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Wen S, Zhu J, Han X, Li Y, Liu H, Yang H, Hou C, Xu S, Wang J, Hu Y, Qu Y, Liu D, Aspelund T, Fang F, Valdimarsdóttir UA, Song H. Childhood maltreatment and risk of endocrine diseases: an exploration of mediating pathways using sequential mediation analysis. BMC Med 2024; 22:59. [PMID: 38331807 PMCID: PMC10854183 DOI: 10.1186/s12916-024-03271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/22/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs), including childhood maltreatment, have been linked with increased risk of diabetes and obesity during adulthood. A comprehensive assessment on the associations between childhood maltreatment and all major endocrine diseases, as well as the relative importance of different proposed mechanistic pathways on these associations, is currently lacking. METHODS Based on the UK Biobank, we constructed a cohort including 151,659 participants with self-reported data on childhood maltreatment who were 30 years of age or older on/after January 1, 1985. All participants were followed from the index date (i.e., January 1, 1985, or their 30th birthday, whichever came later) until the first diagnosis of any or specific (12 individual diagnoses and 9 subtypes) endocrine diseases, death, or the end of follow-up (December 31, 2019), whichever occurred first. We used Cox models to examine the association of childhood maltreatment, treated as continuous (i.e., the cumulative number of experienced childhood maltreatment), ordinal (i.e., 0, 1 and ≥ 2), or binary (< 2 and ≥ 2) variable, with any and specific endocrine diseases, adjusted for multiple covariates. We further examined the risk of having multiple endocrine diseases using Linear or Logistic Regression models. Then, sequential mediation analyses were performed to assess the contribution of four possible mechanisms (i.e., suboptimal socioeconomic status (SES), psychological adversities, unfavorable lifestyle, and biological alterations) on the observed associations. RESULTS During an average follow-up of 30.8 years, 20,885 participants received a diagnosis of endocrine diseases. We observed an association between the cumulative number of experienced childhood maltreatment and increased risk of being diagnosed with any endocrine disease (adjusted hazard ratio (HR) = 1.10, 95% confidence interval 1.09-1.12). The HR was 1.26 (1.22-1.30) when comparing individuals ≥ 2 with those with < 2 experienced childhood maltreatment. We further noted the most pronounced associations for type 2 diabetes (1.40 (1.33-1.48)) and hypothalamic-pituitary-adrenal (HPA)-axis-related endocrine diseases (1.38 (1.17-1.62)), and the association was stronger for having multiple endocrine diseases, compared to having one (odds ratio (95% CI) = 1.24 (1.19-1.30), 1.35 (1.27-1.44), and 1.52 (1.52-1.53) for 1, 2, and ≥ 3, respectively). Sequential mediation analyses showed that the association between childhood maltreatment and endocrine diseases was consistently and most distinctly mediated by psychological adversities (15.38 ~ 44.97%), while unfavorable lifestyle (10.86 ~ 25.32%) was additionally noted for type 2 diabetes whereas suboptimal SES (14.42 ~ 39.33%) for HPA-axis-related endocrine diseases. CONCLUSIONS Our study demonstrates that adverse psychological sequel of childhood maltreatment constitutes the main pathway to multiple endocrine diseases, particularly type 2 diabetes and HPA-axis-related endocrine diseases. Therefore, increased access to evidence-based mental health services may also be pivotal in reducing the risk of endocrine diseases among childhood maltreatment-exposed individuals.
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Affiliation(s)
- Shu Wen
- Mental Health Center and West China Biomedical Big Data Center West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jianwei Zhu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Han
- Mental Health Center and West China Biomedical Big Data Center West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yuchen Li
- Mental Health Center and West China Biomedical Big Data Center West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Haowen Liu
- Mental Health Center and West China Biomedical Big Data Center West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Huazhen Yang
- Mental Health Center and West China Biomedical Big Data Center West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Can Hou
- Mental Health Center and West China Biomedical Big Data Center West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Shishi Xu
- Mental Health Center and West China Biomedical Big Data Center West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Division of Endocrinology & Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Junren Wang
- Mental Health Center and West China Biomedical Big Data Center West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yao Hu
- Mental Health Center and West China Biomedical Big Data Center West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yuanyuan Qu
- Mental Health Center and West China Biomedical Big Data Center West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Di Liu
- Mental Health Center and West China Biomedical Big Data Center West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
- Sichuan University - Pittsburgh Institute, Sichuan University, Chengdu, China
| | - Thor Aspelund
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A Valdimarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Huan Song
- Mental Health Center and West China Biomedical Big Data Center West China Hospital, Sichuan University, Guo Xue Lane 37, Chengdu, China.
- Med-X Center for Informatics, Sichuan University, Chengdu, China.
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
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2
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Block PD, Lim JK. Chronic Hepatitis B Virus: What an Internist Needs to Know. Med Clin North Am 2023; 107:435-447. [PMID: 37001946 DOI: 10.1016/j.mcna.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Chronic hepatitis B virus (HBV) infection is a bloodborne infection which affects approximately 1.6 million persons in the U.S. and 292 million persons worldwide and is associated with significant morbidity and mortality due to cirrhosis and hepatocellular carcinoma. HBV disproportionately affects foreign-persons from endemic regions such as sub-Saharan Africa and the Asian-Pacific region. Chronic HBV is diagnosed with positive HBsAg and detectable HBV DNA. Patients with immunoactive disease (elevated HBV DNA and serum ALT) may require antiviral therapy with peg-interferon or oral nucleos(t)ide analogues which suppress viral replication, and are associated with a decreased risk for liver events.
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Affiliation(s)
- Peter D Block
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Joseph K Lim
- Section of Digestive Diseases and Yale Liver Center, Yale School of Medicine, 333 Cedar Street, LMP 1080, New Haven, CT 06520, USA.
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Tai AS, Lin SH. Complete effect decomposition for an arbitrary number of multiple ordered mediators with time-varying confounders: A method for generalized causal multi-mediation analysis. Stat Methods Med Res 2023; 32:100-117. [PMID: 36321187 DOI: 10.1177/09622802221130580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Causal mediation analysis is advantageous for mechanism investigation. In settings with multiple causally ordered mediators, path-specific effects have been introduced to specify the effects of certain combinations of mediators. However, most path-specific effects are unidentifiable. An interventional analog of path-specific effects is adapted to address the non-identifiability problem. Moreover, previous studies only focused on cases with two or three mediators due to the complexity of the mediation formula in a large number of mediators. In this study, we provide a generalized definition of traditional path-specific effects and interventional path-specific effects with a recursive formula, along with the required assumptions for nonparametric identification. Subsequently, a general approach is developed with an arbitrary number of multiple ordered mediators and with time-varying confounders. All methods and software proposed in this study contribute to comprehensively decomposing a causal effect confirmed by data science and help disentangling causal mechanisms in the presence of complicated causal structures among multiple mediators.
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Affiliation(s)
- An-Shun Tai
- Department of Statistics, 34912National Cheng Kung University, Tainan
| | - Sheng-Hsuan Lin
- Institute of Statistics, 34914National Yang Ming Chiao Tung University, Hsinchu
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4
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Tai AS, Huang YT, Yang HI, Lan LV, Lin SH. G-Computation to Causal Mediation Analysis With Sequential Multiple Mediators-Investigating the Vulnerable Time Window of HBV Activity for the Mechanism of HCV Induced Hepatocellular Carcinoma. Front Public Health 2022; 9:757942. [PMID: 35071157 PMCID: PMC8779208 DOI: 10.3389/fpubh.2021.757942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/30/2021] [Indexed: 12/09/2022] Open
Abstract
Regression-based approaches are widely used in causal mediation analysis. The presence of multiple mediators, however, increases the complexity and difficulty of mediation analysis. In such cases, regression-based approaches cannot efficiently address estimation issues. Hence, a flexible approach to mediation analysis is needed. Therefore, we developed a method for using g-computation algorithm to conduct causal mediation analysis in the presence of multiple ordered mediators. Compared to regression-based approaches, the proposed simulation-based approach increases flexibility in the choice of models and increases the range of the outcome scale. The Taiwanese Cohort Study dataset was used to evaluate the efficacy of the proposed approach for investigating the mediating role of early and late HBV viral load in the effect of HCV infection on hepatocellular carcinoma (HCC) in HBV seropositive patients (n = 2,878; HCV carrier n = 123). Our results indicated that early HBV viral load had a negative mediating role in HCV-induced HCC. Additionally, early exposure to a low HBV viral load affected HCC through a lag effect on HCC incidence [OR = 0.873, 95% CI = (0.853, 0.893)], and the effect of early exposure to a low HBV viral load on HCC incidence was slightly larger than that of a persistently low viral load on HCC incidence [OR = 0.918, 95% CI = (0.896, 0.941)].
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Affiliation(s)
- An-Shun Tai
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yen-Tsung Huang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Lauren V Lan
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Department of Biostatistics, Johns Hopkins University, Baltimore, MD, United States
| | - Sheng-Hsuan Lin
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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5
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Jacob R, Danta M. Pharmacotherapeutic strategies for hepatitis B and hepatitis C coinfection. Expert Opin Pharmacother 2021; 23:465-472. [PMID: 34937470 DOI: 10.1080/14656566.2021.2019708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Hepatitis B (HBV) and Hepatitis C (HCV) infection place a significant burden on the global health system, with chronic carriage leading to cirrhosis and hepatocellular carcinoma. HBV/HCV coinfection can be seen in highly endemic areas and present a heterogenous group given varying virologic profiles. Coinfected patients have a greater risk of advanced liver disease; hence, diagnosis and early antiviral therapy (AVT) should be a priority. Optimal treatment regimens for coinfected patients remain unknown with differing recommendations, particularly relating to the risk of HBV reactivation whilst on AVT for HCV. AREAS COVERED This article summarizes the available data on HBV/HCV coinfection with regards to epidemiology, virologic interactions, and risk of HBV reactivation. The authors also provide a framework for the assessment and treatment of coinfected patients. EXPERT OPINION There is a moderate risk of HBV reactivation in hepatitis B surface antigen (HBsAg) positive patients undergoing HCV direct-acting antiviral (DAA) treatment; however, clinically significant events are rare. The risk of HBV reactivation in HBsAg negative patients undergoing HCV DAA treatment is negligible. Thus, prophylactic HBV treatment in both groups is not required. The authors recommend close monitoring with HBV treatment if there is evidence of HBV reactivation or elevated alanine aminotransferase levels.
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Affiliation(s)
- Rachael Jacob
- Department of Gastroenterology, St Vincent's Hospital, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, Unsw Sydney, St Vincent's Hospital, Sydney, Australia
| | - Mark Danta
- Department of Gastroenterology, St Vincent's Hospital, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, Unsw Sydney, St Vincent's Hospital, Sydney, Australia
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6
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Chen CJ, You SL, Hsu WL, Yang HI, Lee MH, Chen HC, Chen YY, Liu J, Hu HH, Lin YJ, Chu YJ, Huang YT, Chiang CJ, Chien YC. Epidemiology of Virus Infection and Human Cancer. Recent Results Cancer Res 2021; 217:13-45. [PMID: 33200360 DOI: 10.1007/978-3-030-57362-1_2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Seven viruses including the Epstein-Barr virus (EBV), hepatitis B virus (HBV), hepatitis C virus (HCV), Kaposi's sarcoma herpes virus (KSHV), human immunodeficiency virus, type-1 (HIV-1), human T cell lymphotrophic virus, type-1 (HTLV-1), and human papillomavirus (HPV) have been classified as Group 1 human carcinogens by the International Agency for Research on Cancer (IARC). The conclusions are based on the findings of epidemiological and mechanistic studies. EBV, HPV, HTLV-1, and KSHV are direct carcinogens; HBV and HCV are indirect carcinogens through chronic inflammation; and HIV-1 is an indirect carcinogen through immune suppression. Some viruses may cause more than one cancer, while some cancers may be caused by more than one virus. However, only a proportion of persons infected by these oncogenic viruses will develop specific cancers. A series of studies have been carried out to assess the viral, host, and environmental cofactors of EBV-associated nasopharyngeal carcinoma, HBV/HCV-associated hepatocellular carcinoma, and HPV-associated cervical carcinoma. Persistent infection, high viral load, and viral genotype are important risk predictors of these virus-caused cancers. Risk calculators incorporating host and viral risk predictors have been developed for the prediction of long-term risk of hepatocellular carcinoma, nasopharyngeal carcinoma and cervical cancer. These risk calculators are useful for the triage and clinical management of infected patients. Both clinical trials and national programs of immunization, antiviral therapy and screening have demonstrated a significant reduction in the incidence of cancers caused by HBV, HCV, and HPV. Future research on gene-gene and gene-environment interactions of oncogenic viruses and the human host using large-scale longitudinal studies with serial measurements of biosignatures are in urgent need.
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Affiliation(s)
- Chien-Jen Chen
- Genomics Research Center, Academia Sinica, 128 Academia Road, Sect. 2, Taipei, 115, Taiwan.
| | - San-Lin You
- School of Medicine and Big Data Research Centre, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Wan-Lun Hsu
- Genomics Research Center, Academia Sinica, 128 Academia Road, Sect. 2, Taipei, 115, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, 128 Academia Road, Sect. 2, Taipei, 115, Taiwan
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hui-Chi Chen
- Genomics Research Center, Academia Sinica, 128 Academia Road, Sect. 2, Taipei, 115, Taiwan
| | | | - Jessica Liu
- Department of Pediatrics, Perinatal Epidemiology and Health Outcomes Research Unit, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Hui-Han Hu
- Department of Translational Science, Preclinical Research, PharmaEngine Inc., Taipei, Taiwan
| | - Yu-Ju Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Ju Chu
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Yen-Tsung Huang
- Institute of Statistical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chun-Ju Chiang
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Yin-Chu Chien
- Genomics Research Center, Academia Sinica, 128 Academia Road, Sect. 2, Taipei, 115, Taiwan
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7
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Lin HH, Wu CY, Wang CH, Fu H, Lönnroth K, Chang YC, Huang YT. Association of Obesity, Diabetes, and Risk of Tuberculosis: Two Population-Based Cohorts. Clin Infect Dis 2019; 66:699-705. [PMID: 29029077 PMCID: PMC5850624 DOI: 10.1093/cid/cix852] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/20/2017] [Indexed: 01/26/2023] Open
Abstract
Background Mounting data have revealed that body mass index (BMI) is inversely associated with risk of active tuberculosis. The inverse association presents a “paradox” with regard to diabetes, because obesity is a major determinant of diabetes, and diabetes is a well-known risk factor for tuberculosis. Methods We conducted 2 population-based cohort studies involving 167392 participants. The main exposure was BMI and diabetes ascertained at baseline. Occurrence of incident tuberculosis was ascertained from Taiwan’s National Tuberculosis Registry. We conducted a causal mediation analysis and a joint effects analysis to characterize the relationship between BMI, diabetes, and tuberculosis. Results During a median of >7 years of follow-up, 491 individuals developed incident tuberculosis. Compared with normal-weight individuals, obese individuals (>30 kg/m2) had a 67% (95% confidence interval [CI], −3% to −90%) and 64% (31%–81%) reduction in tuberculosis hazard in the 2 cohorts. In the causal mediation analysis, obesity had a harmful effect on tuberculosis mediated through diabetes (0.8% and 2.7% increased odds in the 2 cohorts, respectively) but had a strongly protective effect not mediated through diabetes (72% and 67% decreased odds, respectively). Individuals who were simultaneously obese and diabetic had a lower but statistically insignificant risk of tuberculosis (adjusted hazard ratio, 0.30; 95% CI, .08–1.22) compared with nondiabetic normal-weight individuals. Conclusions Our analyses revealed that the relationship between obesity, diabetes, and risk of tuberculosis was complex and nonlinear. Better understanding of the interplay between host metabolism and tuberculosis immunology may lead to novel therapeutic or preventive strategies.
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Affiliation(s)
- Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Chieh-Yin Wu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Hui Wang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Han Fu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.,Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom
| | - Knut Lönnroth
- Stop TB Department, World Health Organization, Geneva, Switzerland
| | - Yi-Cheng Chang
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University.,Department of Internal Medicine, National Taiwan University Hospital
| | - Yen-Tsung Huang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
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8
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Ko CJ, Li CJ, Wu MY, Chu PY. Overexpression of LGR-5 as a Predictor of Poor Outcome in Patients with Hepatocellular Carcinoma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101836. [PMID: 31126119 PMCID: PMC6572154 DOI: 10.3390/ijerph16101836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/29/2019] [Accepted: 05/21/2019] [Indexed: 12/11/2022]
Abstract
Hepatocarcinogenesis and distant metastasis pose major challenges for physicians. They are regulated by several genes, such as AKT, JUK, Wnt, and P53, and their expression activates several important processes such as cell proliferation, migration, motility, and interaction in the microenvironment. The leucine-rich repeat-containing G-protein-coupled receptor 5 (LGR-5) is a novel biomarker, particularly in stem cells, and is involved in embryogenesis, tumor development, and tumor cell signal transduction. Here, we investigated LGR-5 expression using immunohistochemistry and analyzed the correlation between clinical features and prognosis in patients with hepatocellular carcinoma (HCC). We found that LGR-5 expression was higher in tumor tissues than in normal liver tissues, and that high LGR-5 expression possibly favored poor outcomes in HCC, especially in well/moderate differentiation grade, hepatitis C virus (HCV)-negative, and hepatitis B virus (HBV)-positive groups. Thus, the LGR-5 marker is suggested to be a routine biomarker for poor prognosis, thereby providing a platform for anti-LGR-5-targeted therapy in the future.
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Affiliation(s)
- Chih-Jan Ko
- Department of General Surgery, Changhua Christian Hospital, Changhua 500, Taiwan.
- School of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
| | - Chia-Jung Li
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan.
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
| | - Pei-Yi Chu
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan.
- Department of Pathology, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
- Department of Health Food, Chung Chou University of Science and Technology, Changhua 510, Taiwan.
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Ko CJ, Li CJ, Wu MY, Chu PY. Overexpression of epithelial cell adhesion molecule as a predictor of poor outcome in patients with hepatocellular carcinoma. Exp Ther Med 2018; 16:4810-4816. [PMID: 30542436 DOI: 10.3892/etm.2018.6794] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/13/2018] [Indexed: 02/06/2023] Open
Abstract
Cancer growth, metastasis and development are regulated by a number of genes, whose expression mediates important processes, including cellular plasticity, motility and internal interactions in the tumor microenvironment. The epithelial cell adhesion molecule (EpCAM) serves an important role in cell-cell migration and tumorigenicity, particularly metastasis. The aim of the present study was to measure EpCAM expression using immunohistochemistry and to investigate the association between clinicopathological features and prognosis in hepatocellular carcinoma (HCC). The results revealed that EpCAM expression may be a biomarker for poor prognosis in patients with HCC and may therefore be used to predict clinical outcome. The present study suggests that EpCAM expression in HCC can be considered as a routine biomarker for unfavorable prognosis and may provide a basis for the future development of anti-EpCAM-targeted therapy.
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Affiliation(s)
- Chih-Jan Ko
- Department of General Surgery, Changhua Christian Hospital, Changhua 500, Taiwan, R.O.C.,School of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Chia-Jung Li
- Research Assistant Center, Show Chwan Memorial Hospital, Changhua 500, Taiwan, R.O.C
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan, R.O.C.,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan, R.O.C
| | - Pei-Yi Chu
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan, R.O.C.,Department of Pathology, Show Chwan Memorial Hospital, Changhua 500, Taiwan, R.O.C.,National Institute of Cancer Research, National Health Research Institutes, Tainan 704, Taiwan, R.O.C
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10
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Hsu YC, Ho HJ, Lee TY, Huang YT, Wu MS, Lin JT, Wu CY, El-Serag HB. Temporal trend and risk determinants of hepatocellular carcinoma in chronic hepatitis B patients on entecavir or tenofovir. J Viral Hepat 2018; 25:543-551. [PMID: 29193536 DOI: 10.1111/jvh.12832] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/05/2017] [Indexed: 12/21/2022]
Abstract
This study aimed to elucidate the temporal change and determinants for the risk of HCC in patients with chronic hepatitis B continuously receiving NUC. Through analysis of the national healthcare database in Taiwan, we screened a total of 65 426 infected patients receiving entecavir or tenofovir for at least 3 months and excluded those with lamivudine, adefovir or telbivudine exposure, malignancy, end-stage renal failure or a diagnosis of HCC within 3 months of starting treatment. Eligible patients (N = 27 820) were followed until HCC occurrence, completion of the allowed 3-year regimen or 31 December 2013. During a median follow-up of 25.1 (12.1-35.6) months, 802 patients developed HCC, with 1-, 2- and 3-year cumulative incidence of 1.82% (95% CI, 1.66-1.99%), 3.05% (95% CI, 2.82-3.28%) and 4.06% (95% CI, 3.77-4.36%), respectively. HCC annual incidence decreased with an adjusted IRR of 0.73 (95% CI, 0.66-0.80) per yearly interval and was associated with cirrhosis (IRR, 10.07; 95% CI, 6.00-16.90 in age <40 years; 4.69; 95% CI, 3.94-5.59 in age ≧40 years), age (IRR, 3.38; 95% CI, 2.10-5.47 for 40-50 years; 6.92; 95% CI, 4.27-11.21 for 50-60 years; 12.50; 95% CI, 7.71-20.25 for ≧60 years; <40 years as reference), male sex (IRR, 1.71; 95% CI, 1.44-2.04), HCV coinfection (IRR, 1.27; 95% CI, 1.02-1.58) and diabetes (IRR, 1.24; 95% CI, 1.05-1.45). In conclusion, the risk of HCC in patients with chronic hepatitis B receiving entecavir or tenofovir declines over time and is determined by cirrhosis, age, male sex, HCV coinfection and diabetes.
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Affiliation(s)
- Yao-Chun Hsu
- School of Medicine and Big Data Research Center, Fu-Jen Catholic University, New Taipei, Taiwan.,Department of Internal Medicine, Fu-Jen Catholic University Hospital, New Taipei, Taiwan.,Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan
| | - Hsiu-J Ho
- Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Teng-Yu Lee
- Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yen-Tsung Huang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.,Departments of Epidemiology and Biostatistics, Brown University, Providence, RI, USA
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jaw-Town Lin
- School of Medicine and Big Data Research Center, Fu-Jen Catholic University, New Taipei, Taiwan.,Department of Internal Medicine, Fu-Jen Catholic University Hospital, New Taipei, Taiwan.,Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chun-Ying Wu
- Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan.,Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Michael E DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
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Terrault NA, Lok ASF, McMahon BJ, Chang KM, Hwang JP, Jonas MM, Brown RS, Bzowej NH, Wong JB. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology 2018; 67:1560-1599. [PMID: 29405329 PMCID: PMC5975958 DOI: 10.1002/hep.29800] [Citation(s) in RCA: 2467] [Impact Index Per Article: 411.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Norah A Terrault
- Division of Gastroenterology/Hepatology, University of California San Francisco, San Francisco, CA
| | - Anna S F Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Brian J McMahon
- Liver Diseases and Hepatitis Program, Alaska NativeTribal Health Consortium, Anchorage, AK
| | - Kyong-Mi Chang
- Division of Gastroenterology, Corporal Michael J. Crescenz VA Medical Center & University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jessica P Hwang
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Maureen M Jonas
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY
| | | | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
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Abstract
BACKGROUND Mediation analyses have been a popular approach to investigate the effect of an exposure on an outcome through a mediator. Mediation models with multiple mediators have been proposed for continuous and dichotomous outcomes. However, development of multimediator models for survival outcomes is still limited. METHODS We present methods for multimediator analyses using three survival models: Aalen additive hazard models, Cox proportional hazard models, and semiparametric probit models. Effects through mediators can be characterized by path-specific effects, for which definitions and identifiability assumptions are provided. We derive closed-form expressions for path-specific effects for the three models, which are intuitively interpreted using a causal diagram. RESULTS Mediation analyses using Cox models under the rare-outcome assumption and Aalen additive hazard models consider effects on log hazard ratio and hazard difference, respectively; analyses using semiparametric probit models consider effects on difference in transformed survival time and survival probability. The three models were applied to a hepatitis study where we investigated effects of hepatitis C on liver cancer incidence mediated through baseline and/or follow-up hepatitis B viral load. The three methods show consistent results on respective effect scales, which suggest an adverse estimated effect of hepatitis C on liver cancer not mediated through hepatitis B, and a protective estimated effect mediated through the baseline (and possibly follow-up) of hepatitis B viral load. CONCLUSIONS Causal mediation analyses of survival outcome with multiple mediators are developed for additive hazard and proportional hazard and probit models with utility demonstrated in a hepatitis study.
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Affiliation(s)
- Yen-Tsung Huang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
- Departments of Epidemiology and Biostatistics, Brown University, Providence, RI 02912, United States
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
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Niu M, Hong D, Ma TC, Chen XW, Han JH, Sun J, Xu K. Short-term and long-term efficacy of 7 targeted therapies for the treatment of advanced hepatocellular carcinoma: a network meta-analysis: Efficacy of 7 targeted therapies for AHCC. Medicine (Baltimore) 2016; 95:e5591. [PMID: 27930578 PMCID: PMC5266050 DOI: 10.1097/md.0000000000005591] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 10/26/2016] [Accepted: 11/16/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A variety of targeted drug therapies in clinical trials have been proven to be effective for the treatment of hepatocellular carcinoma (HCC). Our study aims to compare the short-term and long-term efficacies of different targeted drugs in advanced hepatocellular carcinoma (AHCC) treatment using a network meta-analysis approach. METHODS PubMed, Embase, Ovid, EBSCO, and Cochrane central register of controlled trials were searched for randomized controlled trials (RCTs) of different targeted therapies implemented to patients with AHCC. And the retrieval resulted in 7 targeted drugs, namely, sorafenib, ramucirumab, everolimus, brivanib, tivantinib, sunitinib, and sorafenib+erlotinib. Direct and indirect evidence were combined to evaluate stable disease (SD), progressive disease (PD), complete response (CR), partial response (PR), disease control rate (DCR), overall response ratio (ORR), overall survival (OS), and surface under the cumulative ranking curve (SUCRA) of patients with AHCC. RESULTS A total of 11 RCTs were incorporated into our analysis, including 6594 patients with AHCC, among which 1619 patients received placebo treatment and 4975 cases had targeted therapies. The results revealed that in comparison with placebo, sorafenib, and ramucirumab displayed better short-term efficacy in terms of PR and ORR, and brivanib was better in ORR. Regarding long-term efficacy, sorafenib and sorafenib+erlotinib treatments exhibited longer OS. The data of cluster analysis showed that ramucirumab or sorafenib+erlotinib presented relatively better short-term efficacy for the treatment of AHCC. CONCLUSION This network meta-analysis shows that ramucirumab and sorafenib+erlotinib may be the better targeted drugs for AHCC patients, and sorafenib+erlotinib achieved a better long-term efficacy.
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Zhang B, Chaiton MO, Diemert LM, Bondy SJ, Brown KS, Ferrence R. Health professional advice, use of medications and smoking cessation: A population-based prospective cohort study. Prev Med 2016; 91:117-122. [PMID: 27496392 DOI: 10.1016/j.ypmed.2016.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 07/29/2016] [Accepted: 07/31/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The mediating role of cessation medications in the association between health professional advice and quitting behaviors is unclear. METHODS Data were from the Ontario Tobacco Survey longitudinal study, collected between July 2005 and June 2011 in Ontario, Canada. The analytic sample included 3437 baseline smokers who were seen by health professionals during follow-up. Logistic regression with generalized estimating equations and mediation analysis techniques were used to examine the impact of advice and medications on quitting outcomes (making a quit attempt, short-term quitting 1-6months and long-term quitting>6months). RESULTS Those who received advice to quit smoking were more likely to use cessation medications than those who did not receive advice (21% vs. 13%, P<0.001). Receiving advice was associated with making a quit attempt (adjusted odds ratio (OR) 1.25, 95% confidence interval (CI) 1.10-1.41) and long-term quitting (adjusted OR 1.49, 95% CI 1.10-2.02), but not with short-term quitting. Use of cessation medications was associated with making a quit attempt (adjusted OR 11.83, 95% CI 9.93-14.08), short-term quitting (adjusted OR 3.69, 95% CI 2.90-4.68), and long-term quitting (adjusted OR 2.73, 95% CI 1.95-3.82). Using prescription medications was associated with a higher likelihood of quitting short-term (adjusted OR 2.43, 95% CI 2.59-3.74) and long-term (adjusted OR 2.27, 95% CI 1.23-4.17) than using NRT. Use of cessation medications was a significant mediator in the pathway from receiving advice to quitting. CONCLUSION Health professionals should advise smokers to quit and encourage them to use cessation medications, especially prescription medications when trying to quit.
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Affiliation(s)
- Bo Zhang
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
| | - Michael O Chaiton
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Lori M Diemert
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Susan J Bondy
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - K Stephen Brown
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Statistics and Actuarial Science, University of Waterloo, Ontario, Canada
| | - Roberta Ferrence
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Liu J, Yang HI, Lee MH, Jen CL, Hu HH, Lu SN, Wang LY, You SL, Huang YT, Chen CJ. Alcohol Drinking Mediates the Association between Polymorphisms of ADH1B and ALDH2 and Hepatitis B-Related Hepatocellular Carcinoma. Cancer Epidemiol Biomarkers Prev 2016; 25:693-9. [PMID: 26827895 DOI: 10.1158/1055-9965.epi-15-0961] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/25/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The role of polymorphisms on ADH1B and ALDH2 in patients with chronic hepatitis B is unclear. This study aims to examine whether alcohol drinking mediates the association between two ADH1B and ALDH2 polymorphisms and the risk of hepatocellular carcinoma among chronic hepatitis B patients. METHODS A total of 3,824 individuals were enrolled in this study. Two SNPs, rs1229984 (ADH1B) and rs671 (ALDH2), were genotyped using the Affymetrix Axiom Genome-Wide CHB1 Array (Affymetrix, Inc). Multivariate unconditional logistic regression and mediation analyses were used, comparing CT or TT with CC for rs1229984 and GA and AA with GG for rs671. RESULTS There were 602 cases of hepatocellular carcinoma and 3,222 controls. Frequencies of the rs1229984 (ADH1B) T allele and rs671 (ALDH2) A allele were 72.9% and 28.8%, respectively. Individuals who carried at least one deficient allele for both SNPs were significantly less likely to become habitual alcohol drinkers, with an OR and 95% confidence interval (CI) of 0.24 (0.15-0.40). Alleles for rs1229984 (ADH1B) and rs671 (ALDH2) were not associated with hepatocellular carcinoma in multivariate analyses. However, mediation analyses showed that the rs1229984 T allele, rs671 A allele, and two SNPs combined were significantly associated with decreased hepatocellular carcinoma risk, mediated through alcohol drinking, with an OR (95% CI) of 0.87 (0.79-0.96), 0.70 (0.61-0.82), and 0.73 (0.58-0.88), respectively. CONCLUSIONS Polymorphisms on ADH1B and ALDH2 had significant indirect effects on hepatocellular carcinoma risk, mediated through alcohol drinking. IMPACT Future genetic studies of chronic hepatitis B and hepatocellular carcinoma must take mediation effects into consideration. Cancer Epidemiol Biomarkers Prev; 25(4); 693-9. ©2016 AACR.
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Affiliation(s)
- Jessica Liu
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chin-Lan Jen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Hui-Han Hu
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Sheng-Nan Lu
- Department of Gastroenterology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Li-Yu Wang
- MacKay Medical College, New Taipei City, Taiwan
| | - San-Lin You
- Department of Public Health, College of Medicine, Catholic Fu Jen University, New Taipei City, Taiwan
| | - Yen-Tsung Huang
- Departments of Epidemiology and Biostatistics, Brown University, Providence, Rhode Island.
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan. Graduate Institute of Epidemiology and Preventative Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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