{"title":"Front & Back Matter","authors":"Jing-yuan Fang, P. Malfertheiner","doi":"10.1159/000504005","DOIUrl":"https://doi.org/10.1159/000504005","url":null,"abstract":"","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49144662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hepatocellular carcinoma (HCC) represents a worrying public health problem in North Africa and particularly in Egypt. The situation is unclear in western North Africa where HCC has been rarely submitted to careful scrutiny. We decided to analyze demographic, biochemical, virological, and clinical data of a series of HCC from Algerian patients to establish the landscape of this tumor in the country. In the present work, we described 337 cases of primary liver cancer from Bologhine Hospital in Algiers, the capital of Algeria. The mean age of patients was 63.8 ± 11.4 years with a male:female sex ratio of 1.5. The most prevalent risk factors were hepatitis C, hepatitis B, and metabolic pathologies (type 2 diabetes and obesity). The mean BMI was 25.6 ± 4.7 at tumor diagnosis. A strong duality of risk factors and tumor presentation between male and female patients was apparent. Women tended to be older (mean 65.4 vs. 62.7 years, p = 0.039) and either seropositive for anti-HCV (60.0 vs. 41.6%, p = 0.0018) resulting primarily from tattoos and/or scarification (47.2 vs. 25.7%, p = 1.0 × 10-4) or more often affected by metabolic disorders (mean BMI 26.1 ± 0.7 vs. 25.1 ± 0.5, p = 0.0248) commonly associated with personal antecedents of cholecystectomy (21.2 vs. 5.8%, p = 4.4 × 10-5). By contrast, men were younger, poorer survivors (mean 9.3 vs. 13.3 months, p = 0.005), more frequently HBsAg carriers (27.8 vs. 10.5%, p = 4.8 × 10-5), and more exposed to lifestyle risk factors such as smoking (39.4 vs. 3.0%, p = 3.9 × 10-16) or alcohol use (19.1 vs. 0.7%, 1.5 × 10-8). Finally, geographic disparities throughout Algeria were reminiscent of the situation of chronic hepatitis C in the country. A significant excess of cases originated from the region of Batna, Eastern Algeria, already known for its high rate of hepatitis C. Our results suggest that due to culture or sex-dependent biological differences, the tumor process affecting the liver is drastically different between sexes in Algeria.
在北非，特别是在埃及，肝细胞癌是一个令人担忧的公共卫生问题。北非西部的情况尚不清楚，那里的HCC很少接受仔细审查。我们决定分析来自阿尔及利亚患者的一系列HCC的人口学、生化、病毒学和临床数据，以确定该肿瘤在该国的概况。在目前的工作中，我们描述了来自阿尔及利亚首都阿尔及尔的博洛林医院的337例原发性肝癌。患者平均年龄63.8±11.4岁，男女性别比为1.5。最常见的危险因素是丙型肝炎、乙型肝炎和代谢疾病(2型糖尿病和肥胖)。肿瘤诊断时平均BMI为25.6±4.7。男性和女性患者之间的危险因素和肿瘤表现明显具有很强的二重性。女性倾向于年龄较大(平均65.4岁vs. 62.7岁，p = 0.039)，抗- hcv血清阳性(60.0岁vs. 41.6%， p = 0.0018)，主要是由于纹身和/或割伤(47.2 vs. 25.7%， p = 1.0 × 10-4)或更经常受到代谢紊乱(平均BMI 26.1±0.7 vs. 25.1±0.5,p = 0.0248)的影响，通常与个人胆囊切除术的经历相关(21.2 vs. 5.8%， p = 4.4 × 10-5)。相比之下，男性更年轻，更贫穷的幸存者(平均9.3个月对13.3个月，p = 0.005)，更频繁地携带HBsAg(27.8比10.5%，p = 4.8 × 10-5)，更多地暴露于生活方式危险因素，如吸烟(39.4比3.0%，p = 3.9 × 10-16)或饮酒(19.1比0.7%，1.5 × 10-8)。最后，阿尔及利亚各地的地理差异让人想起该国慢性丙型肝炎的情况。大量病例来自阿尔及利亚东部的Batna地区，该地区已经以其丙型肝炎的高发病率而闻名。我们的研究结果表明，由于文化或性别依赖的生物学差异，阿尔及利亚两性之间影响肝脏的肿瘤过程存在巨大差异。
{"title":"Wide Sexual Dimorphism of Hepatocellular Carcinoma Presentation in Algeria.","authors":"Yazid Chikhi, Salima Cheraitia, Rachid Ould Gougam, Fadila Lounes, Chahrazed Zemmouchi, Nassila Belal, Maroua Bendaoud, Sonia Ait Younes, Aicha Bensalem, Saadi Berkane, Hocine Asselah, Pascal Pineau, Mustapha Lahcene","doi":"10.1159/000501453","DOIUrl":"https://doi.org/10.1159/000501453","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) represents a worrying public health problem in North Africa and particularly in Egypt. The situation is unclear in western North Africa where HCC has been rarely submitted to careful scrutiny. We decided to analyze demographic, biochemical, virological, and clinical data of a series of HCC from Algerian patients to establish the landscape of this tumor in the country. In the present work, we described 337 cases of primary liver cancer from Bologhine Hospital in Algiers, the capital of Algeria. The mean age of patients was 63.8 ± 11.4 years with a male:female sex ratio of 1.5. The most prevalent risk factors were hepatitis C, hepatitis B, and metabolic pathologies (type 2 diabetes and obesity). The mean BMI was 25.6 ± 4.7 at tumor diagnosis. A strong duality of risk factors and tumor presentation between male and female patients was apparent. Women tended to be older (mean 65.4 vs. 62.7 years, <i>p</i> = 0.039) and either seropositive for anti-HCV (60.0 vs. 41.6%, <i>p</i> = 0.0018) resulting primarily from tattoos and/or scarification (47.2 vs. 25.7%, <i>p</i> = 1.0 × 10<sup>-4</sup>) or more often affected by metabolic disorders (mean BMI 26.1 ± 0.7 vs. 25.1 ± 0.5, <i>p</i> = 0.0248) commonly associated with personal antecedents of cholecystectomy (21.2 vs. 5.8%, <i>p</i> = 4.4 × 10<sup>-5</sup>). By contrast, men were younger, poorer survivors (mean 9.3 vs. 13.3 months, <i>p</i> = 0.005), more frequently HBsAg carriers (27.8 vs. 10.5%, <i>p</i> = 4.8 × 10<sup>-5</sup>), and more exposed to lifestyle risk factors such as smoking (39.4 vs. 3.0%, <i>p</i> = 3.9 × 10<sup>-16</sup>) or alcohol use (19.1 vs. 0.7%, 1.5 × 10<sup>-8</sup>). Finally, geographic disparities throughout Algeria were reminiscent of the situation of chronic hepatitis C in the country. A significant excess of cases originated from the region of Batna, Eastern Algeria, already known for its high rate of hepatitis C. Our results suggest that due to culture or sex-dependent biological differences, the tumor process affecting the liver is drastically different between sexes in Algeria.</p>","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 3-4","pages":"122-136"},"PeriodicalIF":1.6,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000501453","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10755582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Faraj, D. Mukherji, A. Zaghal, H. Nassar, F. H. Mokadem, S. Jabbour, C. Ayoub, M. Rizk, M. Kanso, R. Jaafar, N. Heaton, M. Khalife
Introduction: With the advancement in surgical expertise at high-volume centers and advances in perioperative management, pancreaticoduodenectomy is becoming safer and remains the gold standard for treating periampullary pathologies. We describe our experience in optimizing perioperative management in order to avoid admission to the intensive care unit and improve outcomes. Method: Retrospective data were collected on 370 surgical patients who underwent a pancreaticoduodenectomy between the years 1994 and 2016. Results: Of the 370 patients, 200 operated between 2009 and 2016 did not require intensive care admission, blood transfusion, or central line insertion. The results were compared between different time intervals: before the year 1998, between the years 1998 and 2008, and between the years 2009 and 2016. The median blood loss dropped from 800 to 400 to 300 mL, respectively. The median operative time also dropped from 360 to 335 to 215 min, respectively. In addition, the median length of hospital stay decreased from 25 to 16 to 7 days, respectively. Conclusion: With the centralization of pancreaticoduodenectomy in high-volume centers and with specialized surgeons performing the surgery, there is a significant decrease in the onset of postoperative complications with a lesser need for blood transfusions and, subsequently, better recovery of patients without the need for intensive care unit admission.
{"title":"Perioperative Management of Pancreaticoduodenectomy: Avoiding Admission to the Intensive Care Unit","authors":"W. Faraj, D. Mukherji, A. Zaghal, H. Nassar, F. H. Mokadem, S. Jabbour, C. Ayoub, M. Rizk, M. Kanso, R. Jaafar, N. Heaton, M. Khalife","doi":"10.1159/000502887","DOIUrl":"https://doi.org/10.1159/000502887","url":null,"abstract":"Introduction: With the advancement in surgical expertise at high-volume centers and advances in perioperative management, pancreaticoduodenectomy is becoming safer and remains the gold standard for treating periampullary pathologies. We describe our experience in optimizing perioperative management in order to avoid admission to the intensive care unit and improve outcomes. Method: Retrospective data were collected on 370 surgical patients who underwent a pancreaticoduodenectomy between the years 1994 and 2016. Results: Of the 370 patients, 200 operated between 2009 and 2016 did not require intensive care admission, blood transfusion, or central line insertion. The results were compared between different time intervals: before the year 1998, between the years 1998 and 2008, and between the years 2009 and 2016. The median blood loss dropped from 800 to 400 to 300 mL, respectively. The median operative time also dropped from 360 to 335 to 215 min, respectively. In addition, the median length of hospital stay decreased from 25 to 16 to 7 days, respectively. Conclusion: With the centralization of pancreaticoduodenectomy in high-volume centers and with specialized surgeons performing the surgery, there is a significant decrease in the onset of postoperative complications with a lesser need for blood transfusions and, subsequently, better recovery of patients without the need for intensive care unit admission.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"108 - 115"},"PeriodicalIF":1.6,"publicationDate":"2019-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000502887","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45946537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Weissman, T. Mehta, Alex Zhornitskiy, R. Tondon, J. Tabibian
Distinguishing between a primary malignancy and a metastasis can be challenging in some cases. Herein, we describe 2 cases of gastric lesions that were endoscopically sampled and ultimately found to be metastatic from a renal-cell carcinoma. In both cases, the gastric metastases were endoscopically homomorphic to the primary organ (the kidney); i.e., grossly resembling and thus providing an endoscopic clue as to the primary tumor source. We report on the evaluation of obscure metastatic gastric involvement of malignancy and present the concept of homomorphism as a potential diagnostic clue in determining the source of unknown and often unsuspected primary malignancy.
{"title":"“Homomorphic” Tumor Metastases as an Endodiagnostic Clue: A Case Series of Renal-Cell Carcinoma Metastatic to the Stomach","authors":"S. Weissman, T. Mehta, Alex Zhornitskiy, R. Tondon, J. Tabibian","doi":"10.1159/000502520","DOIUrl":"https://doi.org/10.1159/000502520","url":null,"abstract":"Distinguishing between a primary malignancy and a metastasis can be challenging in some cases. Herein, we describe 2 cases of gastric lesions that were endoscopically sampled and ultimately found to be metastatic from a renal-cell carcinoma. In both cases, the gastric metastases were endoscopically homomorphic to the primary organ (the kidney); i.e., grossly resembling and thus providing an endoscopic clue as to the primary tumor source. We report on the evaluation of obscure metastatic gastric involvement of malignancy and present the concept of homomorphism as a potential diagnostic clue in determining the source of unknown and often unsuspected primary malignancy.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"147 - 152"},"PeriodicalIF":1.6,"publicationDate":"2019-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000502520","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43361694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Rovesti, G. Orsi, Andrikou Kalliopi, C. Vivaldi, G. Marisi, L. Faloppi, F. Foschi, N. Silvestris, I. Pecora, G. Aprile, E. Molinaro, L. Riggi, P. Ulivi, M. Canale, A. Cucchetti, E. Tamburini, G. Ercolani, L. Fornaro, P. Andreone, P. Zavattari, M. Scartozzi, S. Cascinu, A. Casadei‐Gardini
Background: Sorafenib has been established as the standard of care for patients with advanced hepatocellular carcinoma (HCC) since 2007 on the basis of two landmark trials (SHARP and Asia-Pacific). Ten years have passed since then and, despite much research in the field, still no validated real-life prognostic markers are available for HCC patients treated with this drug. Therefore, going through 10 years of research into sorafenib of several Italian Cancer Centers, we conducted a field-practice study aimed at identifying baseline clinical factors that could be significantly associated with overall survival (OS). Method: Univariate/multivariate analyses were conducted to retrospectively identify the impact of baseline characteristics on the OS of 398 advanced HCC patients treated with sorafenib. Results: Based on univariate analysis, α-fetoprotein (AFP), albumin, AST, bilirubin, Child-Pugh, ECOG, systemic immune-inflammation index (SII), albumin-bilirubin (ALBI) grade, and portal vein thrombosis were significantly associated with shorter OS. Following adjustment for clinical covariates positive in univariate analysis, the multivariate analysis including AFP, age, etiology, albumin, aspartate transaminase (AST), bilirubin, Child-Pugh, LDH, platelet-to-lymphocyte ratio, ECOG, ALBI grade, portal vein thrombosis, SII, and BCLC stage identified increase in LDH, age >70 years, no viral etiologies, ECOG >0, albumin <35, ALBI grade 2, and AST >40 as prognostic factors for poorer OS based on the 5% significance level. Conclusion: Our study highlights that baseline hepatic function, patient-centered variables, and etiology have prognostic value. These findings might have implications in terms of therapeutic decision-making and patient counseling.
{"title":"Impact of Baseline Characteristics on the Overall Survival of HCC Patients Treated with Sorafenib: Ten Years of Experience","authors":"G. Rovesti, G. Orsi, Andrikou Kalliopi, C. Vivaldi, G. Marisi, L. Faloppi, F. Foschi, N. Silvestris, I. Pecora, G. Aprile, E. Molinaro, L. Riggi, P. Ulivi, M. Canale, A. Cucchetti, E. Tamburini, G. Ercolani, L. Fornaro, P. Andreone, P. Zavattari, M. Scartozzi, S. Cascinu, A. Casadei‐Gardini","doi":"10.1159/000502714","DOIUrl":"https://doi.org/10.1159/000502714","url":null,"abstract":"Background: Sorafenib has been established as the standard of care for patients with advanced hepatocellular carcinoma (HCC) since 2007 on the basis of two landmark trials (SHARP and Asia-Pacific). Ten years have passed since then and, despite much research in the field, still no validated real-life prognostic markers are available for HCC patients treated with this drug. Therefore, going through 10 years of research into sorafenib of several Italian Cancer Centers, we conducted a field-practice study aimed at identifying baseline clinical factors that could be significantly associated with overall survival (OS). Method: Univariate/multivariate analyses were conducted to retrospectively identify the impact of baseline characteristics on the OS of 398 advanced HCC patients treated with sorafenib. Results: Based on univariate analysis, α-fetoprotein (AFP), albumin, AST, bilirubin, Child-Pugh, ECOG, systemic immune-inflammation index (SII), albumin-bilirubin (ALBI) grade, and portal vein thrombosis were significantly associated with shorter OS. Following adjustment for clinical covariates positive in univariate analysis, the multivariate analysis including AFP, age, etiology, albumin, aspartate transaminase (AST), bilirubin, Child-Pugh, LDH, platelet-to-lymphocyte ratio, ECOG, ALBI grade, portal vein thrombosis, SII, and BCLC stage identified increase in LDH, age >70 years, no viral etiologies, ECOG >0, albumin <35, ALBI grade 2, and AST >40 as prognostic factors for poorer OS based on the 5% significance level. Conclusion: Our study highlights that baseline hepatic function, patient-centered variables, and etiology have prognostic value. These findings might have implications in terms of therapeutic decision-making and patient counseling.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"92 - 107"},"PeriodicalIF":1.6,"publicationDate":"2019-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000502714","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46631956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Portal hypertensive polyposis is a rare finding represented in about 2.5% of all patients with portal hypertension. The diagnostic criteria are not yet clearly defined. It has been mentioned in a few case reports; its distribution was mainly duodenal and less frequently gastric. Here, a patient with type 2 diabetes and liver cirrhosis was hospitalized for vomiting, abdominal pain, and melena. The patient was admitted to the intensive care unit for stabilization and urgent esophagogastroduodenoscopy (EGD). EGD revealed a single antral polyp occluding the pyloric ring which was the cause of gastric outlet obstruction. Complete debulking by argon plasma was done which improved gastric outlet obstruction and melena. We conclude that argon plasma coagulation is a safe, rapid, and effective method for treating portal hypertensive polyposis.
{"title":"Management of a Portal Hypertensive Polyp: Case Report of a Rare Entity","authors":"Waseem M. Seleem, A. Hanafy","doi":"10.1159/000501909","DOIUrl":"https://doi.org/10.1159/000501909","url":null,"abstract":"Portal hypertensive polyposis is a rare finding represented in about 2.5% of all patients with portal hypertension. The diagnostic criteria are not yet clearly defined. It has been mentioned in a few case reports; its distribution was mainly duodenal and less frequently gastric. Here, a patient with type 2 diabetes and liver cirrhosis was hospitalized for vomiting, abdominal pain, and melena. The patient was admitted to the intensive care unit for stabilization and urgent esophagogastroduodenoscopy (EGD). EGD revealed a single antral polyp occluding the pyloric ring which was the cause of gastric outlet obstruction. Complete debulking by argon plasma was done which improved gastric outlet obstruction and melena. We conclude that argon plasma coagulation is a safe, rapid, and effective method for treating portal hypertensive polyposis.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"137 - 141"},"PeriodicalIF":1.6,"publicationDate":"2019-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000501909","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41396439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Kolli, S. Weissman, Saad Saleem, O. Chan, Maria R. Ver, Richard Inae, M. Ona
The small bowel is an uncommon site for cancer metastasis. Despite this, cases have reported the duodenum as a metastatic site from local organs. However, duodenal involvement from more distant organs, such as the ovaries, has rarely been reported. Herein, we present a case of a 68-year-old female who developed duodenal metastatic disease from a primary ovarian serous adenocarcinoma. The goal of this report is to encourage clinicians to keep a broad differential in patients complaining of abdominal pain, especially in those with a history of primary ovarian malignancy.
{"title":"An Unlikely Route: Metastatic Ovarian Malignancy within the Duodenum","authors":"S. Kolli, S. Weissman, Saad Saleem, O. Chan, Maria R. Ver, Richard Inae, M. Ona","doi":"10.1159/000502094","DOIUrl":"https://doi.org/10.1159/000502094","url":null,"abstract":"The small bowel is an uncommon site for cancer metastasis. Despite this, cases have reported the duodenum as a metastatic site from local organs. However, duodenal involvement from more distant organs, such as the ovaries, has rarely been reported. Herein, we present a case of a 68-year-old female who developed duodenal metastatic disease from a primary ovarian serous adenocarcinoma. The goal of this report is to encourage clinicians to keep a broad differential in patients complaining of abdominal pain, especially in those with a history of primary ovarian malignancy.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"142 - 146"},"PeriodicalIF":1.6,"publicationDate":"2019-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000502094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44490565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Kobayashi, J. Kaneko, Takamune Yamaguchi, Y. Kawaguchi, J. Arita, N. Akamatsu, T. Ishizawa, R. Sekine, H. Ijichi, N. Kubota, K. Fukatsu, N. Kokudo, K. Hasegawa
Background: This prospective study measured body composition based on bioelectrical impedance analysis (BIA) in relation to preoperative and postoperative nutritional support and status in patients undergoing liver surgery. Methods: Thirty-sevenpatients with impaired liver function (indocyanine green retention rate at 15 min >15%) undergoing hepatectomy for hepatocellular carcinoma or colorectal liver metastasis were enrolled. The control group (n = 10) received no nutritional supplementation. The late-evening snack (LES, n = 26) group received a 210-kcal snack comprising a carbohydrate with branched-chain amino acids for 2 weeks before surgery through to 12 weeks after surgery. BIA of body composition, including body cell mass and skeletal muscle volume, was performed. Results: Although there was no sarcopenia based on the consensus report of the Asian Working Group 2 weeks before surgery, the skeletal muscle volumes in the control and LES groups were at the lower limit of the normal range. Body cell mass and skeletal muscle volume were significantly lower in the control group than in the LES group at 4 (p = 0.03) and 12 (p = 0.02) weeks after surgery. Conclusion: Late-evening carbohydrate and branched-chain amino acid snack supplementation may improve nutritional status in patients with impaired liver function undergoing hepatectomy.
{"title":"Late-Evening Carbohydrate and Branched-Chain Amino Acid Snacks Improve the Nutritional Status of Patients Undergoing Hepatectomy Based on Bioelectrical Impedance Analysis of Body Composition","authors":"K. Kobayashi, J. Kaneko, Takamune Yamaguchi, Y. Kawaguchi, J. Arita, N. Akamatsu, T. Ishizawa, R. Sekine, H. Ijichi, N. Kubota, K. Fukatsu, N. Kokudo, K. Hasegawa","doi":"10.1159/000501452","DOIUrl":"https://doi.org/10.1159/000501452","url":null,"abstract":"Background: This prospective study measured body composition based on bioelectrical impedance analysis (BIA) in relation to preoperative and postoperative nutritional support and status in patients undergoing liver surgery. Methods: Thirty-sevenpatients with impaired liver function (indocyanine green retention rate at 15 min >15%) undergoing hepatectomy for hepatocellular carcinoma or colorectal liver metastasis were enrolled. The control group (n = 10) received no nutritional supplementation. The late-evening snack (LES, n = 26) group received a 210-kcal snack comprising a carbohydrate with branched-chain amino acids for 2 weeks before surgery through to 12 weeks after surgery. BIA of body composition, including body cell mass and skeletal muscle volume, was performed. Results: Although there was no sarcopenia based on the consensus report of the Asian Working Group 2 weeks before surgery, the skeletal muscle volumes in the control and LES groups were at the lower limit of the normal range. Body cell mass and skeletal muscle volume were significantly lower in the control group than in the LES group at 4 (p = 0.03) and 12 (p = 0.02) weeks after surgery. Conclusion: Late-evening carbohydrate and branched-chain amino acid snack supplementation may improve nutritional status in patients with impaired liver function undergoing hepatectomy.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"81 - 91"},"PeriodicalIF":1.6,"publicationDate":"2019-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000501452","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41616661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Casadei‐Gardini, L. Solaini, L. Riggi, E. Molinaro, V. Dadduzio, M. Rizzato, A. Pellino, L. Faloppi, G. Marisi, P. Ulivi, M. Canale, G. Orsi, G. Rovesti, K. Andrikou, A. Spallanzani, F. Gelsomino, F. Foschi, F. Conti, A. Cucchetti, G. Ercolani, P. Biason, S. Lonardi, S. Cascinu, M. Scartozzi
Background and Aims: The aim of the present study is to evaluate a new index influenced by the balance between the immune system, α-fetoprotein (AFP), and lactate dehydrogenase (LDH) (RAPID index) as a prognostic factor in patients treated with sorafenib. Methods: This study was conducted on a training cohort of 159 hepatocellular carcinoma (HCC) patients and a validation cohort of 68 HCC patients treated with sorafenib. The RAPID index was calculated as neutrophil/lymphocyte count × LDH × AFP. Results: In the training cohort, the median overall survival (OS) was 23.2 months (95% CI 11–25) and 12.1 months (95% CI 9–15) for patients with a low (≤3,226) and high (>3,226) RAPID index, respectively (ref. <3,226, HR = 0.56, 95% CI 0.35–0.88, p = 0.017). Following adjustment for clinical covariates, multivariate analysis confirmed the RAPID index ≤3,226 versus >3,226 (HR = 0.37, 95% CI 0.18–0.74, p = 0.0054) as an independent prognostic factor for OS. In the validation cohort, the median OS was 26.9 months (95% CI 17.6–26.9) and 7.0 months (95% CI 6.2–9.2) for patients with a low (≤ 3,226) and high (>3,226) RAPID index, respectively (ref. <3,226, HR = 0.19, 95% CI 0.10–0.36, p < 0.0001). Performing the same multivariate analysis of the training cohort (AFP, Eastern Cooperative Oncology Group, aspartate aminotransferase, neutrophil, platelet, systemic inflammatory index and RAPID index), the RAPID index <3,226 versus >3,226 (HR = 3.86, 95% CI 1.45–10.29, p = 0.007) was found to be an independent prognostic factor for predicting OS. Conclusion: The low cost, easy assessment, and reproducibility of a full blood count make the RAPID index a promising tool for assessing HCC prognosis in future clinical practice.
{"title":"Prognostic Role of a New Index (RAPID Index) in Advanced Hepatocellular Carcinoma Patients Receiving Sorafenib: Training and Validation Cohort","authors":"A. Casadei‐Gardini, L. Solaini, L. Riggi, E. Molinaro, V. Dadduzio, M. Rizzato, A. Pellino, L. Faloppi, G. Marisi, P. Ulivi, M. Canale, G. Orsi, G. Rovesti, K. Andrikou, A. Spallanzani, F. Gelsomino, F. Foschi, F. Conti, A. Cucchetti, G. Ercolani, P. Biason, S. Lonardi, S. Cascinu, M. Scartozzi","doi":"10.1159/000501593","DOIUrl":"https://doi.org/10.1159/000501593","url":null,"abstract":"Background and Aims: The aim of the present study is to evaluate a new index influenced by the balance between the immune system, α-fetoprotein (AFP), and lactate dehydrogenase (LDH) (RAPID index) as a prognostic factor in patients treated with sorafenib. Methods: This study was conducted on a training cohort of 159 hepatocellular carcinoma (HCC) patients and a validation cohort of 68 HCC patients treated with sorafenib. The RAPID index was calculated as neutrophil/lymphocyte count × LDH × AFP. Results: In the training cohort, the median overall survival (OS) was 23.2 months (95% CI 11–25) and 12.1 months (95% CI 9–15) for patients with a low (≤3,226) and high (>3,226) RAPID index, respectively (ref. <3,226, HR = 0.56, 95% CI 0.35–0.88, p = 0.017). Following adjustment for clinical covariates, multivariate analysis confirmed the RAPID index ≤3,226 versus >3,226 (HR = 0.37, 95% CI 0.18–0.74, p = 0.0054) as an independent prognostic factor for OS. In the validation cohort, the median OS was 26.9 months (95% CI 17.6–26.9) and 7.0 months (95% CI 6.2–9.2) for patients with a low (≤ 3,226) and high (>3,226) RAPID index, respectively (ref. <3,226, HR = 0.19, 95% CI 0.10–0.36, p < 0.0001). Performing the same multivariate analysis of the training cohort (AFP, Eastern Cooperative Oncology Group, aspartate aminotransferase, neutrophil, platelet, systemic inflammatory index and RAPID index), the RAPID index <3,226 versus >3,226 (HR = 3.86, 95% CI 1.45–10.29, p = 0.007) was found to be an independent prognostic factor for predicting OS. Conclusion: The low cost, easy assessment, and reproducibility of a full blood count make the RAPID index a promising tool for assessing HCC prognosis in future clinical practice.","PeriodicalId":45017,"journal":{"name":"Gastrointestinal Tumors","volume":"6 1","pages":"71 - 80"},"PeriodicalIF":1.6,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000501593","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43696676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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