Importance of Screening for Esophagogastric Varices in Naïve Hepatocellular Carcinoma Patients within Milan Criteria: Indicator for Liver Transplantation.

BACKGROUND/AIMS: Patients with hepatocellular carcinoma (HCC) beyond Milan criteria (MC) are not eligible for liver transplantation (LT). To elucidate prognostic factors significantly linked to recurrence beyond MC or death related to the liver, we evaluated the clinical features in a series of HCC patients within MC at baseline. METHODS: We enrolled 255 naïve HCC patients (≤70 years) within the MC who underwent upper-gastrointestinal-endoscopy, and were treated with resection or radiofrequency ablation (62 years old [median]; male:female = 202:53; Child-Pugh A:B = 216:39). A finding of esophagogastric varices (EGV) with an enlarged tortuous or coil shape, and past history of treatment for EGV were classified as clinically significant. RESULTS: Following curative therapy, there was a significant difference for both 3- and 5-year rates of recurrence beyond the MC or liver-related death between the patients with and without significant-EGV (42.8 and 64.3% vs. 25.2 and 41.2%, respectively; p < 0.001). Positive for significant-EGV, multiple tumor, and elevated levels of fucosylated-alpha-fetoprotein (≥10%) and des-gamma-carboxy-prothrombin (≥100 mAU/mL) were significant prognostic factors for recurrence beyond the MC or liver-related death in multivariate analysis (hazard ratio [HR] 2.020, p = 0.002; HR 1.880, p = 0.005; HR 1.626, p = 0.045; HR 1.722, p = 0.011, respectively). CONCLUSION: LT should be considered for EGV-positive patients with naïve HCC and within the MC.

Sarcopenia and two types of presarcopenia in Japanese patients with chronic liver disease.

BACKGROUND/AIM: The frequency of sarcopenia, defined as loss of both muscle volume and strength, was analyzed in chronic liver disease (CLD). METHODS AND MATERIALS: From April to September 2015, 807 Japanese CLD patients treated as outpatients were enrolled (67.1±10.0 years, men : women=466 : 341, hepatitis C virus : hepatitis B virus : hepatitis B and C virus : alcohol : other=511 : 134 : 3 : 45 : 114). Sarcopenia was diagnosed when the patient showed muscle volume loss and reduced handgrip strength, whereas those with only muscle volume loss were classified as 'v-presarcopenia' and those with only reduced handgrip strength were classified as 's-presarcopenia'. Muscle volume loss was determined using computed tomography findings and a previously reported index (psoas index), and cut-off values for reduced handgrip strength presented by the Asia Working Group for Sarcopenia (AWGS) (AWGS/grip criteria) and European Working Group on Sarcopenia in Older People (EWGSOP) (EWGSOP/grip criteria) (men; 26 and 30 kg, women; 18 and 20 kg, respectively) were used. Clinical features were analyzed for diagnoses of chronic hepatitis (CH, n=381), liver cirrhosis Child-Pugh A (n=330), and liver cirrhosis Child-Pugh B/C (n=96). RESULTS: When the AWGS/grip criteria were used, the frequencies of sarcopenia, v-presarcopenia, and s-presarcopenia in CH were 3.9, 7.9, and 19.4%, whereas those in Child-Pugh A were 4.8, 17.6, and 21.8% and those in Child-Pugh B/C were 16.7, 11.5, and 39.6%, respectively. When the EWGSOP/grip criteria were used, these frequencies were 7.1, 4.7, and 33.1%, in CH, 11.8, 10.6, and 32.7%, in Child-Pugh A, and 21.9, 6.3, and 49.0%, in Child-Pugh B/C, respectively. The incidence rates of sarcopenia and both types of presarcopenia increased with progression of CLD. CONCLUSION: Evaluation of handgrip strength and psoas index is an easy and effective method for the detection of sarcopenia and presarcopenia.

Usefulness of albumin-bilirubin grade for evaluation of prognosis of 2584 Japanese patients with hepatocellular carcinoma.

BACKGROUND AND AIM: The Child-Pugh classification has some non-objective factors, with chronic hepatitis indistinguishable from early liver cirrhosis in Child-Pugh A. We retrospectively evaluated the efficacy of albumin-bilirubin (ALBI) grade, which has been proposed as a new classification for hepatic function, for grading hepatocellular carcinoma (HCC) patients based on hepatic function and predicting their prognosis. METHOD: From 2000 to 2014, 2584 naïve HCC [69.0 ± 9.8 years old, 1850 men, 734 female, Child-Pugh class A:B:C = 1871:558:155] were enrolled. TNM staging was determined using the classification of the Liver Cancer Study Group of Japan and ALBI grade, instead of Child-Pugh classification (ALBI with TNM score: ALBI-T score) (Table 1), and is similar to the Japan Integrated Staging (JIS) score. We retrospectively compared ALBI-T and JIS scores in these patients. RESULTS: Of patients classified as Child-Pugh A (n = 1871), 1285 with 5 points were divided into 858 with ALBI grade 1 and 427 with grade 2, while 586 with 6 points were divided into 53 with grade 1 and 533 with grade 2. The ratio of ALBI grade 2 patients with a Child-Pugh score of 6 points (91.0%) was similar to that of those with 7 points (91.8%). Patients with a lower ALBI-T score (0-5 points) showed a better median survival time than those with a corresponding lower JIS score [137.7:83.2:53.4:27.4:5.0:1.4 vs 97.6:74.9:39.7:15.0:4.0:1.0 months]. CONCLUSION: Albumin-bilirubin grade was found to be superior for distinguishing patients with better hepatic function. ALBI-T scoring may be a better total prognostic scoring system for predicting survival of Japanese patients with HCC.