Impact of diabetes mellitus on the prognosis of patients with hepatocellular carcinoma
Hidenori ToyodaTakashi KumadaSatoshi NakanoIsao TakedaKei‐ichi SugiyamaSeiki KiriyamaMakoto TanikawaYasuhiro SoneYasuhiro Hisanaga
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BACKGROUND The majority of patients with hepatocellular carcinoma (HCC) have coexisting cirrhosis or chronic hepatitis, often complicated by diabetes mellitus. In the current study, the authors evaluated the impact of diabetes mellitus on the prognosis of patients with HCC. METHODS Among 581 patients with HCC who had been diagnosed and treated between 1990 and 1999, survival was compared between those patients with and those patients without diabetes mellitus. The rate of disease recurrence after treatment also was analyzed. RESULTS Ninty-two patients (15.8%) had diabetes mellitus. There was no significant difference with regard to patient characteristics (i.e., age, gender, or alcohol intake) or liver function between those patients with and those patients without diabetes mellitus. No differences were observed in survival between patients with diabetes mellitus and patients without it. Among the 195 patients with a solitary HCC lesion measuring ≦ 3 cm in greatest dimension, the survival of the 32 patients with diabetes mellitus was significantly poorer than that of the 163 patients without diabetes mellitus (P = 0.0273), despite no apparent difference in liver function between the 2 groups. On multivariate analysis, diabetes mellitus was found to be an independent factor predicting lower survival after treatment (P = 0.0077) among patients with a solitary HCC lesion measuring ≦ 3 cm in greatest dimension. No difference in the rate of recurrence was observed between the two groups in all the patients and in those patients with a solitary HCC lesion measuring ≦ 3 cm in greatest dimension. CONCLUSION The results of the current study indicated that the presence of diabetes mellitus worsens the prognosis of patients with a solitary HCC lesion measuring ≦ 3 cm in greatest dimension; it appears to impact prognosis in patients with HCC when HCC is treatable, based on the size and the number of lesions. However, diabetes mellitus did not appear to affect the prognosis in the general population of patients with HCC. Based on the current study data, diabetes mellitus does not appear to modify the progression of HCC and its recurrence after treatment, but it does appear to worsen the prognosis of patients with HCC by means of a rapid decline in remnant liver function caused by repeated treatment of HCC. Cancer 2001;91:957–63. © 2001 American Cancer Society.Keywords:
Liver function
The present studt was completed to assess the clinical utility of B protein, as a tumor marker of hepatocellular carcinoma. The association of B protein and liver cirrhosis was also evaluated because hepatocellular carcinoma is usually combined with cirrhosis. The serum levels of B protein were studied by a Latex-agglutination test. One hundred and twenty-nine patients including 23 hepatocellular carcinoma, 50 hepatocellular carcinoma combined with liver cirrhosis, 40 liver cirrhosis, and 16 chronic hepatitis were tested. The positive rates of B protein in various diseases were as follows: 30.4% (7/23) in patients with hepatocellular carcinoma; 68.6% (35/50) in patients with hepatocellular carcinoma combined with cirrhosis; 82.5% (33/40) in patients with cirrhosis; and 62.5% (10/16) in patients with chronic hepatitis. When B protein was used as a tumor marker of hepatocellular carcinoma, the sensitivity (57.5%) and specificity (25%) were very low. Furthermore, patients with hepatocellular carcinoma, usually combined with cirrhosis; which carried the highest positive rate on B protein determination. This also limited clinical utilization of B protein as a tumor marker of hepatocellular carcinoma. Moreover, there was no correlation of B protein with the serum alpha-fetoprotein level or tumor size. On the contrary, positive correlation of the B protein level with Child's staging (Tau-c value = 0.392, p = 0.008), and death during follow-up (Tau-c value = 0.456, p = 0.021), were discovered in patients with cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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We have measured the serum erythropoietin concentrations in 14 patients with liver cirrhosis and in 14 patients with a hepatocellular carcinoma. Among these patients, 2 with liver cirrhosis (14.3%) and 7 with a hepatocellular carcinoma (50.0%) were found to have raised serum erythropoietin concentrations, ranging up to 40 mU/ml. Negative correlations were found between erythropoietin and the RBC, and the Hb and Ht in the cases with liver cirrhosis. In contrast, a positive correlation which was not significant was found only between the erythropoietin and the RBC in cases involving a hepatocellular carcinoma. This has suggested that the relationship between the erythropoietin and the RBC in cases of a hepatocellular carcinoma differs from the relationship seen under the usual physiological circumstances of those with liver cirrhosis.
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In a retrospective study, 42 out of 44 cases of hepatocellular carcinoma were investigated immunohistochemically for chronic hepatitis B infection. Surface antigen was found in the liver tissue of only 4 of these cases. In 41 of the patients, mildly to moderately active cirrhosis of the liver was found to be underlying the carcinoma. The age distribution and case histories showed that hepatocellular carcinoma often developed from low-complication cirrhosis of long standing and of various etiologies, and must thus be considered a late complication of cirrhosis.
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Objective To investigate the expression and relationship of TRA1 mRNA among hepatocellular carcinoma,liver cirrhosis and normal liver tissues. Methods RT-PCR was used to detect the expression of TRA1 mRNA in 34specimens of hepatocellular carcinoma,liver cirrhosis and normal liver tissues. Results The expression rates of TRA1in hepatocellular carcinoma,liver cirrhosis and normal liver tissues were 95. 00%,84. 21% and 50. 00%,respectively,there were significant differences between hepatocellular carcinoma and normal liver tissues(P 0. 05),but no significant differences between liver cirrhosis and normal liver tissues(P 0. 05). The expression levels of TRA1 mRNA were 1. 67 ± 0. 96,1. 49 ± 0. 53,0. 57 ± 0. 27,respectively,which was significantly higher in hepatocellular carcinoma and liver cirrhosis tissues than that in normal liver tissues(P 0. 05). Conclusion TRA1 mRNA is involved in the progression of hepatocellular carcinoma and liver cirrhosis,and it may be a potential biomarker for diagnosis and target for therapy.
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Abstract: Thrombopoietin (TPO) can improve liver regeneration and fibrosis. We report on a patient with liver cirrhosis who received treatment with TPO to improve liver function. An 82-year-old male had liver cirrhosis with ascites due to hepatitis C virus infection. The Child–Pugh classification was Child B. The patient received human recombinant TPO for 12 months. The platelet counts increased and were maintained at 60–80×109/L. The liver function improved, the ascites resolved, and the liver volume increased. These results indicate that the novel treatment with recombinant human TPO (rhTPO) may be effective for improving liver function in patients with liver cirrhosis.
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Objective To evaluate the diagnostic value of diffusion weighted imaging(DWI) at 3.0 T magnetic resonance in liver cirrhosis and hepatocellular carcinoma.Methods DWI was performed in 10 healthy volunteers,21 patients with liver cirrhosis and 30 patients with hepatocellular carcinoma at 3.0T magnetic resonance. DWI and ADC values in normal liver, liver cirrhosis and hepatocellular carcinoma were analysed.The diagnostic sensitivity and specificity of ADC values in normal liver, liver cirrhosis and hepatocellular carcinoma were also analysed.Results When b value was 100 s/mm2,the ADC values of normal liver were higher than liver cirrhosis, hepatocellular carcinoma(P0.05),but there was not significance between liver cirrhosis and hepatocellular carcinoma(P0.05).When b value was 300 s/mm2,1000 s/mm2,the ADC values of three groups had significant differences(P0.01). When b value was 300 s/mm2, the diagnostic sensitivity and specificity were 82.6% and 100% in liver cirrhosis ,95.2% and 90.4% in hepatocellular carcinoma ,respectively. When b value was 1000 s/mm2, the diagnostic sensitivity and specificity of ADC values were 86.9% and 100% in liver cirrhosis,95.2% and 66.7% in hepatocellular carcinoma,respectively. Conclusion DWI at 3.0 T magnetic resonance in examination of liver could synthetically and quantitatively analyze the rule of ADC values in liver cirrhosis and hepatocellular carcinoma.
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Objective To observe the clinical effect of hyperbaric oxygenation(HBO) on liver cirrhosis.Methods 86 patients with liver cirrhosis were divided into a HBO group(46 cases)and a control group(40 cases)based on the mated principle of patients conditions.The indices of liver function and fibrotic serology of liver cirrhosis and the changes of B type ultrasound images of portal vein and spleen before and after respective treatment were compared.Results The improvement of liver function(TBil,ALT,ALB)and indices of fibrotic serology of liver cirrhosis(HA,PCIII,ⅣC,LN),and also the decrease of portal vein width and spleen thickness were all more significant in the HBO group than that in the control group.Conclusions Hyperbaric oxygenation could be a useful method for treating patients with liver cirrhosis.
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Application of Hepatocyte-Specific MR Contrast Agent Gd-EOB-DTPA in the Evaluation of Liver Function
Objective To discuss the clinical application of liver signal intensity after the injection OF hepatocyte-specific MR contrast agent Gd-EOB-DTPA in assessing liver function. Methods Enhanced MRI using Gd-EOB-DTPA as contrast agent was performed in 31 patients with non-liver cirrhosis and 49 with liver cirrhosis. The 49 liver cirrhosis patients were classified by Child-Pugh grading. The differences in signal intensity were statistically compared between the liver cirrhosis group and the non-liver cirrhosis group,as well as between the different Child-Pugh classes in the liver cirrhosis group. Results Statistically significant differences in liver signal intensity existed between non-liver cirrhosis group and liver cirrhosis group; statistically significant differences in liver signal intensity also existed between each other among Child-Pugh class A,B and C. The liver signal intensity was negatively correlated with the Child-Pugh class. Conclusion Liver signal intensity on Gd-EOB-DTPA enhanced MRI can reflect the hepotocyte function. Enhanced MRI using GdEOB-DTPA as contrast agent is expected to be a reliable method for the evaluation of liver function.
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Grading (engineering)
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