Vol 44 # 2 June 2012 - Kma.org.kw

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153 Bilateral Massive Angiomyolipomatosis Associated with Tuberous Sclerosis June 2012 patients with tuberous sclerosis: association with renal cysts. Nephron 1982; 30:85-88. 11. Roach ES, Smith M, Huttenlocher P. Diagnostic criteria: tuberous sclerosis complex. J Child Neurol 1992; 7:221- 224. 12. Kennelly MJ, Grossman HB, Cho KJ. Outcome analysis of 42 cases of renal angiomyolipoma. J Urol 1994; 152:1988-1991. 13. Neumann HPH. Case 18-1994: Tuberous sclerosis. NEJM 1994; 331:813-814. 14. Farrow GM, Harrison EG Jr, Utz DC, et al. Renal angiomyolipoma: clinicopathologic study of 32 cases. Cancer 1968; 22:564-570. 15. Steiner MS, Stanford GM, Fishman EK, et al. The natural history of renal angiomyolipoma. J Urol 1993; 150:1762- 1786. 16. Israel GM, Bosniak MA, Slywotzky CM, et al. CT differentiation of large exophytic renal angiomyolipomas and perirenal liposarcoma. AJR 2002; 179:769-773. 17. Tuberous Sclerosis Fact Sheet. National institute of neurological disorders and stroke, 2010 (Accessed July 27, 2010, at http://www.ninds.nih.gov/disorders/ tuberous_sclerosis/detail_tuberous_sclerosis.htm.) 18. Shepherd CW, Gomez MR, Lie JT, et al. Causes of death in patients with tuberous sclerosis, Mayo Clinic Proceedings 1991; 66:792-796.
June 2012 KUWAIT MEDICAL JOURNAL 154 Letter to the Editor Evaluation of Lamivudine Effect on Prevention of Hepatocellular Carcinoma Recurrence Kuan-Fu Liao 1,2 , Shih-Wei Lai 3,4 1 Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, 427, Taiwan 2 School of Medicine, Tzu Chi University, Taiwan 3 School of Medicine, China Medical University, Taichung, Taiwan 4 Department of Family Medicine, China Medical University Hospital, Taichung,Taiwan Kuwait Medical Journal 2012; 44 (2): 154 Limited information is available about the effect of lamivudine treatment on prevention of hepatocellular carcinoma (HCC) recurrence in Taiwan. This was a hospital-based observational study. We analyzed the medical records of subjects with HCC initially treated by hepatic resection, were hepatitis B surface antigen (HBsAg) positive and hepatitis C antibody positive, at one medical center in Taiwan from 2000 to 2008. The institutional review board of this medical center approved this retrospective study. In all, seven subjects received 100 mg/day lamivudine after hepatic resection (lamivudine group) and 39 subjects underwent hepatic resection only (control group). The overall follow-up period was 52 weeks. There were no significant differences in gender, age, aspartate aminotransferase, alanine aminotransferase, total bilirubin, albumin, alpha-fetoprotein, platelet count, prothrombin time, presence of ascites, Child–Pugh score, HCC pathological grade [1] and cancer of the liver Italian program (CLIP) score [2] between the control group and the lamivudine group at the time of HCC diagnosis. The mean periods from initial treatment to recurrence were 32.3 ± 17.5 weeks (range 5 to 52) in the control group and 31.3 ± 20.6 weeks in the lamivudine group (range 7 - 52) (p = 0.890). During the followup period, out of the 46 subjects, 24 subjects (52.2%) experienced HCC recurrence at the end of 52 weeks (21 subjects in the control group and three subjects in the lamivudine group). The cumulative recurrence rates of HCC at 26 and 52 weeks in the control group were 33.3% and 53.8%, respectively, while those in the lamivudine group were 28.6% and 42.9%, respectively. There were no significant differences regarding the recurrence rates of HCC between two groups (p = 0.82). To date, there are few reports regarding the effects of antiviral therapy on recurrent HCC. Two studies in Japan have disclosed that the cumulative recurrence rates of HCC did not significantly differ between the lamivudine group and the control group [3,4] , which was compatible with this present study. In Kim’s study, lamivudine therapy could increase albumin, decrease ascites and decrease Child-Pugh score in patients with hepatitis B virus-related HCC [5] . The author concluded that lamivudine therapy could increase the curative chance in patients with hepatitis B virus-related HCC [5] . To date, according to the above literature [3,4] and this present study, lamivudine therapy seems to be not effective in prevention of HCC recurrence after resection of primary tumor. However, because this present study is a small sample size, we cannot make a strong recommendation about the effect of lamivudine therapy. A larger sample size is needed to confirm whether antiviral drugs can improve the recurrence rate. REFERENCES 1. Edmondson HA, Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48900 necropsies. Cancer 1954; 7:462-503. 2. Cancer of the Liver Italian Program (CLIP) investigators: A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients. Hepatology 1998; 28:751-755. 3. Kuzuya T, Katano Y, Kumada T, et al. Efficacy of antiviral therapy with lamivudine after initial treatment for hepatitis B virus-related hepatocellular carcinoma. J Gastroenterol Hepatol 2007; 22: 1929-1935. 4. Piao CY, Fujioka S, Iwasaki Y, et al. Lamivudine treatment in patients with HBV-related hepatocellular carcinoma - using an untreated, matched control cohort. Acta Med Okayama 2005; 59:217-224. 5. Kim JH, Park JW, Koh DW, Lee WJ, Kim CM. Efficacy of lamivudine on hepatitis B viral status and liver function in patients with hepatitis B virus-related hepatocellular carcinoma. Liver Int 2009; 29:203-207. Address correspondence to: Shih-Wei Lai, Department of Family Medicine, China Medical University Hospital, No 2, Yuh-Der Road, Taichung, 404, Taiwan. Tel: 886-4-2206- 2121 ext. 4507, Fax: 886-4-2203-3986, E-mail: wei@mail.cmuh.org.tw
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