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Martins A, Cortez-Pinto H, Marques-Vidal P, Mendes N, Silva S, Fatela N, Glória H, Marinho R, Távora I, Ramalho F, de Moura MC. Treatment and prognostic factors in patients with hepatocellular carcinoma. Liver Int 2006; 26:680-7. [PMID: 16842324 DOI: 10.1111/j.1478-3231.2006.001285.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Hepatocellular carcinoma is a leading cause of death from cancer worldwide. Survival of patients depends on tumor extension and liver function, but yet there is no consensual prognostic model. AIMS To evaluate the influence on survival of pretreatment parameters (clinico-laboratorial, liver function, tumor extension, Okuda and Cancer of the Liver Italian program (CLIP) staging) and treatment modalities. METHODS We retrospectively analyzed 207 patients, diagnosed between 1993 and 2003. The initial treatment was: surgery--six patients; radiofrequency ablation--21; percutaneous ethanol injection--29; transarterial chemoembolization--49; tamoxifen--49; supportive care alone--53. Factors determining survival were assessed by Kaplan-Meier method and Cox regression models. RESULTS Median survival was 24 months. In univariate analysis, Child-Pugh classification and Model for end-stage liver disease (MELD) score, portal vein thrombosis (PVT), tumor size, number of lesions, Okuda and CLIP scores were all associated with prognosis (P < 0.001). Alpha-fetoprotein levels were not predictive of survival. Independent predictors of survival were ascites, bilirubin, PVT and therapeutic modalities (P < 0.001). In early stage hepatocellular carcinoma (HCC), survival was similar for both percutaneous ablation modalities, either radiofrequency or ethanol injection (P = NS). In advanced HCC, survival was better in patients receiving tamoxifen than supportive care alone (P < 0.001). CONCLUSION This study reinforces the importance of baseline liver function (Child-Pugh classification and MELD score) in the survival of patients with HCC, although staging systems allowed the stratification of patients in different prognostic groups. Ascites, bilirubin and PVT were independent pretreatment predictors of survival. All treatments influenced the patient's outcome, whether in early or advanced stages.
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Affiliation(s)
- A Martins
- Unidade de Hepatologia-Serviço Gastrenterologia, Hospital Universitário de Santa Maria, IMM, Lisboa, Portugal.
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Ramalho F, Costa A, Pires A, Cabrita P, Serejo F, Correia AP, Fatela N, Clória H, Lopes J, Pinto HC, Marinho R, Raimundo M, Velosa J, Batista A, de Moura MC. Correlation of genotypes and route of transmission with histologic activity and disease stage in chronic hepatitis C. Dig Dis Sci 2000; 45:182-7. [PMID: 10695633 DOI: 10.1023/a:1005442317680] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Our objective was to evaluate the histopathological features of chronic hepatitis C of 64 liver biopsies and to correlate this with the route of transmission of hepatitis C virus, the genotype of HCV, and the patient's age. Moderate chronic hepatitis was the most frequently observed (62.5%). Cirrhosis was observed in 14 patients (21.9%) and was more frequently found among patients over 40 years of age (34.3% vs. 6.9%, P = 0.025). The mean histopathological activity index (HAI) was significantly higher in the sporadic (10+/-3.1) than the posttransfusional (7.5+/-3.7) and the intravenous drug use (IVDU) groups (6.3+/-2.8) (P<0.02). Moreover the sporadic group showed more fibrosis (P<0.04) than the posttransfusional group. No liver cirrhosis was found in the IVDU group. The overall prevalence of HCV variants was: 54.7% type 1b, 4.6% type 1a, 37.5% type 2c, 1.6% type 2b, 1.6% type 2. The genotype distribution showed no relation to the HAI, hepatitis activity (grade), and fibrosis (stage) of the liver disease. In conclusion, the sporadic route of transmission of HCV was related to a more severe chronic hepatic disease, a finding that could influence future antiviral therapies. The predominance of HCV type 1b in this study reflects the higher frequency of this variant in our area. Our data suggests that the ultimate consequence of HCV chronic infection depends on patient age rather than on HCV genotype.
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Affiliation(s)
- F Ramalho
- Pathology Department, Hospital de Santa Maria, Lisbon, Portugal
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Fixa B, Komárková O, Krejsek K, Bures J, Nozicka Z, Giorcelli W, Rodi M, Camisasca G, Martinotti RG, Mendall MA, Goggin PM, Molineaux N, Levy J, Toosy T, Strachan D, Northfield TC, Vorobjova T, Vassiljev V, Kisand K, Wadström T, Uibo R, Zotz RB, Xu SG, Recklinghausen GV, Meusers P, Goebell H, Rhee KH, Youn HS, Paik SK, Lee WK, Cho MJ, Park CK, Li Y, Hu P, Du G, Wong Z, Hazell SL, Mitchell HM, Korwin JDD, Remot P, Hartemann P, Catelle A, Conroy MC, Schmitt J, Stolte M, Wellens E, Bethke B, Ritter M, Eidt H, Zanten SVV, Best L, Bezanson G, Marrie T, Poniewierka E, Gosciniak G, Matysiak-Budnik T, Quatrini M, Boni F, Baldassarri AR, Vecchi AD, Castelnovo C, Viganò E, Tenconi L, Bianchi PA, Carlucci A, Ferrini G, Bianco I, Larcinese G, Sciascio AD, Fly GF, Hauge T, Persson J, Coelho LGV, Teixeira MM, Passos MCF, Givisiez CB, Santos CMFR, Rodrigues CJS, Chausson Y, Castro LP, Hyvärinen H, Seppälä K, Kivilaakso E, Kosunen T, Gormse M, Pilotto A, Vianello F, Tornaboni D, Dotto P, Battaglia G, Binda F, Mario FD, Donisi PM, Pasini M, Benve-nuti ME, Stracca-Pansa V, Pasquino M, Jablonowski H, Szelényi H, Hengels KJ, Strohmeyer G, Banatvala N, Mayo K, Megraud F, Jennings R, Deeks JJ, Feldman RA, Bulighin G, Ederie A, Pilati S, Franzin G, Zamboni G, Maran M, Musola R, Tobin A, Hackman RC, McDonald GB, Fatela N, Cristino JM, Monteiro L, Ramalho F, Saragoça A, Salgado MJ, Moura MCD, Pretolani S, Gasbarrini G, Bonvicini F, Baraldini M, Tonelli E, Gatto MRA, Ghironzi GC, égraud FM, Bouchard S, Lubcvzumiska-Kowalska W, Knapik Z, Meenan J, Goggins M, Shahi C, Keeling PWN, Keane C, Weir DG, Vaira D, Miglioli M, Mulè P, Holten J, Menegati M, Biasco G, Vergura M, Nannetti A, Barbara L, Boschini A, Begnini M, Menegatti M, Ghira C, D’Errico A, Evans DG, Asnicar MA, Evans DJ, Graham DY, Lee CH, Coschieri M, Fosse T, Paul MCS, Michiels JR, Delmont JP, Péroux JL, Pradier C, Rampai P, Pazzi P, Merighi A, Gamberini S, Scarliarini R, Bicochi R, Libanore M, Bisi G, Gulllini S. Epidemiology. Ir J Med Sci 1992. [DOI: 10.1007/bf02942891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Figura N, Owen RJ, Desai M, Bayeli PF, HGregorio LD, Russi M, Musmanno RA, Hawtin PR, Sharpstone D, Hayes L, Nøorgaard A, Nielsen H, Andersen LP, Geis G, Leying H, Suerbaum S, Opferkuch W, Tonokatsu Y, Hayashi T, Fukuda Y, Yamamoto I, Takami S, Tamura T, Shimoyama T, Lopez-Brea M, Martin E, C.Sanz J, Alonso M, Alarcon T, Michetti P, Porta N, Racine L, P.Kraehenbuhl J, L.Blum A, Cardeñoso L, Moran AP, Muotiala A, Pyhälä L, Kosunen TU, Helander IM, Roine RP, Salmela KS, Höök-Nikanne J, Salaspuro M, Daw MA, Xia HX, O’Morain C, Lelwala-Guruge J, Ascencio F, Ljungh Å, Wadström T, Ringnér M, Valkonen K, Paulsson M, Ljungh Å, Wadström T, Guldvog I, Tannaes T, Bukholm G, Grav H, Corinaldesi R, Tucci A, Stanghellini V, Gasperoni S, Varoli O, Paparo GF, Gaetani M, Cioffi G, Barbara L, Husson MO, Legrand D, Mazurier J, Caron C, Leclerc H, Spik G, English L, Keane CT, O’Morain CA, Fox JG, Correa P, Taylor NS, Fatela N, Melo Cristino J, Monteiro L, Ramalho F, Saragoça A, Salgado M, Mauch F, Bode G, Ditschuneit H, Malfertheiner P, Nilius M, Pugliese M, Moshkowitz M, Gorea A, Santo M, Berger S, Gilat T, Belluzzi A, Vaira D, Campieri M, Boschi S, Gionchetti P, Mulè P, Brignola C, Rizzello F, Miglioli M, Barbara L, Lamouliatte H, Brugmann D, Cayla R, H. Bernard P, Mégraud F, Quinton A, Bär W, Wagner S, Glen-Calvo E, Koopmann H, Szentmihalyi A, Radnai Z, Molnar G, Bálint A, Ihász M. Microbiology. Ir J Med Sci 1992. [DOI: 10.1007/bf02942889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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