
- Irsan Hasan
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Lutfie Lutfie
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia.
| | - Ikhwan Rinaldi
- Division of Medical Oncology Hematology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Juferdy Kurniawan
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Imelda Maria Loho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dharmais National Cancer Center Hospital, Jakarta, Indonesia
| |
Collapse
|
3
|
Sulaiman AS, Gani RA, Hasan I, Lesmana CRA, Kurniawan J, Jasirwan COM, Kalista KF, Nababan SHH, Aprilicia G, Lesmana LA. Overall Survival of Hepatocellular Carcinoma Patients Underwent Radiofrequency Ablation (RFA) Treatment: a Retrospective Cohort Study from Two Referral Hospitals in Indonesia. J Gastrointest Cancer 2021; 53:632-640. [PMID: 34379264 DOI: 10.1007/s12029-021-00676-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is one of the curative modality therapies commonly used for the early stage of HCC management. Although numerous studies have reported the outcome of RFA around the world, the data regarding the usage of RFA for the early and intermediate stage of HCC remains limited. Hence, the study aimed to report the survival rate of the early and intermediate stage HCC patients who underwent RFA in two tertiary referral hospitals in Jakarta, Indonesia. METHODS A retrospective cohort study was conducted in Cipto Mangunkusumo and Medistra multicenter hospital in Jakarta, Indonesia. The patients with HCC BCLC A and B who underwent RFA treatments between January 2015 to December 2017 were recruited for the study. Baseline characteristics of patients were collected from the medical record. Survival analysis was calculated using the Kaplan Meier. p value result was obtained from the log-rank test. Sub-analysis of factors associated with the survival was also included in this study. RESULTS There were 62 patients enrolled in this study (32.3% were BCLC A and 67.7% were BCLC B). Forty-six out of 62 patients (74.2%) were reported to have RFA as their first line of treatment, while 12 (25.8%) were reported to have a combination of RFA and other therapy modalities. All these patients were follow-up with an average duration of 27 months. The survival rate of liver cancer due to HCC for 12 and 36 months in patients who received RFA was 82.3% and 57.8%, respectively. Moreover, BCLC staging of liver cancer and response after RFA was significantly associated with survival. CONCLUSION RFA still can be used as initial modality therapy nor combination with another therapy for the early and intermediate stage of HCC. BCLC staging and response after RFA had shown to be the independent factors related to survival.
Collapse
Affiliation(s)
- Andri Sanityoso Sulaiman
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
| | - Rino Alvani Gani
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Irsan Hasan
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Cosmas Rinaldi A Lesmana
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Juferdy Kurniawan
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Chyntia Olivia Maurine Jasirwan
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Kemal Fariz Kalista
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Saut Horas Hotaguan Nababan
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Gita Aprilicia
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | | |
Collapse
|
4
|
The Role of Interventional Endoscopic Ultrasound in Liver Diseases: What Have We Learnt? Can J Gastroenterol Hepatol 2021; 2021:9948979. [PMID: 34258255 PMCID: PMC8257328 DOI: 10.1155/2021/9948979] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic liver disease (CLD) is still a major problem, where the disease progression will lead to liver cirrhosis (LC) or hepatocellular carcinoma (HCC). Portal hypertension (PH) management and loco-regional therapy for HCC have become the cornerstones in advanced liver disease management. Recently, there are studies looking at the potential role of interventional endoscopic ultrasound (EUS) in liver diseases. EUS may be useful in vascular changes of the digestive wall evaluation, performing dynamic assessment of hemodynamic changes, predicting variceal bleeding and rebleeding risk, and assessing the pharmacological effects. In PH management, EUS-guided vascular therapy-which revolves around glue injection, endovascular coil placement/embolization, and combination of both-has shown promising results. As a diagnostic modality for liver cancer, the implementation of EUS in liver diseases is currently not only limited to liver biopsy (EUS-LB) but also in shear-wave elastography (SWE) and portal pressure gradient measurement, as well as portal vein sampling. The application of EUS-guided radiofrequency ablation (EUS-RFA) and tumor injection can also overcome the limitations shown by both modalities without EUS. Nevertheless, establishing EUS as a firm diagnostic and therapeutic modality is still challenging since the performance of interventional EUS requires high expertise and adequate facilities.
Collapse
|
5
|
Kurniawan J, Gani RA, Hasan I, Sulaiman AS, Lesmana CRA, Jasirwan COM, Kalista KF, Nababan SHH, Zulkifly S. The Improvement in 1-Year Survival Rate of Patients with Hepatocellular Carcinoma BCLC Stage A and B after the Implementation of Comprehensive Management. J Gastrointest Cancer 2020; 51:829-835. [DOI: 10.1007/s12029-019-00298-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
6
|
Mardian Y, Yano Y, Ratnasari N, Choridah L, Wasityastuti W, Setyawan NH, Hayashi Y. "Sarcopenia and intramuscular fat deposition are associated with poor survival in Indonesian patients with hepatocellular carcinoma: a retrospective study". BMC Gastroenterol 2019; 19:229. [PMID: 31888500 PMCID: PMC6937974 DOI: 10.1186/s12876-019-1152-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/18/2019] [Indexed: 02/08/2023] Open
Abstract
Background A large-scale Japanese study showed that low skeletal muscle index (SMI) and intramuscular fat (IMF) deposition are associated with hepatocellular carcinoma (HCC) survival. Here, we evaluated the effects of SMI and IMF on the survival of Indonesian HCC patients, whose characteristics differ from those of Japanese patients. Methods SMI and mean muscle attenuation (MA) were evaluated using computed tomography images of the third lumbar vertebra (L3) in a prospective cohort of 100 Indonesian HCC patients. Clinical, laboratory and body composition data were analysed using the Kaplan–Meier method and Cox regression model to investigate which factors are associated with prognosis. Results Of 100 patients, 31 were diagnosed with sarcopenia (L3 SMI value ≤36.2 cm2/m2 for men and ≤ 29.6 cm2/m2 for women), and 65 had IMF deposition (MA value ≤44.4 HU for men and ≤ 39.3 HU for women). These groups had shorter median survival than the reference groups (both P < 0.0001). In multivariable analysis, sarcopenia (hazard ratio [HR], 1.921; P = 0.016), IMF deposition (HR, 3.580; P < 0.001), Barcelona Clinic Liver Cancer (BCLC) stages C and D (HR: 2.396, P < 0.01 and HR: 6.131, P < 0.01, respectively), Japan Integrated Staging (JIS) score 4 (HR: 2.067, P = 0.020), and male gender (HR: 3.211, P < 0.001) were independently associated with mortality. Conclusion Sarcopenia and IMF deposition showed superior value in combination with BCLC stage and JIS score for predicting the survival of Indonesian HCC patients. Increased awareness and strategies to prevent or reverse these factors might improve patient outcomes. (Electric word counts: 249).
Collapse
Affiliation(s)
- Yan Mardian
- Division of Infectious Disease Pathology, Department of Microbiology and Infectious Disease, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihiko Yano
- Division of Infectious Disease Pathology, Department of Microbiology and Infectious Disease, Kobe University Graduate School of Medicine, Kobe, Japan. .,Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Neneng Ratnasari
- Division of Gastroenterohepatology, Department of Internal Medicine, Dr. Sardjito Hospital, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Lina Choridah
- Department of Radiology, Dr. Sardjito Hospital, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Widya Wasityastuti
- Division of Infectious Disease Pathology, Department of Microbiology and Infectious Disease, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nurhuda Hendra Setyawan
- Department of Radiology, Dr. Sardjito Hospital, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Yoshitake Hayashi
- Division of Infectious Disease Pathology, Department of Microbiology and Infectious Disease, Kobe University Graduate School of Medicine, Kobe, Japan.,Division of Molecular Medicine & Medical Genetics, Department of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
7
|
Jasirwan COM, Hasan I, Sulaiman AS, Lesmana CRA, Kurniawan J, Kalista KF, Nababan SH, Gani RA. Risk factors of mortality in the patients with hepatocellular carcinoma: A multicenter study in Indonesia. Curr Probl Cancer 2019; 44:100480. [PMID: 31130257 DOI: 10.1016/j.currproblcancer.2019.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Hepatocellular carcinoma (HCC) is considered a significant burden, and its associated rate of mortality is increasing. Therefore, a population-based cancer registry is considered an essential element in the baseline and comprehensive analysis of the risk factors associated with HCC. We present a multicenter analysis of HCC registry from 2 hospitals in Indonesia. METHODS We performed a follow-up on patients with HCC who were admitted between January 2015 and November 2017 in Cipto Mangunkusumo National General Hospital and Dharmais Hospital, Jakarta, Indonesia. Patient's death was considered the primary outcome of the study. A multivariate analysis was conducted using logistic regression, and odds ratio (OR) with 95% confidence intervals (CIs) were calculated. RESULTS A total of 282 patients with HCC included. At the last follow-up, 136 (48.2%) patients had died. Mortality rate was not significantly affected by sex, age, etiology, the presence of cirrhosis, nor surveillance of HCC. Based on the Child-Pugh (CP) classification, the OR increased progressively in CP C patients (OR 1.95; 95% CI 1.08-3.53; P = 0.026). The progressive increase was also found in patients with a higher Barcelona Clinic Liver Cancer stage, and the OR for CP C and D patients were 3.50 (95% CI 1.18-10.38; P = 0.024) and 3.41 (95% CI 1.02-11.41; P = 0.047), respectively. Supportive treatment was the most common treatment modality with an OR of 2.17 (95% CI 1.14-4.16; P = 0.019), and it was associated with the mortality rate of HCC. CONCLUSIONS The CP classification, Barcelona Clinic Liver Cancer staging system, and treatment modality might predict mortality in patients with HCC. Moreover, other parameters must be further evaluated.
Collapse
MESH Headings
- Adult
- Aged
- Carcinoma, Hepatocellular/diagnosis
- Carcinoma, Hepatocellular/mortality
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/therapy
- Chemoembolization, Therapeutic/statistics & numerical data
- Female
- Follow-Up Studies
- Hepatectomy/statistics & numerical data
- Hepatitis B, Chronic/diagnosis
- Hepatitis B, Chronic/epidemiology
- Hepatitis B, Chronic/pathology
- Hepatitis B, Chronic/therapy
- Hepatitis C, Chronic/epidemiology
- Hepatitis C, Chronic/pathology
- Hepatitis C, Chronic/therapy
- Hepatitis C, Chronic/virology
- Humans
- Indonesia/epidemiology
- Kaplan-Meier Estimate
- Liver/pathology
- Liver/surgery
- Liver/virology
- Liver Cirrhosis/diagnosis
- Liver Cirrhosis/epidemiology
- Liver Cirrhosis/pathology
- Liver Cirrhosis/therapy
- Liver Neoplasms/diagnosis
- Liver Neoplasms/mortality
- Liver Neoplasms/pathology
- Liver Neoplasms/therapy
- Male
- Middle Aged
- Neoplasm Staging
- Palliative Care/statistics & numerical data
- Radiofrequency Ablation/statistics & numerical data
- Registries/statistics & numerical data
- Retrospective Studies
- Risk Assessment/statistics & numerical data
- Risk Factors
- Severity of Illness Index
- Sorafenib/administration & dosage
- Treatment Outcome
Collapse
Affiliation(s)
- Chyntia Olivia Maurine Jasirwan
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
| | - Irsan Hasan
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Andri Sanityoso Sulaiman
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Cosmas Rinaldi A Lesmana
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Juferdy Kurniawan
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Kemal Fariz Kalista
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Saut Horas Nababan
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Rino Alvani Gani
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| |
Collapse
|
8
|
Kerdsuknirun J, Vilaichone V, Vilaichone RK. Risk Factors and Prognosis of Spontaneously Ruptured Hepatocellular Carcinoma in Thailand. Asian Pac J Cancer Prev 2018; 19:3629-3634. [PMID: 30583692 PMCID: PMC6428545 DOI: 10.31557/apjcp.2018.19.12.3629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: Hepatocellular carcinoma (HCC) is the fatal cancer worldwide. Spontaneously Rupture remains important complication of HCC. The incidence of spontaneous HCC rupture was high in ASEAN but limited studies were reported. The aim of this study was to evaluate predictors and overall survival of ruptured HCC in tertiary care center in Thailand. Methods: We conducted a retrospective cohort study of HCC patients aged ≥15 years old during January 2012-January 2016 and followed up through June 2016 at Thammasat University Hospital, Thailand. All clinical information, laboratory and radiologic findings were collected from reviewing computer data base of medical records. Results: 333 patients had completely retrievable information. Of which, 51patients (15.3%) had spontaneous ruptured HCC. Clinical symptoms with abdominal discomfort and anemic symptoms were significantly higher in ruptured than non-ruptured HCC groups. (76.47% vs.39.36%: p<0.001, 13.73vs.0.71%, p<0.001). Furthermore, size of tumors, presences of metastasis and serum AFP>200 ng/mL were significantly higher in ruptured than non-ruptured HCC groups (10.29cm. vs. 6.47cm. p<0.001, 17.65% vs. 8.16%, p=0.034, 60.78% vs. 36.88%, p=0.001, respectively). In multivariate analysis, age, abdominal discomfort, anemic symptoms, Child-Pugh score>6 were independent risk factors of HCC rupture (OR=0.96, 95%CI=0.93-0.99, p=0.02; OR=3.47, 95%CI=1.26-9.6, p=0.016; OR=54.51, 95%CI=7.09-418.89, p<0.001; OR=2.62, 95%CI=1.09-6.31, p=0.031, respectively). 1-year and 2-year survival rates of ruptured HCC were 66.9% and 44.6% respectively. Conclusions: Age, abdominal discomfort, anemic symptoms and Child-Pugh score>6 might be predictive factors of spontaneous ruptured HCC. Ruptures of HCC remained a fatal disease with poor survival rate in Thailand. Appropriate treatment in early stage could be effective tool to improve the treatment outcomes
Collapse
Affiliation(s)
- Jitrapa Kerdsuknirun
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand.
| | | | | |
Collapse
|
9
|
Kerdsuknirun J, Vilaichone V, Vilaichone RK. Clinical Outcome and Predictive Factors of Variceal Bleeding in Patients with Hepatocellular Carcinoma in Thailand. Asian Pac J Cancer Prev 2018; 19:3301-3305. [PMID: 30486641 PMCID: PMC6318381 DOI: 10.31557/apjcp.2018.19.11.3301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective: Hepatocellular carcinoma (HCC) is common cancer in ASEAN. Variceal bleeding (VB) is considered to be fatal complication of cirrhosis with HCC. However, limited studies were reported in ASEAN. Aim of this study was to evaluate overall survival rate and predictors of VB in HCC patients. Methods: We conducted a retrospective cohort study of HCC patients aged ≥15 years between January 2012-January 2016 and follow up through June 2016 at Thammasat University Hospital, Thailand. Clinical information and radiologic findings were collected from reviewing computer database of medical records. Results: 333 patients had completely retrievable information. Of which, 27 patients (8.1%) had documented with VB. Clinical presentations with weight loss and jaundice were higher in VB than non-VB groups (40.74% vs. 34.64%, p=0.525 and 7.41% vs. 2.29%, p=0.116) but the differences were not significant. The most common causes of cirrhosis in HCC patients with VB were chronic HBV infection (55.56%). In multivariate analysis; presence of ascites, Child-Pugh score>6, presence of varices were independent risk factors of having VB in HCC patients (OR=7.59, 95%CI=1.13-50.88, p=0.037; OR=5.07, 95%CI=1.08-23.76, p=0.039; OR=23.51, 95%CI=4.71-117.35, p<0.001, respectively). In HCC patients with VB, 1-year and 2.5-year survival rates were 56.6% and 28.3%. Conclusions: HCC patients with ascites, Child-Pugh score>6 and presence of varices might be important predictive factors of VB. Having VB were greatly impact to the survival rate of HCC patients. Clinical suspicion and regular surveillance of VB in HCC patients at risk could improve treatment outcomes.
Collapse
Affiliation(s)
- Jitrapa Kerdsuknirun
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand.
| | | | | |
Collapse
|
10
|
Makvandi M, Soleimani Jelodar R, Samarbafzadeh A, Neisi N, Sharifi Z, Gholampour A, Masjedizadeh A, Shayesteh A. Natural History of Chronic Hepatitis B Virus Infection in Ahvaz City, Iran. Asian Pac J Cancer Prev 2018; 19:2125-2129. [PMID: 30139211 PMCID: PMC6171397 DOI: 10.22034/apjcp.2018.19.8.2125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Objective: A long persistent of Chronic Hepatitis B (CHB) infection may develop liver cirrhosis or hepatocellular
carcinoma (HCC) and about one million people die due to HBV -related liver cancer and end-stage liver disease annually
worldwide. The natural history of CHB phases comprises four phases: immune tolerant (HBeAg detectable and ALT
(Alanine Transaminase) normal, HBeAg-positive immune active (HBeAg detectable, anti-HBe antibodies undetectable
and ALT persistently elevated), HBeAg-negative immune active (HBeAg undetectable, anti-HBe antibodies present
and ALT persistently elevated), inactive carrier (HBeAg undetectable, anti-HBe antibodies present and ALT normal).
The evaluation of chronic hepatitis B phases is a crucial to manage the burden of disease and limit the development
of associated complications, such as cirrhosis and hepatocellular carcinoma (HCC). Thus this study conducted to
evaluate the natural history of HBV infection in patients with chronic HBV infection in Ahvaz city, Iran. Methods: In
this study, 71 non-treated CHB individuals were recruited including 44 (62%) males and 27(38%) females. The sera
were tested for HBV markers, HBsAg, HBcIgG, HBeAg, and HBeAb. ALT assay and HBV viral load were carried out
for each CHB individual. Results: Based on the analysis of serological, ALT status and viral load, the results showed:
immune tolerance 5(7%), eAg+ Immune Clearance 14(19.7%), eAg- Immune Clearance 29 (40.84%) and Inactive
Carrier 23 (32.39%). The HBeAg seroconversion was observed in a male age 18 year. Conclusion: The results of
the natural history of individuals with chronic hepatitis B phases CHB shows immune tolerance (7%), eAg+ Immune
Clearance (19.7%), eAg- Immune Clearance (40.84%) and Inactive Carrier (32.39%). To prevent the consequence of
CHB infection, an individual in immune tolerance phase should be tested periodically for ALT level, HBV markers,
HBsAg, HBcIgG, HBeAg, HBeAb and HBV viral load. Then decision-making therapy can be applied for CHB patients
at early stage of immune clearance.
Collapse
Affiliation(s)
- Manoochehr Makvandi
- Infectious and Tropical Disease Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Virology Department, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | | | | | | | | | | | | | | |
Collapse
|