Ghrelin's second life - World Journal of Gastroenterology

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level, or rapid enlargement of lesions without typical HCC characteristics. If tumor recurrence was diagnosed, patients received a second hepatectomy, chemoembolization and locoregional ablation, such as RFA or percutaneous ethanol rejection. Statistical analysis Patient demographics, tumor parameters, liver function and hepatitis-associated characteristics were evaluated. Continuous data are expressed as mean ± SD. Categorical data were compared using the χ 2 test and Fisher’s exact test as appropriate. Survival analyses were performed using the Kaplan-Meier method and compared using the logrank test. For continuous data with statistical significance in the univariate analysis, a series of receiver operating characteristics (ROC) curves were used to identify the cutoff values with optimal discriminatory ability for 1-year survival. Multivariate analysis was performed using the Cox proportional hazard ratio model to identify independent prognostic factors. The factors with a P-value less than 0.1 in univariate analysis were included in the multivariate Cox regression analysis. In order to estimate the clinical value of the independent factors, a prognostic scoring system was constructed. We assigned points to each independent predictor according to the value of the partial regression coefficient, because each factor had different importance in the final Cox model [22] . Each patient’s score was the total points of 6 factors. A ROC curve was constructed to estimate the prognostic ability of the new scoring model. Overall survival was the time from the day of surgery to the day of death or to the most recent follow-up visit. Disease-free survival was the time from the day of surgery to the most recent follow-up visit at which evidence of a tumor was clear. The deaths caused by non-HCCassociated factors were included in the overall survival analysis, but not in the disease-free survival analysis. A P value < 0.05 was considered statistically significant. All statistical processing was performed by SPSS 18.0 (SPSS Inc., Chicago, IL, United States). RESULTS Survival, outcome and morbidity after liver resection The mean postoperative hospitalization period was 10.6 d (range: 5-28 d). The overall morbidity was 25.31% (n = 41). Pleural effusion (n = 24) and ascites (n = 14), which required diuretics or paracentesis, were the most common sequelae, with both occurring in 7 patients. Two patients developed bile leakage and one developed transitory arrhythmia. The median overall survival was 38.3 mo (range: 3-80 mo); overall survival rates at 1 year, 3 years and 5 years were 86%, 51% and 35%, respectively; the median disease-free survival was 18.6 mo (range: 1-79 mo); 1-year, 3-year and 5-year disease-free survival rates were 56%, 40% and 31%, respectively. The survival outcome was similar to that in 2 previous retrospective studies [4,8] . During the entire follow-up, a total of 100 (61.73%) patients were diagnosed with tumor recurrence during the follow- WJG|www.wjgnet.com Zhao WC et al . Prognostic factors of multinodular HCC up period. Among them, twelve patients underwent a second hepatic resection, 65 received transarterial chemoembolization (TACE) alone, 18 received TACE combined with locoregional ablation and 5 received locoregional ablation alone. A total of 32 patients died within the first year after resection. Four patients died at the 3rd month, one died of acute severe hepatitis and 3 of unrecovered liver impairment after chemoembolization for recurrence. Of the remaining 28 patients, one died of incidental hemorrhage of the upper digestive tract at the 7th month after resection, 27 died of liver failure, including 4 patients within 4-6 mo, 2 within 7-9 mo, and 9 within 10-12 mo. All 27 patients had diffuse tumor recurrence leading to liver failure. Predictive factors for 1-year survival In the evaluation of preoperative factors that may have potential prognostic ability for short-term outcome, we limited the endpoint of follow-up to 1 year. The univariate Kaplan-Meier analysis showed that TBIL, prealbumin, AST, AFP, HBeAg, HBV-DNA, GGT, AFU, total tumor size, largest tumor size, ALP, and platelet count were significantly associated with 1-year mortality after hepatic resection (Table 2). For the above factors, we analyzed continuous data by ROC curves to determine cutoff values that had the optimal sensitivity and specificity (i.e., the largest sum of sensitivity and specificity). The cutoff values of platelet count, AST, TBIL, AFU, AFP, GGT and ALP (92.5 × 10 9 /L, 41.8 U/L, 17.25 μg/L, 36 U/L, 32.6 μg/L, 75.5 U/L, 119.5 U/L, respectively) were similar to the limits of normal values, thus we defined the normal upper or low limitations as the best cutoff points (Table 3). Multivariate analysis showed that 6 variables were significant predictive factors for 1-year survival status after resection: prealbumin < 170 mg/L [hazard ratio (HR): 5.531, P < 0.001]; ALP > 129 U/L (HR: 3.252, P = 0.005); AFP > 20 μg/L (HR: 7.477, P = 0.011); total tumor size > 8 cm (HR: 10.543, P < 0.001); platelet count < 100 × 10 9 /L (HR: 9.937, P < 0.001), and GGT > 64 U/L (HR: 3.791, P < 0.001) (Table 4). Although factors of tumor invasiveness cannot be detected before surgery, the data showed that microvascular invasion and poor tumor differentiation were associated with tumor size (Figure 1). Construction of a scoring system to determine indication for surgery We assigned points for each prognostic factor (Table 4). The theoretical range of the prognostic score was 0 to 9. In the total population in our study, 10 patients scored 0, 16 patients scored 1, 44 patients scored 2, 32 patients scored 3, 18 patients scored 4, 22 patients scored 5, 10 patients scored 6, 6 patients scored 7, and 4 patients scored 8. A higher score implied a lower chance of 1-year survival. We assessed the prognostic value of the score on 1-year survival using a ROC curve (Figure 2). The area under the curve was 0.925 [95% confidence interval (CI): 0.864-0.985, P < 0.001]. The data indicated that, 3275 July 7, 2012|Volume 18|Issue 25|
Zhao WC et al . Prognostic factors of multinodular HCC Table 2 Univariate Cox analysis of potential prognostic factors Variables n The 1-year survival rates % WJG|www.wjgnet.com P value Age < 0.001 > 40 yr 128 85.9 ≤ 40 yr 34 64.7 Parameters of liver function TBIL < 0.001 > 17.1 μmol/L 49 58.33 ≤ 17.1 μmol/L 113 91.22 ALB 0.530 < 35 g/L 8 75.00 ≥ 35 g/L 154 81.82 GLB 0.565 > 30 g/L 79 79.48 ≤ 30 g/L 83 83.33 Prealbumin < 0.001 < 170 mg/L 33 58.3 ≥170 mg/L 129 90.6 ALT 0.281 > 38 U/L 82 78.04 ≤ 38 U/L 80 85.00 ALT 0.993 > 76 U/L 10 80.00 ≤ 76 U/L 152 81.58 AST 0.001 > 38 U/L 88 75.00 ≤ 38 U/L 74 89.21 AFU 0.004 > 40 U/L 31 64.31 ≤ 40 U/L 131 85.89 ALP 0.001 > 129 U/L 27 58.33 ≤ 129 U/L 135 85.50 GGT < 0.001 > 64 U/L 82 65.00 ≤ 64 U/L 80 97.56 PT 0.428 > 13 s 41 75.00 ≤ 13 s 121 82.00 APTT 0.566 > 37 s 72 77.80 ≤ 37 s 90 82.20 Parameters of blood test WBC 0.389 < 4 × 10 9 /L 35 76.5 ≥ 4 × 10 9 /L 127 82.5 PLT < 0.001 < 100 × 10 9 /L 44 59.1 ≥100 × 10 9 /L 118 89.7 Parameters of tumors Total tumor size 0.010 > 5 cm 108 75.9 ≤ 5 cm 54 92.6 Total tumor size < 0.001 > 8 cm 54 66.7 ≤ 8 cm 108 88.9 Largest tumor size 0.050 > 5 cm 58 72.41 ≤ 5 cm 104 84.61 Largest tumor size 0.001 > 8 cm 22 54.54 ≤ 8 cm 140 84.28 AFP < 0.001 > 20 μg/L 102 72.00 ≤ 20 μg/L 60 96.78 AFP 0.014 > 400 μg/L 59 72.41 ≤ 400 μg/L 103 86.54 CA19-9 0.287 > 39 U/L 35 72.22 ≤ 39 U/L 127 83.87 Location in same segment Yes 20 80.00 0.924 No 142 81.96 Location in same lobe Yes 34 88.2 0.238 No 128 79.7 Location in same hemiliver Yes 74 83.8 0.530 No 88 79.5 Number of tumors 0.529 ≤ 3 146 80.82 > 3 16 87.50 Parameters of hepatitis B HBsAg 0.517 Positive 156 80.81 Negative 6 100.00 HBsAb 0.803 Positive 8 100.0 Negative 154 80.52 HBeAg Positive 64 71.88 0.005 Negative 98 87.76 HBeAb Positive 101 84.31 0.041 Negative 61 74.19 HBV-DNA 1 0.228 > 10 4 /L 88 79.54 ≤ 10 4 /L 50 88.00 HBV-DNA 1 0.019 > 10 6 /L 32 68.75 ≤ 10 6 /L 106 86.79 1 There were only 138 patients received HBV-DNA examinations. GLB: Globulin; ALP: Alkaline phosphatase; AFU: α fucosidase; GGT: γ-glutamyl transpeptidase; PLT: Platelet; HBV: Hepatitis B virus; HBsAg: Hepatitis B surface antigen; HBeAg: Hepatitis B e antigen; HBsAb: Hepatitis B surface antibody; HBeAb: Hepatitis B e antibody; CA19-9: Carbohydrate antigen 19-9; PT: Prothrombin time; APTT: Activated partial thromboplastin time; TBIL: Total bilirubin; ALB: Albumin; ALT: Alanine transaminase; AST: Aspartate aminotransferase; WBC: White blood cell. for patients with multinodular HCC, the scoring system had a satisfactory ability to predict 1-year mortality after hepatic resection. A score of 5 was the cut-off value with optimal specificity and sensitivity. For patients with a score of 5 or more, the 1-year mortality was 62% which was similar to that of patients who received nonsurgical treatment [2,15-17] , while patients with a score of 0-4 had 1-year mortality of only 5%. We also compared the long-term survival of patients with a score 0-4 (n = 120, group 1) and those with a score of 5-8 (n = 42, group 2). In group 1, the median survival was 53.55 mo (range: 6-80), the median diseasefree survival was 37.14 mo (range: 1-79). In group 2, the median survival was 12.86 mo (range: 3-51), the median disease-free survival was 7.00 mo (range: 1-45). The 1-year and 3-year survival rates of group 1 were 95% and 60%, respectively, while the 1-year and 3-year survival rates of group 2 were 38% and 8%, respectively. The 1-year and 3-year disease-free survival rates of group 1 were 67% and 35%, respectively, while the 1-year and 3-year 3276 July 7, 2012|Volume 18|Issue 25|
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World Journal of Gastroenterology W
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Phillip S Oates, Perth Ross C Smith
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Deepak N Amarapurkar, Mumbai Abhiji
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Trine Olsen, Tromsø Eyvind J Pauls
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Conor P Delaney, Cleveland Sharon D
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S Contents EDITORIAL TOPIC HIGHLIGH
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Contents ACKNOWLEDGMENTS APPENDIX A
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Verhulst PJ et al . Ghrelin and glu
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Online Submissions: http://www.wjgn
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Ishikawa T. Zinc during interferon
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Sitarz R et al . Gastroenterostoma
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Sitarz R et al . Gastroenterostoma
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Morais TC et al . Gastrointestinal
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Page 45 and 46:
Page 47 and 48:
Song MJ et al . Usefulness of PET/C
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A Sensitivity B Sensitivity C Sensi
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Page 55 and 56: Bae GS et al . Anti-inflammatory ef
Page 59 and 60: B Myeloperoxidase activity (U/mg pr
Page 61 and 62: A Time (h) - 1 3 6 NJ4 B Relative H
Page 63 and 64: A C Time (h) - 1 3 6 NJ4-2 B Relati
Page 70 and 71: A Collagen staining (fold change) C
Page 72 and 73: CCl4/YGJ CCl4-13 wk CCl4-7 wk Contr
Page 74 and 75: CCl4/YGJ CCl4-13 wk CCl4-7 wk Contr
Page 76 and 77: liver and have potent proliferative
Page 78 and 79: A 8 wk 9 wk 10 wk 13 wk CCl4/YGJ CC
Page 80 and 81: Cheng JC. A Chinese Herbal Decoctio
Page 82 and 83: Singh R, Neo EN, Nordeen N, Shanmug
Page 84 and 85: etter patient tolerance with regard
Page 86: Key words: Intestinal alkaline phos
Page 89 and 90: Molnár K et al . iAP in pediatric
Page 97 and 98: Chung WC et al . Ulcer after gastre
Page 99: Yang HY et al . Early resection of
Page 102 and 103: indicate a later timing for radical
Page 104 and 105: Zhao WC, Zhang HB, Yang N, Fu Y, Qi
Page 108 and 109: Table 3 Area under the receiver ope
Page 111 and 112: Zhao WC et al . Prognostic factors
Page 113 and 114: Online Submissions: http://www.wjgn
Page 116 and 117: mV 0 2 4 6 8 cpm FD patients are sh
Page 118 and 119: COMMENTS Background Gastric motilit
Page 120 and 121: thirds partial hepatectomy (PH) in
Page 122: A Serum ALT (U/L) C Serum alkaline
Page 126 and 127: REFERENCES 1 Schibler U. Circadian
Page 132 and 133: positive patients were found to hav
Page 134: Online Submissions: http://www.wjgn
Page 140: 21 Tosolini M, Kirilovsky A, Mlecni
Page 147 and 148: Diao TJ et al . NO and hepatopulmon
Page 149 and 150: Gallegos M et al . Lymphogranuloma
Page 151 and 152: Gallegos M et al . Lymphogranuloma
Page 153 and 154: Online Submissions: http://www.wjgn
Page 155 and 156: A Hadžić N et al . Diagnosis in B
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Hadžić N et al . Diagnosis in BAA
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A B Chung HJ et al . Choledocholith
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Chung HJ et al . Choledocholithiasi
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Online Submissions: http://www.wjgn
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Instructions to authors ISSN and EI
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Instructions to authors AIM (no mor
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Instructions to authors Guidelines
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