scholarly journals Predictors of residual hepatic reserve and hepatic decompensation in cirrhotic patients after ablated hepatocellular carcinoma treated by DDAs or systemic therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Amr Shaaban Hanafy ◽  
Mohamed Sorour Mohamed ◽  
Mohamed Abu Taleb ◽  
H. M. Mohammed ◽  
Tarek M. H. Ibrahim ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systemic Therapy ◽  
Complete Blood Count ◽  
Liver Volume ◽  
Liver Stiffness ◽  
Unfavorable Outcome ◽  
Control Group ◽  
Hepatic Decompensation ◽  
Hepatic Reserve ◽  
Cirrhotic Patients

Abstract Background Therapeutic interventions for hepatocellular carcinoma (HCC) particularly in patients with advanced liver disease may lead to more aggravation of clinical and biochemical parameters of liver functions. We aimed to assess the utilization of easily applied variables which evaluate residual hepatic reserve to predict liability for complications and hepatic decompensation in cirrhotic patients with ablated HCC particularly when these patients were exposed to specific medical treatment such as DAAs and systemic therapy for HCC such as sorafenib. This study included 3 groups with HCC. Group 1: patients with ablated HCC and Child-Turcotte-Pugh (CTP) class A, who received Sofosbuvir (SOF)-based treatment (n = 250), group 2: HCC patients CTP (A), managed with sorafenib after transarterial chemoembolization (TACE) (n = 250) and group 3 as a control group of non-cirrhotic patients (n = 176). Evaluation for all patients was done by routine laboratory investigations including liver and kidney functions, complete blood count, platelet indices and plasma ammonia, upper gastrointestinal (GI) endoscopy and estimation of liver volume by ultrasound and liver stiffness (LS) by Fibroscan. Results Unfavorable outcome and increased incidence of complications during DAAs were independently associated with severity of thrombocytopenia (p = 0.001) at a cut-off 78,000/μl, LS > 20 kPa (p = 0.001), liver volume < 500 ml (p = 0.002), and gamma globulin levels > 4 gm/dl (p = 0.004). In the sorafenib group, unfavorable outcome and complications were independently associated with PDW/MPV ratio > 2.74 (p = 0.001), level of ammonia > 87 μg/dl (p = 0.001), LS > 25 kPa (p = 0.001), and liver volume < 490 ml (p = 0.001). Conclusion Non-invasive parameters of residual hepatic reserve are promising tools to guide therapy and avoid further complications in patients with liver cirrhosis and ablated HCC.

scholarly journals Significance of Liver Size in Hepatic Surgery

HPB Surgery ◽  
1997 ◽  
Vol 10 (4) ◽  
pp. 195-200 ◽  
Author(s):  
K. Yanaga ◽  
H. Honda ◽  
Y. Ikeda ◽  
A. T. Nishizaki ◽  
K. Yamamoto ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Body Weight ◽  
Liver Volume ◽  
Functional Reserve ◽  
Liver Size ◽  
Hepatic Reserve ◽  
Preoperative Serum ◽  
Hepatic Atrophy ◽  
Cirrhotic Patients

The purpose of this study was to evaluate the significance of liver volumetry as a parameter for hepatic functional reserve in cirrhotic patients with hepatocellular carcinoma. Liver volume was calculated from preoperative computed tomograms of 44 cirrhotic patients who underwent elective hepatic resections for hepatocellular carcinoma.The liver volume per body weight of non-alcoholic cirrhotics was significantly smaller than that of alcoholic cirrhotics (20.9 vs. 26.7 cc/kg; p=0.03). The values for alcoholic cirrhotics was comparable with normal values. The liver volume per body weight of the cirrhotic patients demonstrated correlation with the preoperative serum albumin (p<0.01) and indocyanine green clearance (p=0.02). We conclude that the determination of hepatic atrophy by volume try can serve as a parameter for the assessment of hepatic reserve but not as a predictor of postoperative complications in elective liver surgery for cirrhotic patients.

Spleen Stiffness Measurements Predict the Risk of Hepatic Decompensation After Direct-Acting Antivirals in HCV Cirrhotic Patients

2020 ◽  
Author(s):  
Elton Dajti ◽  
Federico Ravaioli ◽  
Antonio Colecchia ◽  
Giovanni Marasco ◽  
Maria Letizia Bacchi Reggiani ◽  
...  
Keyword(s):  
Protective Factor ◽  
Control Group ◽  
Direct Acting Antivirals ◽  
Hepatic Decompensation ◽  
Weighting Method ◽  
Historical Cohort ◽  
Tertiary Center ◽  
Cirrhotic Patients ◽  
Direct Acting ◽  
Noninvasive Tests

Abstract Purpose Little evidence is available regarding the risk of hepatic decompensation (HD) after direct-acting antivirals (DAAs) in patients with advanced chronic liver disease. Our aim was to assess the risk of decompensation and the prognostic role of noninvasive tests, such as liver (LSM) and spleen (SSM) stiffness measurements, in the prediction of decompensation after sustained virologic response (SVR) by DAAs. Materials and Methods A cohort study involving 146 cirrhotic patients treated with DAAs in our tertiary center with LSM and SSM available both before and six months after treatment (SVR24). A historical cohort of 92 consecutive cirrhotic patients with active HCV was used as a control group. A propensity score inverse probability weighting method was used to account for differences between the groups. Time-dependent models for the prediction of decompensation were applied to account for changes in noninvasive tests after therapy. Results The decompensation incidence in the DAA cohort was 7.07 (4.56–10.96) per 100 person-years (PYs), which was significantly lower than in the active HCV cohort. The DAA therapy was an independent protective factor for HD development (SHR: 0.071, 95 %-CI: 0.015–0.332). SSM ≥ 54 kPa was independently associated with decompensation despite SVR achievement (SHR: 4.169, 95 %-CI: 1.050–16.559), alongside with a history of decompensation (SHR: 7.956, 95 %-CI: 2.556–24.762). SSM reduction < 10 % also predicted the risk of decompensation after SVR24. Conclusion The risk of decompensation was markedly reduced after DAA therapy, but it was not eliminated. Paired SSM values stratified the risk of decompensation after SVR better than other noninvasive tests.

scholarly journals Prediction of esophageal varices in liver cirrhosis by transient elastography and aspartate aminotransferase - to - platelet ratio index (APRI)

2018 ◽  
Vol 6 (1) ◽  
pp. 16-21
Author(s):  
Debashis Kumar Sarkar ◽  
Golam Azam ◽  
Majharul Haque ◽  
Anisur Rahman
Keyword(s):  
Liver Cirrhosis ◽  
Complete Blood Count ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Variceal Hemorrhage ◽  
Cutoff Value ◽  
Liver Injuries ◽  
Cirrhotic Patients ◽  
Cirrhosis Of Liver ◽  
Almost All

Background: Cirrhosis is a chronic liver disease that can be caused by almost all progressive liver injuries, such as viral, autoimmune, hereditary, metabolic and toxin mediated liver diseases. Esophageal varix (EV) is a frequent complication of cirrhosis. Although the survival rate of patients with bleeding cirrhosis has improved because of the progress in variceal hemorrhage management, the hospital mortality rate is still around 14.5% cases. Early detection of EV in all patients with liver cirrhosis is required in order to reduce the mortality.Method: This observational study was done at department of Gastrointestinal, Hepatobiliary & Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka, during the period of August 2015 to October 2016. A total of 65 patients with cirrhosis of liver were included. Complete blood count, liver function test, endoscopy of upper GIT, ultrasonography, transient elastogram were done for all patients. Statistical analysis was done with SPSS version 22.Result: The study included 65 cirrhotic patients, among them 66.2 % were male. The mean age was 53.8 years. For predicting EVs, transient elastography at a cutoff value of 18 kpa demonstrated a sensitivity was 88.7% (95% CI=82.3-92.7), specificity 75.0% (95% CI=46.9-92.6), PPV 94.0% (95% CI=87.2-98.2), NPV 60.0% (95% CI= 37.5 -74.0), AUC was 0.769. In APRI for prediction of EVs at cutoff value 1.00, sensitivity was 63.3% (95% CI=55.6-65.4), specificity 83.3.0% (95% CI=53.7-97.0), PPV 94.3% (95% CI=84.1-99.0), NPV 33.3% (95%CI=21.5-38.8) and AUC was 0.779.Conclusion: A significant positive correlation found between transient elastography with EVs in cirrhotic patients. Liver stiffness value at 18 Kpa can predict EVs in cirrhotic patients. On contrary, APRI had a less(negative predictive value) NPV that showed there is no satisfactory cutoff value for APRI to be used as a predictor of EVs.Bangladesh Crit Care J March 2018; 6(1): 16-21

Natural history of T1N0M0 hepatocellular carcinoma: Large scale study in the United States.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 416-416
Author(s):  
Humaid Obaid Al-Shamsi ◽  
Reham Abdel-Wahab ◽  
Manal Hassan ◽  
Gehan Botrus ◽  
Ahmed S Shalaby ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systemic Therapy ◽  
Cox Regression ◽  
Univariate Analysis ◽  
The United States ◽  
Categorical Variables ◽  
Cancer Center ◽  
Female Ratio ◽  
Cox Regression Analysis ◽  
Hepatic Reserve

416 Background: Prognostic modeling of hepatocellular carcinoma (HCC) is complex due to preexisting cirrhosis in most cases. Tumor features and factors related to functional hepatic reserve must be taken into account when considering treatment options or counseling patients about their survival. The key prognostic factors may vary at different stages of the disease especially for early stage. Methods: From 1992 to 2011 total of 397 HCC patients with T1N0M0 were referred to MD Anderson Cancer Center for treatment. Detailed clinical-pathologic information were retrieved from medical records. Univariate analysis was done using the c2or Fisher’s exact test for categorical variables. Kaplan-Meier used to estimate the median overall survival (OS). Multivariate cox regression analysis was performed to estimate the hazard ratio (HR) and 95% confidence interval (CI). Results: The male to female ratio was3:1. The mean age ± standard deviation was 65.04 ± 12.5, 57.2% were non-viral related, 59.7% had cirrhosis, and 9.3% had poorly differentiated tumor (PDT). Median OS (95% CI) was 28.5 months (23.6 – 33.4). First line therapy is summarized in table 1. Surgical intervention was similar to systemic therapy with 76% reduction in mortality compared to non-treated group. Restricted analysis among cirrhotic patients showed similar results. PDT was associated with significant poor prognosis compared to well-differentiated tumor, HR (95% CI) was 2.42 (1.36-4.28) after adjustment for demographic, epidemiological, and clinical factors. Conclusions: Our results indicate that T1N0M0 HCC patients have similar outcome with systemic therapy and surgery which could be beneficial for patients with underlying cirrhosis and high risk of postsurgical complications. [Table: see text]

Incidence and significance of hepatitis B e antigen and antibody in postnecrotic cirrhosis and primary hepatocellular carcinoma

1978 ◽  
Vol 7 (4) ◽  
pp. 394-395
Author(s):  
P Coursaget ◽  
P Maupas ◽  
A Goudeau ◽  
J Drucker
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatitis B ◽  
Blood Donors ◽  
Primary Hepatocellular Carcinoma ◽  
Control Group ◽  
Serological Markers ◽  
Hepatitis B E Antigen ◽  
B Virus ◽  
Postnecrotic Cirrhosis ◽  
Cirrhotic Patients

A study of the serological markers of Hepatitis B virus (HBV) including e antigen (HBe Ag) and antibody against HBe Ag (anti-HBe) was performed in Senegalese patients suffering from cirrhosis and primary hepatocellular carcinoma, and in a control group (blood donors). It was not possible to diagnose additional HBV infections in primary hepatocellular carcinoma patients using HBe Ag or anti-HBe Ab alone as serological markers. The lower prevalence of HBe Ag among primary hepatocellular carcinoma patients as compared with cirrhotic patients suggests that active replication of HBV becomes increasingly defective during the course of the malignant process.

Evaluation of Serum voltage gated calcium channel α2δ1 as a novel Marker for diagnosis of Hepatocellular Carcinoma in Cirrhotic Egyptian Patient

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Essam Mohammed Bayoumi ◽  
Ahmed El Saady Mohamed ◽  
Ahmed El Metwally Ahmed ◽  
Al Saied Al Saied Al Refaey
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Calcium Channel ◽  
Liver Tumors ◽  
Control Group ◽  
Voltage Gated ◽  
Group A ◽  
Cirrhotic Patients ◽  
Voltage Gated Calcium Channel ◽  
Group B

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver tumor and represents the third-leading cause of cancer-related death in the world. The incidence of HCC continues to increase worldwide, with a unique geographic, age, and sex distribution. The most important risk factor associated with HCC is liver cirrhosis, with the majority of cases caused by chronic infection with hepatitis B (HBV) and C (HCV) viruses and alcohol abuse, although nonalcoholic fatty liver disease is emerging as an increasingly important cause. Primary prevention in the form of HBV vaccination has led to a significant decrease in HBV-related HCC, and initiation of antiviral therapy appears to reduce the incidence of HCC in patients with chronic HBV or HCV infection. Additionally, the use of ultrasonography enables the early detection of small liver tumors and forms the backbone of recommended surveillance programs for patients at high risk for the development of HCC. Cross-sectional imaging studies, including computed tomography and magnetic resonance imaging, represent further noninvasive techniques that are increasingly employed to diagnose HCC in patients with cirrhosis. The mainstay of potentially curative therapy includes surgery – either resection or liver transplantation. However, most patients are ineligible for surgery, because of either advanced disease or underlying liver dysfunction, and are managed with locoregional and/or systemic therapies. Randomized controlled trials have demonstrated a survival benefit with both local therapies, either ablation or embolization, and systemic therapy in the form of the multikinase inhibitor sorafenib. Despite this, median survival remains poor and recurrence rates significant. Further advances in our understanding of the molecular pathogenesis of HCC hold promise in improving the diagnosis and treatment of this highly lethal cancer. Objectives Evaluation of Serum voltage gated calcium channel α2δ1 as a novel Marker for diagnosis of Hepatocellular Carcinoma in Cirrhotic Egyptian Patients. Patients and Methods This study had been carried out on 90 subjects, age range 21-73 year selected from Internal medicine and Hepatology outpatient clinics and inpatient wards at Ain shams university hospitals. Subjects were divided as follow: Group A(Case): 40 patients with liver cirrhosis without Hepatocellular carcinoma and group B (Control): 40 patients with liver cirrhosis and Hepatocellular carcinoma and group C: 10 normal population for detecting normal value of the marker with exclusion criteria including age &lt; 18 years old and Patients diagnosed with malignancy other than HCC. Results The study subjects are classified into three groups: Group A cirrhotic patients without HCC, Group B cirrhotic patients with HCC and Group C normal individual subjects. Conclusion Serum voltage gated calcium channel levels were significantly higher in patients with HCC and mildly elevated in patients with liver cirrhosis compared to the control group. Thus it can be used as a tumor marker for HCC.

scholarly journals Cirrhosis aggravates the ninety-day mortality after liver resection for hepatocellular carcinoma

2019 ◽  
Vol 6 (8) ◽  
pp. 2869
Author(s):  
Hosam Farouk Abdelhameed ◽  
Ashraf M. El-Badry
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Hospital Mortality ◽  
Postoperative Mortality ◽  
University Hospital ◽  
Control Group ◽  
Complication Rates ◽  
Hospital Stays ◽  
Cirrhotic Patients ◽  
Prolonged Hospital

Background: Ninety-day postoperative mortality (90-D POM) measures accurately the liver resection-related mortality. In cirrhotic patients, reporting post-hepatectomy-related death only as in-hospital or thirty-day postoperative mortality (30-D POM) may underestimate cirrhosis-related death after liver resection.Methods: Medical records of adult cirrhotic (cirrhosis group) and matched non-cirrhotic (control group) patients, who underwent elective liver resection at Sohag University Hospital (April 2014- March 2018), were analyzed. The 90-D POM versus in-hospital mortality and 30-D POM were compared in both groups.Results: Forty-six patients (23 per group) were eligible for the study. Liver resection was carried out in all cirrhosis group patients for hepatocellular carcinoma (HCC). In the control group, liver resection was indicated for colorectal metastasis (13), benign masses (7) and intrahepatic cholangiocarcinoma (3). Compared with the control group, cirrhotic patients exhibited significantly higher complication rates (p<0.05), prolonged hospital stays (p<0.05), increased postoperative levels of serum bilirubin and reduced prothrombin concentration (p<0.05). In the control group, in-hospital mortality and 30-D POM were zero while 90-D POM was 4%. In the cirrhosis group, the in-hospital mortality and 30-D POM were identical (8.7%), however the 90-D POM was significantly higher and almost doubled (17%). Conclusion: Liver cirrhosis triggers significant mortality that may extend for ninety days postoperatively. In cirrhotic patients, post-hepatectomy death should be reported as 90-D POM rather than the obviously misleading in-hospital mortality or 30-D POM.

Improved survival following transarterial radioembolization of infiltrative-appearance hepatocellular carcinoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15591-e15591
Author(s):  
Michael J Nisiewicz ◽  
Reema Anil Patel ◽  
Adam J Dugan ◽  
Joseph W Owen
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Systemic Therapy ◽  
Treatment Guidelines ◽  
International Normalized Ratio ◽  
Hazard Ratio ◽  
Control Group ◽  
Transarterial Radioembolization ◽  
Pugh Class ◽  
The Mean

e15591 Background: Infiltrative-appearance hepatocellular carcinoma (IHCC), also known as diffuse HCC, presents a distinct challenge to clinicians as evidence-based treatment guidelines have yet to be established. While transarterial radioembolization (TARE) has shown efficacy in HCC, many studies exclude IHCC in their analysis. The purpose of this study was to evaluate whether TARE of IHCC improves survival. Methods: With IRB approval, patients with IHCC were identified. Patient were divided into two groups: TARE versus systemic therapy/palliative care. Demographics, date of diagnosis, date of expiry, albumin, international normalized ratio (INR), sodium, alpha-fetoprotein (AFP), creatinine, Child-Pugh class, model for end-stage liver disease (MELD) score, and bilirubin were collected. Patients with bilirubin >3 were excluded. Mann-Whitney U test and Fisher’s exact test assessed for differences between groups. Kaplan-Meier survival analysis and Cox proportional hazard analysis were performed. Results: Forty-one patients were identified, 10 underwent TARE while the remaining 31 served as a control. Mean age was 62, 30 patients were male. The mean overall survival of the TARE treatment group was 16.6 months (506 days) and the mean overall survival of the control group was 5.6 months (170 days) (Log-rank p < 0.004), with a combined overall survival of 8.5 months (259 days). Cox proportional regression analysis revealed statistically significant associations between survival and albumin (hazard ratio 0.12, 0.032-0.41, p < 0.001), Child-Pugh class B (hazard ratio 0.25, 0.064-0.941, p < 0.041), and sorafenib therapy (hazard ratio 0.246, 0.071 – 0.847, p < 0.026). Conclusions: Transarterial radioembolization for patients with IHCC improves life expectancy compared to treatment with comfort measures or systemic therapy.[Table: see text]

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