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Fujiwara N, Nakagawa H, Kudo Y, Tateishi R, Taguri M, Watadani T, Nakagomi R, Kondo M, Nakatsuka T, Minami T, Sato M, Uchino K, Enooku K, Kondo Y, Asaoka Y, Tanaka Y, Ohtomo K, Shiina S, Koike K. Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma. J Hepatol 2015; 63:131-40. [PMID: 25724366 DOI: 10.1016/j.jhep.2015.02.031] [Citation(s) in RCA: 496] [Impact Index Per Article: 55.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 02/02/2015] [Accepted: 02/18/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Obesity defined by body mass index (BMI) significantly increases the risk of hepatocellular carcinoma (HCC). In contrast, not only obesity but also underweight is associated with poor prognosis in patients with HCC. Differences in body composition rather than BMI were suggested to be true determinants of prognosis. However, this hypothesis has not been demonstrated conclusively. METHODS We measured skeletal muscle index (SMI), mean muscle attenuation (MA), visceral adipose tissue index, subcutaneous adipose tissue index, and visceral to subcutaneous adipose tissue area ratios (VSR) via computed tomography in a large-scale retrospective cohort of 1257 patients with different stages of HCC, and comprehensively analyzed the impact of body composition on the prognoses. RESULTS Among five body composition components, low SMI (called sarcopenia), low MA (called intramuscular fat [IMF] deposition), and high VSR (called visceral adiposity) were significantly associated with mortality, independently of cancer stage or Child-Pugh class. A multivariate analysis revealed that sarcopenia (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.18-1.96; p=0.001), IMF deposition (HR, 1.34; 95% CI, 1.05-1.71; p=0.020), and visceral adiposity (HR, 1.35; 95% CI, 1.09-1.66; p=0.005) but not BMI were significant predictors of survival. The prevalence of poor prognostic body composition components was significantly higher in underweight and obese patients than in normal weight patients. CONCLUSIONS Sarcopenia, IMF deposition, and visceral adiposity independently predict mortality in patients with HCC. Body composition rather than BMI is a major determinant of prognosis in patients with HCC.
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Affiliation(s)
- Naoto Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yotaro Kudo
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
| | - Masataka Taguri
- Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, Japan
| | - Takeyuki Watadani
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Ryo Nakagomi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Mayuko Kondo
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Takuma Nakatsuka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Tatsuya Minami
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Masaya Sato
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Koji Uchino
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kenichiro Enooku
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yuji Kondo
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yoshinari Asaoka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yasuo Tanaka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kuni Ohtomo
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Japan
| | | | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
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Fujiwara N, Tateishi R, Nakagawa H, Nakagomi R, Kondo M, Minami T, Sato M, Uchino K, Enooku K, Kondo Y, Asaoka Y, Shiina S, Yoshida H, Koike K. Slight elevation of high-sensitivity C-reactive protein to predict recurrence and survival in patients with early stage hepatitis C-related hepatocellular carcinoma. Hepatol Res 2015; 45:645-55. [PMID: 25070147 DOI: 10.1111/hepr.12398] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 07/13/2014] [Accepted: 07/22/2014] [Indexed: 12/29/2022]
Abstract
AIM Hepatocellular carcinoma (HCC) is associated with chronic inflammation derived from various origins. We investigated whether high-sensitivity C-reactive protein (hsCRP) could predict recurrence and survival after curative treatment for early stage hepatitis C virus-related HCC (C-HCC). METHODS We enrolled 387 patients with three or fewer C-HCC nodules, none of which exceeded 3 cm, and of Child-Pugh class A or B who underwent radiofrequency ablation. We divided the patients into high and low hsCRP groups based on the optimal cut-off value for recurrence using a split-sample method and maximally selected rank statistics. Differences in recurrence and survival rates were evaluated by the Kaplan-Meier method and the log-rank test. Hazard ratios of hsCRP were adjusted with confounding factors using a multiple Cox regression model. We also assessed the correlations between hsCRP levels and clinical parameters. RESULTS The optimal hsCRP cut-off value was 0.08 mg/dL. The cumulative recurrence rates after 5 years in the high and low hsCRP groups were 90.0% and 82.2%, respectively (P = 0.028), and the corresponding survival rates were 50.9% and 71.8%, respectively (P < 0.001). Higher hsCRP was an independent predictor for recurrence (adjusted hazard ratio [aHR], 1.32; 95% confidence interval [CI], 1.03-1.67; P = 0.026) and survival (aHR, 1.59; 95% CI, 1.14-2.22; P = 0.007). hsCRP was correlated with central obesity as well as tumor burden and liver dysfunction. CONCLUSION Slight elevation of the hsCRP level, even within the normal range, can predict recurrence and survival after curative treatment among patients with early stage C-HCC.
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Affiliation(s)
- Naoto Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Nakagomi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mayuko Kondo
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Minami
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaya Sato
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Uchino
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichiro Enooku
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuji Kondo
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshinari Asaoka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Haruhiko Yoshida
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Ohki T, Tateishi R, Akahane M, Mikami S, Sato M, Uchino K, Arano T, Enooku K, Kondo Y, Yamashiki N, Goto T, Shiina S, Yoshida H, Matsuyama Y, Omata M, Ohtomo K, Koike K. CT with hepatic arterioportography as a pretreatment examination for hepatocellular carcinoma patients: a randomized controlled trial. Am J Gastroenterol 2013; 108:1305-13. [PMID: 23629602 PMCID: PMC3734528 DOI: 10.1038/ajg.2013.109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 03/12/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The combination of computed tomography with hepatic arteriography and arterial portography (CTHA/CTAP) can detect additional hepatocellular carcinoma (HCC) nodules undetected by conventional dynamic CT. METHODS In this single-center, randomized, open-label, controlled trial, we randomly assigned 280 patients who were diagnosed as having HCC by conventional dynamic CT, and eligible for radiofrequency ablation (RFA), to undergo CTHA/CTAP before treatment, or to the control group. Newly detected HCC nodules by CTHA/CTAP were intended to be ablated completely. The primary end point was recurrence-free survival and the key secondary end point was overall survival. The analysis was conducted on an intention-to-treat basis. Those with nonablated nodules were treated as for recurrence. RESULTS A total of 75 nodules were newly diagnosed as HCC by CTHA/CTAP in 45 patients. Three patients (one in the CTHA/CTAP group and two in the control group) who refused treatment were excluded from all analyses. The cumulative recurrence-free survival rates at 1, 2, and 3 years were 60.1, 29.0, and 18.9% in the CTHA/CTAP group and 52.2, 29.7, and 23.1% in the control group, respectively (P=0.66 by log-rank test; hazard ratio, 0.94 for CTHA/CTAP vs. control; 95% confidence interval (CI), 0.73-1.22). The cumulative overall survival rates at 3 and 5 years were 79.7 and 56.4% in the CTHA/CTAP group and 86.8 and 60.1% in the control group, respectively (P=0.50; hazard ratio, 1.15, 95% CI, 0.77-1.71). CONCLUSIONS CTHA/CTAP may detect recurrent lesions earlier. However, CTHA/CTAP before RFA did not improve cumulative recurrence-free survival or overall survival.
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Affiliation(s)
- Takamasa Ohki
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan
- The first two authors contributed equally to this work
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- The first two authors contributed equally to this work
| | - Masaaki Akahane
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shintaro Mikami
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masaya Sato
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Koji Uchino
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Toru Arano
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kenichiro Enooku
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yuji Kondo
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Noriyo Yamashiki
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tadashi Goto
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Haruhiko Yoshida
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masao Omata
- Yamanashi Prefectural Hospital Organization, Kofu, Japan
| | - Kuni Ohtomo
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Characteristics of hepatocellular carcinoma nodules newly detected by computed tomography during arteriography and arterial portography: preliminary report of a randomized controlled trial. Hepatol Int 2011; 6:639-45. [PMID: 22020826 DOI: 10.1007/s12072-011-9310-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 08/17/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS This study was part of an on-going randomized controlled trial to investigate the utility of computed tomography (CT) during hepatic arteriography and arterial portography (CTHA/CTAP) as a pre-treatment examination for patients with small hepatocellular carcinoma (HCC). METHODS A total of 137 patients with HCC who were diagnosed by dynamic CT showing hyperattenuation in the arterial phase and hypoattenuation in the equilibrium phase, were Child-Pugh class A, and had three or less tumors with diameters ≤ 3.0 cm were randomly assigned to undergo CTHA/CTAP. We compared the diagnostic utilities of CTHA/CTAP and dynamic CT. Univariate and multivariate logistic regression analyses with stepwise variable selection were performed to identify factors related to the detection of additional nodules. RESULTS The total number of HCCs at the time of diagnosis with contrast-enhanced dynamic CT was 197. 75 nodules with a mean diameter of 8.7 mm (range 2-20) in 45 patients (32.8%) were additionally diagnosed as definite HCC on CTHA/CTAP compared with dynamic CT. A retrospective review revealed that 54 nodules could have been identified on arterial or equilibrium phase of the previous dynamic CT, whereas 21 were indiscernible. Multivariate logistic regression analysis revealed that multinodularity on dynamic CT [odds ratio (OR) = 5.35, P = 0.002], recurrent case as opposed to initial case (OR = 2.16, P = 0.06), and seronegativity for hepatitis B surface antigen (OR = 10.0, P = 0.03) were associated with the detection of additional nodules. CONCLUSION CTHA/CTAP may be useful for detecting additional nodules prior to percutaneous ablation in patients with multinodular HCC on dynamic CT, in recurrent cases, and in hepatitis B surface antigen-negative cases.
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Ikeda H, Tateishi R, Enooku K, Yoshida H, Nakagawa H, Masuzaki R, Kondo Y, Goto T, Shiina S, Kume Y, Tomiya T, Inoue Y, Nishikawa T, Ohtomo N, Tanoue Y, Ono T, Koike K, Yatomi Y. Prediction of hepatocellular carcinoma development by plasma ADAMTS13 in chronic hepatitis B and C. Cancer Epidemiol Biomarkers Prev 2011; 20:2204-11. [PMID: 21876190 DOI: 10.1158/1055-9965.epi-11-0464] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic liver injury evokes a wound healing response, promoting fibrosis and finally hepatocellular carcinoma (HCC), in which hepatic stellate cells play an important role. Although a blood marker of hepatic stellate cells is not known, those cells importantly contribute to the regulation of plasma a disintegrin-like and metalloproteinase with thrombospondin type-1 motifs 13 (ADAMTS13) activity, a defect of which causes thrombotic thrombocytopenic purpura. METHODS Plasma ADAMTS13 was evaluated in chronic hepatitis B or C patients with or without HCC. RESULTS Plasma ADAMTS13 activity significantly correlated with serum aspartate aminotransferase and alanine aminotransferase, liver stiffness value, and aspartate aminotransferase-to-platelet ratio index, irrespective of the presence of HCC, suggesting that it may reflect hepatocellular damage and subsequent wound healing and fibrosis as a result of hepatic stellate cell action. During the three-year follow-up period for patients without HCC, it developed in 10 among 81 patients. Plasma ADAMTS13 activity was significantly higher in patients with HCC development than in those without and was a significant risk for HCC development by univariate and multivariate analyses. Furthermore, during the one-year follow-up period for patients with HCC treated with radiofrequency ablation, HCC recurred in 55 among 107 patients. Plasma ADAMTS13 activity or antigen level was significantly higher in patients with HCC recurrence than in those without and was retained as a significant risk for HCC recurrence by multivariate analysis. CONCLUSIONS Higher plasma ADAMTS13 activity and antigen level was a risk of HCC development in chronic liver disease. IMPACT Plasma ADAMTS13 as a potential marker of hepatic stellate cells may be useful in the prediction of hepatocarcinogenesis.
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Affiliation(s)
- Hitoshi Ikeda
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
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Ohki T, Tateishi R, Shiina S, Sato T, Masuzaki R, Yoshida H, Kanai F, Obi S, Yoshida H, Omata M. Obesity did not diminish the efficacy of percutaneous ablation for hepatocellular carcinoma. Liver Int 2007; 27:360-7. [PMID: 17355458 DOI: 10.1111/j.1478-3231.2006.01420.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
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<or=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% in the overweight group and 7.6% in the control group (P=0.94). There was no significant difference in cumulative recurrence rate and local tumor-progression rate between the two groups (P=0.63 and 0.44). Cumulative survival rates at 1, 3, and 5 years were 95.4%, 75.7%, and 57.8%, respectively, in the overweight group and 94.1%, 78.0%, and 58.8% in the control group (P=0.99). CONCLUSIONS The results indicated that overweight did not increase complications nor affect HCC recurrence and overall survival. However, the number of sessions of RFA was significantly greater in overweight patients, suggesting that overweight was associated with minor technical difficulties.
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Affiliation(s)
- Takamasa Ohki
- Department of Gastroenterology, University of Tokyo, Tokyo, Japan
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