Takamasa Ohki - Academia.edu (original) (raw)

Papers by Takamasa Ohki

Research paper thumbnail of W1789 Risk Factors for Hemorrhagic Complications After Radiofrequency Ablation Therapy for Liver Tumors

Gastroenterology, May 1, 2009

A S L D A b st ra ct s insufficiency in 2 and liver abscess in 3 patients). A post-embolization s... more A S L D A b st ra ct s insufficiency in 2 and liver abscess in 3 patients). A post-embolization syndrome was seen in 14%. None of the patients developed liver failure after TACE. Our study shows that TACE is an efficacious and safe therapeutic modality for HCC patients unsuitable for surgical therapy. Tumor stage, degree of liver disease, response to TACE and patients' age were independent risk factors for patient survival.

Research paper thumbnail of W1791 Treatment Response Evaluated By Des-Gamma-Carboxy Prothrombin and Alpha-Fetoprotein L3 Fraction Can Predict Prognosis of Hepatocellular Carcinoma Independently of Radiological Evaluation

Gastroenterology, May 1, 2009

Research paper thumbnail of T1927 Treatment Response Evaluated By Tumor Markers Can Predict Prognosis of Hepatocellular Carcinoma Independently of Radiological Evaluation

Gastroenterology, Apr 1, 2008

Research paper thumbnail of W1770 Radiofrequency Ablation (RFA) in the Treatment of Hepatocellular Carcinoma (HCC): Long-Term Results

Gastroenterology, May 1, 2009

Research paper thumbnail of Characteristics of hepatocellular carcinoma nodules newly detected by computed tomography during arteriography and arterial portography: preliminary report of a randomized controlled trial

Hepatology International, Aug 31, 2011

Research paper thumbnail of Extrahepatic metastasis of hepatocellular carcinoma: incidence and risk factors

Liver International, Aug 15, 2008

Hepatocellular carcinoma (hcc) arising from a hepatic adenoma is a rare phenomenon accounting for... more Hepatocellular carcinoma (hcc) arising from a hepatic adenoma is a rare phenomenon accounting for fewer than 5% of hcc cases; it seldom recurs after resection of the primary tumour. We report a case of extrahepatic metastasis of hcc arising from a hepatic adenoma that presented as a solitary sternal metastasis without any evidence of intrahepatic recurrence. Our patient was initially treated with radiation therapy and bland embolization, without response. Subsequently, the patient developed progressive disease while taking sorafenib. He later received chemotherapy with docetaxel and gemcitabine, with the development of multiple pulmonary and splenic nodules. However, he remained free of intrahepatic recurrence. To the best of our knowledge, this is the first case of extrahepatic metastasis of hcc arising from a hepatic adenoma without evidence of intrahepatic recurrence.

Research paper thumbnail of Treatment Strategy of Hepatocellular Carcinoma

The Japanese journal of gastro-enterology, 2008

Research paper thumbnail of Impact of Obesity and Heavy Alcohol Consumption on Hepatocellular Carcinoma Development after HCV Eradication with Antivirals

Liver Cancer, 2021

Background and Aims: It remains unclear whether obesity increases the risk of hepatocellular carc... more Background and Aims: It remains unclear whether obesity increases the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C who achieved a sustained virological response (SVR) with antiviral therapy. Methods: In this multicenter cohort study, we enrolled patients with chronic hepatitis C who achieved SVR with interferon (IFN)-based therapy (IFN group) or direct-acting antiviral (DAA) therapy (DAA group) between January 1, 1990, and December 31, 2018. The patients underwent regular surveillance for HCC. Cumulative incidence of and the risk factors for HCC development after SVR were assessed using the Kaplan-Meier method and Cox proportional hazard regression analysis, respectively. Results: Among 2,055 patients (840 in the IFN group and 1,215 in the DAA group), 75 developed HCC (41 in the IFN group and 34 in the DAA group) during the mean observation period of 4.1 years. The incidence rates of HCC at 1, 2, and 3 years were 1.2, 1.9, and 3.0%, respectively. Multi...

Research paper thumbnail of Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update

Hepatology international, Jan 15, 2017

There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with... more There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia-Pacific region, where HCC is one of the leading public health problems. Since the "Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines" meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia-Pacific region, which has a diversity of medical environments.

Research paper thumbnail of Comparison of Liver Biopsy and Transient Elastography based on Clinical Relevance

Canadian Journal of Gastroenterology, 2008

BACKGROUND: Liver stiffness measurement (LSM) by transient elastography has recently been validat... more BACKGROUND: Liver stiffness measurement (LSM) by transient elastography has recently been validated for the evaluation of liver fibrosis in chronic liver diseases. The present study focused on cases in which liver biopsy and LSM were discordant.METHODS: Three hundred eighty-six patients with chronic hepatitis C who underwent a liver biopsy between December 2004 and April 2007 were studied. First, the optimal cut-off value of LSM was selected for the determination of cirrhosis based on the receiver operating characteristic curve. Then, the cases in which liver histology and evaluation by LSM were discordant were selected. Laboratory test results such as serum total bilirubin concentration, prothrombin activity, albumin concentration, platelet count and the aspartate aminotransferase to platelet ratio index, together with the presence of esophageal varices, were analyzed.RESULTS: The optimal cut-off value was chosen to be 15.9 kPa for cirrhosis (fibrosis stage [F] 4) determination to ...

Research paper thumbnail of Assessing liver tumor stiffness by transient elastography

Hepatology International, 2007

Background and aims Transient elastography is a novel noninvasive method to assess liver fibrosis... more Background and aims Transient elastography is a novel noninvasive method to assess liver fibrosis by measuring liver stiffness. This study is a first step toward the provision of a noninvasive measurement of hepatic tumor stiffness by transient elastography. Patients and methods Patients with liver tumor larger than 5 cm in diameter and located near the liver surface were enrolled between June 2004 and February 2005. Histology of each tumor was evaluated on ultrasoundguided liver biopsy specimens. Transient elastography (Fibroscan, Echosens, Paris) was used to measure tumor stiffness. Tumor stiffness was measured as follows. First, by using B-mode ultrasound, we searched for the optimal right intercostal position for tumor stiffness measurement while keeping the ultrasound probe and body surface at right angles. Then the vibrator for transient elastography was applied at the same position and angle, and stiffness was measured according to the manufacturer's instruction. Results Tumor stiffness was measured in 40 patients, 17 with hepatocellular carcinoma (HCC), six with cholangiocellular carcinoma (CCC), 16 with metastatic tumors (mostly adenocarcinoma), and one with malignant lymphoma. The median value was 55 kPa in HCC, 75 kPa in CCC, 66.5 kPa in metastatic tumor, and 16.9 kPa in malignant lymphoma. The stiffness value of CCC was significantly higher than that of HCC and metastatic tumors (P = .049). Conclusion We showed that stiffness of liver tumors could be measured with transient elastography. Improvements in the device, such as smaller and variable region of interest of measurement and real-time B-mode display, may ensure wider clinical application.

Research paper thumbnail of Safety and efficacy of lamivudine after radiofrequency ablation in patients with hepatitis B virus-related hepatocellular carcinoma

Hepatology International, 2008

Background Antiviral treatments for hepatitis B virus (HBV) are not established in patients with ... more Background Antiviral treatments for hepatitis B virus (HBV) are not established in patients with HBV-related hepatocellular carcinoma (HCC). Aim To investigate the safety and efficacy of lamivudine (LAM) in patients with HBV-related HCC who were treated with radiofrequency ablation (RFA). Methods RFA-treated patients with HBV-related HCC were retrospectively divided into those who received LAM (LAM group) and those who did not (nontreatment group). The first-year changes in serum alanine aminotransferase (ALT), total bilirubin (TBIL), and albumin (ALB) levels were compared in corresponding subsets based on Child-Pugh classification (Mann-Whitney U test) and between one-to-one matched pairs (Wilcoxon signed rank test), who were selected on the basis of their propensity scores for receiving LAM. Overall and recurrence-free survival was also compared. Results Complete ablation of HCC was achieved in 104 patients with HBV-related HCC between January 2000 and December 2005. LAM was administered to 33 patients after RFA. Serum HBV-DNA became negative by TMA method in 24 (73%) patients. Four patients showed redetection of HBV-DNA with ALT elevation. Subset analysis based on initial Child-Pugh class and paired analysis with matching revealed significant decreases in ALT and bilirubin levels and increases in ALB levels in the first year in the LAM group (DALT =-17, DALB = +0.3, and DTBIL =-0.2) compared with controls (DALT = +5, DALB = ±0.0, and DTBIL = +0.3). Overall survival and recurrence-free survival did not differ between the two groups. No specific adverse effect was observed in the LAM group. Conclusion LAM after RFA for HBV-related HCC was safe and improved liver function. Further studies are needed to evaluate its effect on survival.

Research paper thumbnail of Neoplastic seeding after radiofrequency ablation for hepatocellular carcinoma

American Journal of Gastroenterology, 2008

BACKGROUND: Neoplastic seeding reportedly occurs in up to 12.5% of patients treated with radiofre... more BACKGROUND: Neoplastic seeding reportedly occurs in up to 12.5% of patients treated with radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). The aim of this study is to assess the incidence, risk factors, and prognosis of neoplastic seeding after RFA among a large number of patients with a long-term follow-up. METHOD: From February 1999 to December 2004, 1,031 patients underwent a total of 1,845 treatments with RFA for a total of 3,837 HCC nodules. The following variables were assessed to elucidate the risk factors of neoplastic seeding: age, sex, positivity for viral markers, tumor size, number of tumor nodules, number of RFA sessions, tumor location, percutaneous biopsy prior to RFA, alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP) and lens culinaris agglutinin-reactive fraction of AFP (AFP-L3) levels, and the degree of tumor differentiation. RESULTS: Neoplastic seeding was detected in 33 patients (3.2% per patient) at intervals of 4.8-63.8 (median, 15.2) months after RFA. On multivariate logistic regression analysis, only the poor differentiation degree was associated with the risk of neoplastic seeding (P = 0.012). Of tumor factors, tumor size, and AFP, DCP, and AFP-L3 levels were significantly associated with the poor differentiation degree. The cumulative survival rates 1 and 2 yr after the detection of neoplastic seeding were 86% and 47%, respectively. CONCLUSION: Poor differentiation degree was the risk factor of neoplastic seeding after RFA for HCC. The surrogate markers for poor differentiation degree were larger tumor size and elevated tumor marker levels. Indication for RFA should be carefully considered for HCC patients under these conditions.

Research paper thumbnail of Ultrasound surveillance for early detection of hepatocellular carcinoma among patients with chronic hepatitis C

Research paper thumbnail of Influence of serum HBV DNA load on recurrence of hepatocellular carcinoma after treatment with percutaneous radiofrequency ablation

Background High serum load of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) is a strong ris... more Background High serum load of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) is a strong risk factor of hepatocellular carcinoma (HCC) development, independent of hepatitis B e antigen, serum alanine aminotransferase level, and liver cirrhosis. We evaluated whether serum HBV DNA load is associated with the risk of recurrence of HBV-related HCC treated with radiofrequency ablation (RFA). Methods The study population was 69 consecutive patients with HBV-related HCC treated locally completely with RFA between January 2000 and September 2007. The risk factors for HCC recurrence were analyzed based on laboratory data, including serum HBV DNA load, together with tumor size and number using univariate and multivariate proportional hazard regression analyses. Results HCC recurrence was observed in 42 of 69 patients during the median observation period of 1.5 years. Cumulative recurrence rates at 1, 3, and 5 years were 26.5, 57.8, and 74.3%, respectively. In univariate analysis, albumin (\3.5 g/dl), platelet count (\150 9 10 3 /mm 3), prothrombin activity (PT) (\70%), Child-Pugh class B, serum HBV DNA load ([4.0 log10 copies/ml), and tumor number ([3) were associated with the recurrence at p B 0.15. Multivariate Cox regression analysis with stepwise variable selection showed that the tumor number (risk ratio, 4.63; 95% CI, 1.50-14.25, P = 0.0076), low PT (3.39, 1.52-5.78, P = 0.0029), and high HBV DNA load (2.67, 1.16-6.14, P = 0.021) were independent risk factors for HCC recurrence. Conclusion Serum HBV DNA load is associated with the risk of recurrence of HBV-related HCC after RFA.

Research paper thumbnail of Obesity did not diminish the efficacy of percutaneous ablation for hepatocellular carcinoma

Liver International, 2007

Background: Overweight and hepatic steatosis can increase the risk of hepatocarcinogenesis. In ad... more Background: Overweight and hepatic steatosis can increase the risk of hepatocarcinogenesis. In addition, overweight may affect the treatment efficacy of ultrasound‐guided percutaneous ablation. We evaluated the impact of overweight on the safety and efficacy of percutaneous ablation to hepatocellular carcinoma (HCC).Methods: We enrolled 743 patients with naïve HCC who were treated by percutaneous ablation including ethanol injection, microwave coagulation, and radiofrequency ablation (RFA) between 1995 and 2003. Patients were divided into two groups by body mass index (BMI): 219 overweight patients with BMI>25 kg/m2 and 524 control patients with BMI≤25 kg/m2. The effects of BMI on complications of percutaneous ablation, HCC recurrence, and overall survival were analyzed, together with others including tumor and liver function‐related factors.Results: The overweight group required a significantly larger number of sessions by RFA (P=0.01). Major complications were identified in 8.7...

Research paper thumbnail of Extrahepatic metastasis of hepatocellular carcinoma: incidence and risk factors

Liver International, 2008

Background: Extrahepatic metastasis of hepatocellular carcinoma (HCC) is of growing importance as... more Background: Extrahepatic metastasis of hepatocellular carcinoma (HCC) is of growing importance as the survival of patients has been improved owing to advances in treatments to intrahepatic lesions.Methods: To elucidate the incidence and risk factors of extrahepatic metastasis of HCC, we enrolled 1573 (1131 treatment‐naïve and 442 previously treated on referral) patients with HCC without extrahepatic tumour spread treated at the authors' department between 1990 and 2003. Patients received medical treatment including percutaneous ablation and transcatheter arterial chemoembolization, and followed by dynamic computed tomography (CT) or magnetic resonance imaging (MRI) and tumour markers every 3–4 months. Extrahepatic metastasis was diagnosed by plain X‐ray, CT, MRI and scintigraphy. Clinical parameters at the time of treatment to intrahepatic lesions were evaluated as a predictor of subsequent extrahepatic metastasis among the 1131 treatment‐naïve patients by Cox's proportional...

Research paper thumbnail of Influence of anti-HBc seropositivity on the risk of hepatocellular carcinoma in HCV-infected patients after adjusting for confounding factors

Journal of Viral Hepatitis, 2010

It is controversial whether past hepatitis B virus infection constitutes an additional risk of he... more It is controversial whether past hepatitis B virus infection constitutes an additional risk of hepatocellular carcinoma (HCC) among patients with hepatitis C virus (HCV). The incidence of HCC between 1994 and 2004 was analysed among 1262 patients who were only positive for HCV. The cumulative incidence of HCC was assessed by Kaplan-Meier analysis and the difference between two groups was assessed by the log-rank test. The effect of anti-HBc positivity on the risk of HCC was assessed with multivariate Cox proportional analysis. Anti-HBc was positive in 522 (41.4%) patients. The proportion of male patients (56.7 vs 46.8%, P < 0.001) and mean age (60.8 vs 56.9 years, P < 0.001) were significantly higher in the anti-HBc positive group. HCC developed in 339 patients (mean follow-up 7.0 years), with cumulative incidence rates at 3, 5 and 10 years of 12.7, 24.5 and 41.9% in the anti-HBc positive group and 10.6, 17.7 and 33.4% in the negative group, respectively (P = 0.005). However, anti-HBc seropositivity did not reach statistical significance in multivariate analysis including age and gender (hazard ratio, 1.06; 95% CI, 0.85-1.31; P = 0.63). Anti-HBc positivity and HCC incidence were confounded by male gender and older age.

Research paper thumbnail of 409 Prospective Risk Assessment for Hepatocellular Carcinoma Development in Chronic Hepatitis C Patients by Transient Elastography

Journal of Hepatology, 2009

Background and Aims: Hepatitis C virus (HCV) infection has been reported to be associated with li... more Background and Aims: Hepatitis C virus (HCV) infection has been reported to be associated with liver and extra-hepatic diseases. This cohort study aimed to compare the mortality from various cancers between HCVinfected and uninfected participants. Methods: A total of 23,820 adult residents in seven townships in Taiwan were recruited during 1991-1992. Serum samples were collected for anti-HCV test by immunoassay at study entry. Deaths from various cancers were ascertained through computerized data linkage using national death certification profiles from 1991 to 2007. Person-years at risk were calculated for each person as the time interval from enrollment date to either the date at death or December 31, 2007. Cox's proportional hazard models were used to estimate age-gender-adjusted relative risk (RR adj) of developing various cancers for HCV infection. Results: There were 22,472 anti-HCV-seronegatives and 1,313 anti-HCVseropositives in the study. The number of cancer deaths was 905 for anti-HCV-seronegatives and 130 for anti-HCV seropositives, with mortality rate per 100,000 person-years of 264 and 673, respectively. The RR adj (95% confidence interval) of dying from all cancer was 2.23 (1.86−2.69). The mortality rates of liver cancer (ICD9:155) per 100,000 personyears was 64 and 373, respectively, for anti-HCV-seronegatives and anti-HCV-seropositives showing an RR adj (95% confidence interval) of 5.46 (4.17−7.13). The RR adj (95% confidence interval) of dying from esophagus cancer (ICD-9 150), prostate cancer (ICD-9 185), thyroid cancer (ICD-9 193), and leukemia (ICD-9 204-208) for anti-HCV-seropositives compared with anti-HCV-seronegatives was 3.

Research paper thumbnail of Treatment strategy for hepatocellular carcinoma: expanding the indications for radiofrequency ablation

Journal of Gastroenterology, 2009

Hepatocellular carcinoma is the most common malignancy in liver, is also a global problem and is ... more Hepatocellular carcinoma is the most common malignancy in liver, is also a global problem and is the fourth most commonly diagnosed cancers among men and the fourth leading causes of cancer death among both men and women in China. Liver resection or hepatic resection and radiofrequency ablation is widely accepted as a first-line surgical approach for hepatocellular carcinoma in China. However, the indications of radiofrequency ablation or hepatic resection are different and not unified in China. In this article, we review the current status of hepatic resection and radiofrequency ablation therapies in hepatocellular carcinoma management in China.

Research paper thumbnail of W1789 Risk Factors for Hemorrhagic Complications After Radiofrequency Ablation Therapy for Liver Tumors

Gastroenterology, May 1, 2009

A S L D A b st ra ct s insufficiency in 2 and liver abscess in 3 patients). A post-embolization s... more A S L D A b st ra ct s insufficiency in 2 and liver abscess in 3 patients). A post-embolization syndrome was seen in 14%. None of the patients developed liver failure after TACE. Our study shows that TACE is an efficacious and safe therapeutic modality for HCC patients unsuitable for surgical therapy. Tumor stage, degree of liver disease, response to TACE and patients' age were independent risk factors for patient survival.

Research paper thumbnail of W1791 Treatment Response Evaluated By Des-Gamma-Carboxy Prothrombin and Alpha-Fetoprotein L3 Fraction Can Predict Prognosis of Hepatocellular Carcinoma Independently of Radiological Evaluation

Gastroenterology, May 1, 2009

Research paper thumbnail of T1927 Treatment Response Evaluated By Tumor Markers Can Predict Prognosis of Hepatocellular Carcinoma Independently of Radiological Evaluation

Gastroenterology, Apr 1, 2008

Research paper thumbnail of W1770 Radiofrequency Ablation (RFA) in the Treatment of Hepatocellular Carcinoma (HCC): Long-Term Results

Gastroenterology, May 1, 2009

Research paper thumbnail of Characteristics of hepatocellular carcinoma nodules newly detected by computed tomography during arteriography and arterial portography: preliminary report of a randomized controlled trial

Hepatology International, Aug 31, 2011

Research paper thumbnail of Extrahepatic metastasis of hepatocellular carcinoma: incidence and risk factors

Liver International, Aug 15, 2008

Hepatocellular carcinoma (hcc) arising from a hepatic adenoma is a rare phenomenon accounting for... more Hepatocellular carcinoma (hcc) arising from a hepatic adenoma is a rare phenomenon accounting for fewer than 5% of hcc cases; it seldom recurs after resection of the primary tumour. We report a case of extrahepatic metastasis of hcc arising from a hepatic adenoma that presented as a solitary sternal metastasis without any evidence of intrahepatic recurrence. Our patient was initially treated with radiation therapy and bland embolization, without response. Subsequently, the patient developed progressive disease while taking sorafenib. He later received chemotherapy with docetaxel and gemcitabine, with the development of multiple pulmonary and splenic nodules. However, he remained free of intrahepatic recurrence. To the best of our knowledge, this is the first case of extrahepatic metastasis of hcc arising from a hepatic adenoma without evidence of intrahepatic recurrence.

Research paper thumbnail of Treatment Strategy of Hepatocellular Carcinoma

The Japanese journal of gastro-enterology, 2008

Research paper thumbnail of Impact of Obesity and Heavy Alcohol Consumption on Hepatocellular Carcinoma Development after HCV Eradication with Antivirals

Liver Cancer, 2021

Background and Aims: It remains unclear whether obesity increases the risk of hepatocellular carc... more Background and Aims: It remains unclear whether obesity increases the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C who achieved a sustained virological response (SVR) with antiviral therapy. Methods: In this multicenter cohort study, we enrolled patients with chronic hepatitis C who achieved SVR with interferon (IFN)-based therapy (IFN group) or direct-acting antiviral (DAA) therapy (DAA group) between January 1, 1990, and December 31, 2018. The patients underwent regular surveillance for HCC. Cumulative incidence of and the risk factors for HCC development after SVR were assessed using the Kaplan-Meier method and Cox proportional hazard regression analysis, respectively. Results: Among 2,055 patients (840 in the IFN group and 1,215 in the DAA group), 75 developed HCC (41 in the IFN group and 34 in the DAA group) during the mean observation period of 4.1 years. The incidence rates of HCC at 1, 2, and 3 years were 1.2, 1.9, and 3.0%, respectively. Multi...

Research paper thumbnail of Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update

Hepatology international, Jan 15, 2017

There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with... more There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia-Pacific region, where HCC is one of the leading public health problems. Since the "Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines" meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia-Pacific region, which has a diversity of medical environments.

Research paper thumbnail of Comparison of Liver Biopsy and Transient Elastography based on Clinical Relevance

Canadian Journal of Gastroenterology, 2008

BACKGROUND: Liver stiffness measurement (LSM) by transient elastography has recently been validat... more BACKGROUND: Liver stiffness measurement (LSM) by transient elastography has recently been validated for the evaluation of liver fibrosis in chronic liver diseases. The present study focused on cases in which liver biopsy and LSM were discordant.METHODS: Three hundred eighty-six patients with chronic hepatitis C who underwent a liver biopsy between December 2004 and April 2007 were studied. First, the optimal cut-off value of LSM was selected for the determination of cirrhosis based on the receiver operating characteristic curve. Then, the cases in which liver histology and evaluation by LSM were discordant were selected. Laboratory test results such as serum total bilirubin concentration, prothrombin activity, albumin concentration, platelet count and the aspartate aminotransferase to platelet ratio index, together with the presence of esophageal varices, were analyzed.RESULTS: The optimal cut-off value was chosen to be 15.9 kPa for cirrhosis (fibrosis stage [F] 4) determination to ...

Research paper thumbnail of Assessing liver tumor stiffness by transient elastography

Hepatology International, 2007

Background and aims Transient elastography is a novel noninvasive method to assess liver fibrosis... more Background and aims Transient elastography is a novel noninvasive method to assess liver fibrosis by measuring liver stiffness. This study is a first step toward the provision of a noninvasive measurement of hepatic tumor stiffness by transient elastography. Patients and methods Patients with liver tumor larger than 5 cm in diameter and located near the liver surface were enrolled between June 2004 and February 2005. Histology of each tumor was evaluated on ultrasoundguided liver biopsy specimens. Transient elastography (Fibroscan, Echosens, Paris) was used to measure tumor stiffness. Tumor stiffness was measured as follows. First, by using B-mode ultrasound, we searched for the optimal right intercostal position for tumor stiffness measurement while keeping the ultrasound probe and body surface at right angles. Then the vibrator for transient elastography was applied at the same position and angle, and stiffness was measured according to the manufacturer's instruction. Results Tumor stiffness was measured in 40 patients, 17 with hepatocellular carcinoma (HCC), six with cholangiocellular carcinoma (CCC), 16 with metastatic tumors (mostly adenocarcinoma), and one with malignant lymphoma. The median value was 55 kPa in HCC, 75 kPa in CCC, 66.5 kPa in metastatic tumor, and 16.9 kPa in malignant lymphoma. The stiffness value of CCC was significantly higher than that of HCC and metastatic tumors (P = .049). Conclusion We showed that stiffness of liver tumors could be measured with transient elastography. Improvements in the device, such as smaller and variable region of interest of measurement and real-time B-mode display, may ensure wider clinical application.

Research paper thumbnail of Safety and efficacy of lamivudine after radiofrequency ablation in patients with hepatitis B virus-related hepatocellular carcinoma

Hepatology International, 2008

Background Antiviral treatments for hepatitis B virus (HBV) are not established in patients with ... more Background Antiviral treatments for hepatitis B virus (HBV) are not established in patients with HBV-related hepatocellular carcinoma (HCC). Aim To investigate the safety and efficacy of lamivudine (LAM) in patients with HBV-related HCC who were treated with radiofrequency ablation (RFA). Methods RFA-treated patients with HBV-related HCC were retrospectively divided into those who received LAM (LAM group) and those who did not (nontreatment group). The first-year changes in serum alanine aminotransferase (ALT), total bilirubin (TBIL), and albumin (ALB) levels were compared in corresponding subsets based on Child-Pugh classification (Mann-Whitney U test) and between one-to-one matched pairs (Wilcoxon signed rank test), who were selected on the basis of their propensity scores for receiving LAM. Overall and recurrence-free survival was also compared. Results Complete ablation of HCC was achieved in 104 patients with HBV-related HCC between January 2000 and December 2005. LAM was administered to 33 patients after RFA. Serum HBV-DNA became negative by TMA method in 24 (73%) patients. Four patients showed redetection of HBV-DNA with ALT elevation. Subset analysis based on initial Child-Pugh class and paired analysis with matching revealed significant decreases in ALT and bilirubin levels and increases in ALB levels in the first year in the LAM group (DALT =-17, DALB = +0.3, and DTBIL =-0.2) compared with controls (DALT = +5, DALB = ±0.0, and DTBIL = +0.3). Overall survival and recurrence-free survival did not differ between the two groups. No specific adverse effect was observed in the LAM group. Conclusion LAM after RFA for HBV-related HCC was safe and improved liver function. Further studies are needed to evaluate its effect on survival.

Research paper thumbnail of Neoplastic seeding after radiofrequency ablation for hepatocellular carcinoma

American Journal of Gastroenterology, 2008

BACKGROUND: Neoplastic seeding reportedly occurs in up to 12.5% of patients treated with radiofre... more BACKGROUND: Neoplastic seeding reportedly occurs in up to 12.5% of patients treated with radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). The aim of this study is to assess the incidence, risk factors, and prognosis of neoplastic seeding after RFA among a large number of patients with a long-term follow-up. METHOD: From February 1999 to December 2004, 1,031 patients underwent a total of 1,845 treatments with RFA for a total of 3,837 HCC nodules. The following variables were assessed to elucidate the risk factors of neoplastic seeding: age, sex, positivity for viral markers, tumor size, number of tumor nodules, number of RFA sessions, tumor location, percutaneous biopsy prior to RFA, alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP) and lens culinaris agglutinin-reactive fraction of AFP (AFP-L3) levels, and the degree of tumor differentiation. RESULTS: Neoplastic seeding was detected in 33 patients (3.2% per patient) at intervals of 4.8-63.8 (median, 15.2) months after RFA. On multivariate logistic regression analysis, only the poor differentiation degree was associated with the risk of neoplastic seeding (P = 0.012). Of tumor factors, tumor size, and AFP, DCP, and AFP-L3 levels were significantly associated with the poor differentiation degree. The cumulative survival rates 1 and 2 yr after the detection of neoplastic seeding were 86% and 47%, respectively. CONCLUSION: Poor differentiation degree was the risk factor of neoplastic seeding after RFA for HCC. The surrogate markers for poor differentiation degree were larger tumor size and elevated tumor marker levels. Indication for RFA should be carefully considered for HCC patients under these conditions.

Research paper thumbnail of Ultrasound surveillance for early detection of hepatocellular carcinoma among patients with chronic hepatitis C

Research paper thumbnail of Influence of serum HBV DNA load on recurrence of hepatocellular carcinoma after treatment with percutaneous radiofrequency ablation

Background High serum load of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) is a strong ris... more Background High serum load of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) is a strong risk factor of hepatocellular carcinoma (HCC) development, independent of hepatitis B e antigen, serum alanine aminotransferase level, and liver cirrhosis. We evaluated whether serum HBV DNA load is associated with the risk of recurrence of HBV-related HCC treated with radiofrequency ablation (RFA). Methods The study population was 69 consecutive patients with HBV-related HCC treated locally completely with RFA between January 2000 and September 2007. The risk factors for HCC recurrence were analyzed based on laboratory data, including serum HBV DNA load, together with tumor size and number using univariate and multivariate proportional hazard regression analyses. Results HCC recurrence was observed in 42 of 69 patients during the median observation period of 1.5 years. Cumulative recurrence rates at 1, 3, and 5 years were 26.5, 57.8, and 74.3%, respectively. In univariate analysis, albumin (\3.5 g/dl), platelet count (\150 9 10 3 /mm 3), prothrombin activity (PT) (\70%), Child-Pugh class B, serum HBV DNA load ([4.0 log10 copies/ml), and tumor number ([3) were associated with the recurrence at p B 0.15. Multivariate Cox regression analysis with stepwise variable selection showed that the tumor number (risk ratio, 4.63; 95% CI, 1.50-14.25, P = 0.0076), low PT (3.39, 1.52-5.78, P = 0.0029), and high HBV DNA load (2.67, 1.16-6.14, P = 0.021) were independent risk factors for HCC recurrence. Conclusion Serum HBV DNA load is associated with the risk of recurrence of HBV-related HCC after RFA.

Research paper thumbnail of Obesity did not diminish the efficacy of percutaneous ablation for hepatocellular carcinoma

Liver International, 2007

Background: Overweight and hepatic steatosis can increase the risk of hepatocarcinogenesis. In ad... more Background: Overweight and hepatic steatosis can increase the risk of hepatocarcinogenesis. In addition, overweight may affect the treatment efficacy of ultrasound‐guided percutaneous ablation. We evaluated the impact of overweight on the safety and efficacy of percutaneous ablation to hepatocellular carcinoma (HCC).Methods: We enrolled 743 patients with naïve HCC who were treated by percutaneous ablation including ethanol injection, microwave coagulation, and radiofrequency ablation (RFA) between 1995 and 2003. Patients were divided into two groups by body mass index (BMI): 219 overweight patients with BMI>25 kg/m2 and 524 control patients with BMI≤25 kg/m2. The effects of BMI on complications of percutaneous ablation, HCC recurrence, and overall survival were analyzed, together with others including tumor and liver function‐related factors.Results: The overweight group required a significantly larger number of sessions by RFA (P=0.01). Major complications were identified in 8.7...

Research paper thumbnail of Extrahepatic metastasis of hepatocellular carcinoma: incidence and risk factors

Liver International, 2008

Background: Extrahepatic metastasis of hepatocellular carcinoma (HCC) is of growing importance as... more Background: Extrahepatic metastasis of hepatocellular carcinoma (HCC) is of growing importance as the survival of patients has been improved owing to advances in treatments to intrahepatic lesions.Methods: To elucidate the incidence and risk factors of extrahepatic metastasis of HCC, we enrolled 1573 (1131 treatment‐naïve and 442 previously treated on referral) patients with HCC without extrahepatic tumour spread treated at the authors' department between 1990 and 2003. Patients received medical treatment including percutaneous ablation and transcatheter arterial chemoembolization, and followed by dynamic computed tomography (CT) or magnetic resonance imaging (MRI) and tumour markers every 3–4 months. Extrahepatic metastasis was diagnosed by plain X‐ray, CT, MRI and scintigraphy. Clinical parameters at the time of treatment to intrahepatic lesions were evaluated as a predictor of subsequent extrahepatic metastasis among the 1131 treatment‐naïve patients by Cox's proportional...

Research paper thumbnail of Influence of anti-HBc seropositivity on the risk of hepatocellular carcinoma in HCV-infected patients after adjusting for confounding factors

Journal of Viral Hepatitis, 2010

It is controversial whether past hepatitis B virus infection constitutes an additional risk of he... more It is controversial whether past hepatitis B virus infection constitutes an additional risk of hepatocellular carcinoma (HCC) among patients with hepatitis C virus (HCV). The incidence of HCC between 1994 and 2004 was analysed among 1262 patients who were only positive for HCV. The cumulative incidence of HCC was assessed by Kaplan-Meier analysis and the difference between two groups was assessed by the log-rank test. The effect of anti-HBc positivity on the risk of HCC was assessed with multivariate Cox proportional analysis. Anti-HBc was positive in 522 (41.4%) patients. The proportion of male patients (56.7 vs 46.8%, P < 0.001) and mean age (60.8 vs 56.9 years, P < 0.001) were significantly higher in the anti-HBc positive group. HCC developed in 339 patients (mean follow-up 7.0 years), with cumulative incidence rates at 3, 5 and 10 years of 12.7, 24.5 and 41.9% in the anti-HBc positive group and 10.6, 17.7 and 33.4% in the negative group, respectively (P = 0.005). However, anti-HBc seropositivity did not reach statistical significance in multivariate analysis including age and gender (hazard ratio, 1.06; 95% CI, 0.85-1.31; P = 0.63). Anti-HBc positivity and HCC incidence were confounded by male gender and older age.

Research paper thumbnail of 409 Prospective Risk Assessment for Hepatocellular Carcinoma Development in Chronic Hepatitis C Patients by Transient Elastography

Journal of Hepatology, 2009

Background and Aims: Hepatitis C virus (HCV) infection has been reported to be associated with li... more Background and Aims: Hepatitis C virus (HCV) infection has been reported to be associated with liver and extra-hepatic diseases. This cohort study aimed to compare the mortality from various cancers between HCVinfected and uninfected participants. Methods: A total of 23,820 adult residents in seven townships in Taiwan were recruited during 1991-1992. Serum samples were collected for anti-HCV test by immunoassay at study entry. Deaths from various cancers were ascertained through computerized data linkage using national death certification profiles from 1991 to 2007. Person-years at risk were calculated for each person as the time interval from enrollment date to either the date at death or December 31, 2007. Cox's proportional hazard models were used to estimate age-gender-adjusted relative risk (RR adj) of developing various cancers for HCV infection. Results: There were 22,472 anti-HCV-seronegatives and 1,313 anti-HCVseropositives in the study. The number of cancer deaths was 905 for anti-HCV-seronegatives and 130 for anti-HCV seropositives, with mortality rate per 100,000 person-years of 264 and 673, respectively. The RR adj (95% confidence interval) of dying from all cancer was 2.23 (1.86−2.69). The mortality rates of liver cancer (ICD9:155) per 100,000 personyears was 64 and 373, respectively, for anti-HCV-seronegatives and anti-HCV-seropositives showing an RR adj (95% confidence interval) of 5.46 (4.17−7.13). The RR adj (95% confidence interval) of dying from esophagus cancer (ICD-9 150), prostate cancer (ICD-9 185), thyroid cancer (ICD-9 193), and leukemia (ICD-9 204-208) for anti-HCV-seropositives compared with anti-HCV-seronegatives was 3.

Research paper thumbnail of Treatment strategy for hepatocellular carcinoma: expanding the indications for radiofrequency ablation

Journal of Gastroenterology, 2009

Hepatocellular carcinoma is the most common malignancy in liver, is also a global problem and is ... more Hepatocellular carcinoma is the most common malignancy in liver, is also a global problem and is the fourth most commonly diagnosed cancers among men and the fourth leading causes of cancer death among both men and women in China. Liver resection or hepatic resection and radiofrequency ablation is widely accepted as a first-line surgical approach for hepatocellular carcinoma in China. However, the indications of radiofrequency ablation or hepatic resection are different and not unified in China. In this article, we review the current status of hepatic resection and radiofrequency ablation therapies in hepatocellular carcinoma management in China.