Hepatic venous pressure gradient can predict the development of hepatocellular carcinoma and hyponatremia in decompensated alcoholic cirrhosis.

OBJECTIVE: Portal hypertension is closely associated with serious complications of cirrhosis, which contribute to bad prognosis. Hepatocellular carcinoma (HCC) and low serum sodium (SNa) are manifestations of end-stage liver disease and are associated with poor survival in decompensated cirrhosis patients. We aimed to determine the relationship between hepatic venous pressure gradient (HVPG) and the development of HCC or low SNa in decompensated alcoholic cirrhosis patients. METHODS: Child-Pugh scores, Model for End-Stage Liver Disease scores, and HVPG at baseline, and the development of HCC or low SNa (SNa <130 mEq/l) during follow-up were analyzed prospectively in 170 patients with decompensated alcoholic cirrhosis from December 1999 to January 2008 (mean follow-up period of 33.9+/-27.9 months). The predictive value of different risk factors for the development of HCC and low SNa and survival were investigated. RESULTS: Twenty-four patients developed HCC during the follow-up period. In the multivariate analysis, only baseline HVPG greater than 15 mmHg was an independent predictive factor for the development of HCC (relative risk=1.128, P<0.05) and which showed a significantly shorter time for the development of HCC on the Kaplan-Meier analysis. Twenty patients developed low SNa during follow-up. Initial HVPG was also an independent predictive factor for the new development of low SNa in the multivariate analysis (relative risk=1.169, P<0.05) and which also showed significantly shorter times for the development of low SNa on the Kaplan-Meier analysis. CONCLUSION: In decompensated alcoholic cirrhosis, HVPG may be a useful predictive factor for the development of HCC and low SNa.

Differences in overall survival when colorectal cancer patients are stratified into new TNM staging strategy.

PURPOSE: The purpose of this study is to determine whether the prognosis can be more precisely gauged by the revised 6th AJCC staging system and if this is suitable for Korean colorectal cancer patients, and especially for those patients in the Youngdong district. MATERIALS AND METHODS: Between September 1996 and December 2003, 365 patients with histologically confirmed colorectal cancer were analyzed. Kaplan-Meier analyses were used to compare the overall and stage-specific 5-year survival. All the statistical tests were two-sided. RESULTS: The overall 5-year survival for the entire cohort was 62%. According to the stages defined by the AJCC fifth edition system, the 5-year stage-specific survival was 91% for stage I, 82% for stage II, 51% for stage III and 4% for stage IV. According to the stages defined by the AJCC sixth edition system, the 5-year stage-specific survival was 91% for stage I, 81% for stage IIa, 83% for stage IIb, 100% for stage IIIa, 64% for stage IIIb, 37% for stage IIIc and 4% for stage IV. The 5-year survival was significantly better for the patients with stage IIIb (64%) than those patients with stage IIIc (37%) (p<.001). CONCLUSION: It is widely known that the AJCC sixth edition system for colorectal cancer stratifies survival more distinctly than does the fifth edition system by providing more substages. Our study showed that stage IIIb disease had better survival than stage IIIc disease, but we couldn't confirm that this new staging system is relevant in our Korean clinical practice due to the small study population. Therefore, further study is required in a larger population.