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  • S. Karger AG  (10)
  • Han, Kwang-Hyub  (10)
  • 1
    Online Resource
    Online Resource
    Adjuvant Hepatic Arterial Infusional Chemotherapy with 5-Fluorouracil and Cisplatin after Curative Resection of Hepatocellular Carcinoma
    S. Karger AG ; 2011
    In:  Oncology Vol. 81, No. 3-4 ( 2011), p. 184-191
    Details
    In: Oncology, S. Karger AG, Vol. 81, No. 3-4 ( 2011), p. 184-191
    Abstract: 〈 i 〉 Objectives: 〈 /i 〉 We investigated whether adjuvant hepatic arterial infusional chemotherapy (HAIC) with 5-fluorouracil (5-FU) and cisplatin reduces the recurrence of hepatocellular carcinoma (HCC) after curative resection. 〈 i 〉 Methods: 〈 /i 〉 Between January 2006 and December 2008, 31 HCC patients received four cycles of adjuvant HAIC with 5-FU and cisplatin via port system after curative resection. During the same period, 62 patients, who did not take any adjuvant therapy, were selected as controls. 〈 i 〉 Results: 〈 /i 〉 Tumor characteristics, such as distribution of TNM stage, pathologic differentiation, portal vein invasion, or microscopic invasion did not differ between control and adjuvant groups. During follow-up, recurrence developed in 11 adjuvant (35.5%) and 24 control patients (38.7%; p = 0.823). Tumor progression after recurrence was the cause of death in 2 adjuvant (28.6%) and 7 control patients (38.8%; p = 0.912). The 2-year recurrence rate was 9.1% in the adjuvant group and 4.2% in the control group, with the median recurrence-free survival time being 10.5 and 7.5 months, respectively (p = 0.324). The 3-year cumulative survival rate was 73.3% in the adjuvant group and 68.3% in the control group (p = 0.355). 〈 i 〉 Conclusion: 〈 /i 〉 Adjuvant HAIC with 5-FU and cisplatin did not offer any beneficial effect on the recurrence after curative resection of HCC.
    Type of Medium: Online Resource
    ISSN: 0030-2414 , 1423-0232
    URL: Article
    DOI: 10.1159/000333827
    RVK:
    XH 3305
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
    detail.hit.zdb_id: 1483096-6
    detail.hit.zdb_id: 250101-6
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  • 2
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    Online Resource
    Advanced Liver Fibrosis Predicts Unfavorable Long-Term Prognosis in First-Ever Ischemic Stroke or Transient Ischemic Attack
    S. Karger AG ; 2020
    In:  Cerebrovascular Diseases Vol. 49, No. 5 ( 2020), p. 474-480
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 49, No. 5 ( 2020), p. 474-480
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 There are a limited number of studies investigating the relationship between the degree of liver fibrosis and the long-term prognosis, especially ischemic stroke (IS) recurrence, in first-ever IS or transient ischemic attack (TIA). 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 We investigated whether there are differences in the long-term all-cause and cardiovascular mortalities and IS recurrence based on the degree of liver fibrosis in first-ever IS or TIA. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 This analysis included 2,504 patients with first-ever IS or TIA recruited from a prospective stroke cohort. Liver fibrosis was predicted using the fibrosis-4 (FIB-4) index, and advanced fibrosis was defined as an FIB-4 index of & #x3e;3.25. Using Cox regression models, we compared the all-cause and cardiovascular mortalities and IS recurrence. As measures for the additive predictive value of the FIB-4 index for prediction of all-cause mortality, the integrated area under the receiver operating characteristic curve (iAUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 There were 231 (9.2%) patients with advanced fibrosis. During a median follow-up of 1.2 years, the cumulative all-cause and cardiovascular mortalities were 6.4 and 1.9%, and IS recurrence was observed in 5.3%. The advanced fibrosis was associated with an increased risk of all-cause mortality (hazard ratio [HR] = 3.98, 95% confidence interval [CI] = 2.40–6.59), cardiovascular mortality (HR = 4.48, 95% CI = 1.59–12.65), and IS recurrence (HR = 1.95, 95% CI = 1.05–3.65). Adding the FIB-4 index to the model consisting of traditional cardiovascular risk factors improved the predictive accuracy for all-cause mortality as measured using the iAUC (from 0.7594 to 0.7729) and for all-cause mortality at 1 year as measured using the NRI (38.6%) and IDI (0.037). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The burden of liver fibrosis is associated with unfavorable long-term prognosis, including recurrent IS, in first-ever IS or TIA.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000510436
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 1482069-9
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  • 3
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    Liver Fibrosis, Not Steatosis, Associates with Long-Term Outcomes in Ischaemic Stroke Patients
    S. Karger AG ; 2019
    In:  Cerebrovascular Diseases Vol. 47, No. 1-2 ( 2019), p. 32-39
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 47, No. 1-2 ( 2019), p. 32-39
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 To investigate whether there are differences in long-term all-cause and cardiovascular mortality according to the burden of liver fibrosis or steatosis in patients with ischaemic stroke or transient ischaemic attack (TIA). ­ 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Consecutive patients with acute ischaemic stroke or TIA who underwent transient elastography (TE) from January 2014 to December 2014 were considered eligible. The influence of liver fibrosis or steatosis, assessed via TE, on long-term outcomes was investigated using Cox proportional hazard models. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Among 395 patients included in this study, there were 37 (9%) patients with significant fibrosis ( & #x3e; 8.0 kPa) and 164 (41.5%) patients with fatty liver ( & #x3e; 250 dB/m). During the follow-up period (median 2.7 years), all-cause and cardiovascular mortality occurred in 28 (7.1%) and 20 (5.1%) patients. On multivariate analyses, significant liver fibrosis was independently associated with increased risk of all-cause (hazard ratio [HR] 8.14, 95% CI 3.03–21.90, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001) and cardiovascular (HR 4.29, 95% CI 1.10–16.73, 〈 i 〉 p 〈 /i 〉 = 0.036) mortality, whereas fatty liver was not (all 〈 i 〉 p 〈 /i 〉 & #x3e; 0.05). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 This study found that the burden of liver fibrosis but not that of steatosis, assessed via TE, was an independent predictor of all-cause and cardiovascular mortality during long-term follow-up in patients with ischaemic stroke.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000497069
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2019
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  • 4
    Online Resource
    Online Resource
    Prediction of Esophageal Variceal Bleeding in B-Viral Liver Cirrhosis Using the P2/MS Noninvasive Index Based on Complete Blood Counts
    S. Karger AG ; 2012
    In:  Digestion Vol. 86, No. 3 ( 2012), p. 264-272
    Details
    In: Digestion, S. Karger AG, Vol. 86, No. 3 ( 2012), p. 264-272
    Abstract: 〈 b 〉 〈 i 〉 Background/Aim: 〈 /i 〉 〈 /b 〉 Periodic endoscopy for esophageal varices (EVs) and prophylactic treatment of high-risk EVs, i.e. medium/large EVs, small EVs with the red-color sign or decompensation, are recommended in cirrhotic patients. We assessed the cumulative risks for future EV bleeding using the following simple P2/MS index: (platelet count) 〈 sup 〉 2 〈 /sup 〉 /[monocyte fraction (%) × segmented neutrophil fraction (%)]. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We enrolled 475 consecutive B-viral cirrhosis patients for 4 years, none of whom experienced EV bleeding. All underwent laboratory work-ups, endoscopy and ultrasonography. Those with EV bleeding took a nonselective β-blocker as prophylaxis. The major endpoint was the first occurrence of EV bleeding, analyzed using the Kaplan-Meier and Cox regression methods. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Among patients with EV bleeding (n = 131), 25 experienced their first EV bleeding during follow-up. To differentiate the risk for EV bleeding, we divided them into two subgroups according to their P2/MS value (subgroup 1: P2/MS ≥9 and subgroup 2: P2/MS 〈 9). The risk was significantly higher in subgroup 2 (p = 0.029). From multivariate analysis, a lower P2/MS (p = 0.040) remained a significant predictor for EV bleeding along with large varix size (p = 0.015), red-color sign (p = 0.041) and Child-Pugh classification B/C (p = 0.001). In subgroup 1, the risk for EV bleeding was similar to that of patients with low-risk EVs (p = 0.164). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The P2/MS is a reliable predictor for the risk of EV bleeding among patients with EV bleeding. According to risk stratification, different prophylactic treatments should be considered for the subgroup with a P2/MS 〈 9.
    Type of Medium: Online Resource
    ISSN: 0012-2823 , 1421-9867
    URL: Article
    DOI: 10.1159/000341507
    RVK:
    XA 40650
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2012
    detail.hit.zdb_id: 1482218-0
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  • 5
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    Combination of preS Deletions and A1762T/G1764A Mutations in HBV Subgenotype C2 Increases the Risk of Developing HCC
    S. Karger AG ; 2012
    In:  Intervirology Vol. 55, No. 4 ( 2012), p. 112-118
    Details
    In: Intervirology, S. Karger AG, Vol. 55, No. 4 ( 2012), p. 112-118
    Type of Medium: Online Resource
    ISSN: 1423-0100 , 0300-5526
    URL: Article
    DOI: 10.1159/000329941
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2012
    detail.hit.zdb_id: 1482863-7
    SSG: 12
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  • 6
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    Clinical Course of Virologic Breakthrough after Emergence of YMDD Mutations in HBeAg-Positive Chronic Hepatitis B
    S. Karger AG ; 2008
    In:  Intervirology Vol. 51, No. 4 ( 2008), p. 293-298
    Details
    In: Intervirology, S. Karger AG, Vol. 51, No. 4 ( 2008), p. 293-298
    Abstract: 〈 i 〉 Objective: 〈 /i 〉 High rate of resistance to lamivudine is a major problem in treating chronic hepatitis B (CHB) patients. We investigated the course of virologic breakthrough (VB) after emergence of YMDD mutants in CHB patients receiving lamivudine. 〈 i 〉 Methods: 〈 /i 〉 Ninety-three consecutive HBeAg-positive CHB patients treated with lamivudine (100 mg/day) who developed YMDD mutants and VB were enrolled. The clinical breakthrough (CB) was defined by elevation of alanine aminotransferase (ALT) 〉 2 times the upper limit of normal. 〈 i 〉 Results: 〈 /i 〉 The median age was 47 years, and genotype of hepatitis B virus (HBV) was all C. The median duration of lamivudine administration was 39 months, and median pre-lamivudine ALT and HBV DNA were 165 IU/l and 1.2 × 10 〈 sup 〉 8 〈 /sup 〉 copies/ml. In all patients, CB concurred with VB or appeared some months following VB. When patients were divided into two groups according to time sequence of two breakthroughs – group 1 (VB followed by CB, n = 68) and group 2 (concurrent VB and CB, n = 25) – there was no difference in patient and virologic characteristics between the two groups. The median time from VB to CB was 8 months in group 1. 〈 i 〉 Conclusion: 〈 /i 〉 VB might eventually progress to CB in HBeAg-positive patients harboring YMDD mutants with high pretreatment ALT and HBV DNA.
    Type of Medium: Online Resource
    ISSN: 0300-5526 , 1423-0100
    URL: Article
    DOI: 10.1159/000170904
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2008
    detail.hit.zdb_id: 1482863-7
    SSG: 12
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  • 7
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    Less Fibrotic Burden Differently Affects the Long-Term Outcomes of Hepatocellular Carcinoma after Curative Resection
    S. Karger AG ; 2017
    In:  Oncology Vol. 93, No. 4 ( 2017), p. 224-232
    Details
    In: Oncology, S. Karger AG, Vol. 93, No. 4 ( 2017), p. 224-232
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 The clinical features of hepatocellular carcinoma (HCC) differ in patients with and without cirrhosis. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 We aimed to investigate the long-term outcomes of noncirrhotic HCC patients after curative resection. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We retrospectively examined 649 consecutive patients with HCC who underwent curative resection from 1996 to 2012; 387 (59.6%) were cirrhotic and 262 (40.4%) were noncirrhotic. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The mean age was 54.7 years, and 511 (78.7%) of the study participants were men. The most common cause of HCC was hepatitis B virus ( 〈 i 〉 n 〈 /i 〉 = 419, 64.6%). Noncirrhotic tumors were larger and more advanced than cirrhotic tumors. However, the noncirrhotic group showed better disease-free survival (DFS) and overall survival (OS) after resection than the cirrhotic group (median 64.0 vs. 56.0 months for OS and 48.0 vs. 31.0 months for DFS, 〈 i 〉 p 〈 /i 〉 〈 0.05). The predictors for HCC recurrence were cirrhosis, tumor number, portal vein invasion, and major surgery. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Noncirrhotic HCC showed better DFS and OS after resection than cirrhotic HCC, although noncirrhotic HCC presented more aggressively.
    Type of Medium: Online Resource
    ISSN: 0030-2414 , 1423-0232
    URL: Article
    DOI: 10.1159/000477173
    RVK:
    XH 3305
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
    detail.hit.zdb_id: 1483096-6
    detail.hit.zdb_id: 250101-6
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  • 8
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    Online Resource
    Risk Assessment of Development of Hepatic Decompensation in Histologically Proven Hepatitis B Viral Cirrhosis Using Liver Stiffness Measurement
    S. Karger AG ; 2012
    In:  Digestion Vol. 85, No. 3 ( 2012), p. 219-227
    Details
    In: Digestion, S. Karger AG, Vol. 85, No. 3 ( 2012), p. 219-227
    Abstract: 〈 i 〉 Background/Aims: 〈 /i 〉 There are few studies regarding the predictive value of liver stiffness measurement (LSM) for development of hepatic decompensation. We assessed the risk of hepatic decompensations in B-viral compensated cirrhosis, using an LSM and LSM-based model (LSM-spleen diameter to platelet ratio score, LSPS = LSM × spleen diameter/platelet count) in a prospective, longitudinal study. 〈 i 〉 Methods: 〈 /i 〉 We analyzed 217 patients with histologically proven B-viral cirrhosis, well-preserved liver function, and no history of decompensation. The Kaplan-Meier and Cox regression method were used to examine the major endpoint, time to the first decompensation event, defined as development of ascites, hepatic encephalopathy, variceal hemorrhage, and deterioration of liver function to Child-Pugh class B/C. 〈 i 〉 Results: 〈 /i 〉 During follow-up, 26 patients experienced hepatic decompensation, ascites (n = 22), hepatic encephalopathy (n = 11), variceal hemorrhage (n = 9), and deterioration of liver function (n = 20). For risk stratification, patients were grouped as LSM 〈 13, 13–18, and ≥18 kPa, and from multivariate analysis, patients with LSM 13–18 kPa [hazard ratio (HR) 4.547/ p = 0.044] and ≥18 kPa (HR 12.446/p 〈 0.001) retained independently higher risks than patients with LSM 〈 13 kPa. Similarly, when patients were grouped as LSPS 〈 1.1, 1.1–2.5, and ≥2.5, those with LSPS 1.1–2.5 (HR 5.796/p = 0.004) and ≥2.5 (HR 13.618/p 〈 0.001) retained independently higher risks than those with LSPS 〈 1.1. 〈 i 〉 Conclusion: 〈 /i 〉 LSM and LSPS are useful in risk assessment of hepatic decompensation among complication-naive B-viral cirrhotic patients.
    Type of Medium: Online Resource
    ISSN: 0012-2823 , 1421-9867
    URL: Article
    DOI: 10.1159/000335430
    RVK:
    XA 40650
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2012
    detail.hit.zdb_id: 1482218-0
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  • 9
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    Online Resource
    Partial Virological Response to Adefovir Add-On Lamivudine Rescue Therapy in Patients with Lamivudine-Resistant Chronic Hepatitis B
    S. Karger AG ; 2013
    In:  Digestion Vol. 87, No. 3 ( 2013), p. 196-203
    Details
    In: Digestion, S. Karger AG, Vol. 87, No. 3 ( 2013), p. 196-203
    Abstract: 〈 b 〉 〈 i 〉 Background/Aims: 〈 /i 〉 〈 /b 〉 In patients 〈 b 〉 〈 /b 〉 with lamivudine (LAM)-resistant chronic hepatitis B (CHB) 〈 b 〉 〈 /b 〉 receiving 〈 b 〉 〈 /b 〉 adefovir (ADV) add-on LAM therapy, insufficient viral suppression or the appearance of additional ADV resistance has remained unresolved. This study determined the partial virological response (PVR) criteria to predict a virological response (VR) at week 96 in these patients. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 96 patients with LAM-resistant CHB (ADV add-on LAM therapy 〉 2 years) were analyzed. For predicting VR at week 96, the area under the receiver operating characteristic curve values at different time points were compared to establish the optimal time point, and the maximal Youden index was calculated to determine the optimal cut-off hepatitis B virus (HBV) DNA level. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 50 (52.1%) patients achieved VR at 2 years after ADV add-on LAM therapy. The optimal PVR criteria were determined to be HBV DNA 500 IU/ml at week 48. 44 (45.8%) patients who met optimal PVR criteria showed a significantly higher risk for detectable HBV DNA levels at week 96 than those with a favorable VR (HBV 〈 b 〉 〈 /b 〉 DNA 〈 500 IU/ml) at week 48. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 This study suggested optimal PVR criteria in patients with LAM-resistant CHB receiving ADV add-on LAM therapy. Modification of the antiviral agent regimen should be considered if the serum HBV DNA level exceeds 500 IU/ml at week 48.
    Type of Medium: Online Resource
    ISSN: 0012-2823 , 1421-9867
    URL: Article
    DOI: 10.1159/000348853
    RVK:
    XA 40650
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
    detail.hit.zdb_id: 1482218-0
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  • 10
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    Role of 〈sup〉18〈/sup〉F-Fluorodeoxyglucose Positron Emission Tomography in Detecting Extrahepatic Metastasis in Pretreatment Staging of Hepatocellular Carcinoma
    S. Karger AG ; 2007
    In:  Oncology Vol. 72, No. Suppl. 1 ( 2007), p. 104-110
    Details
    In: Oncology, S. Karger AG, Vol. 72, No. Suppl. 1 ( 2007), p. 104-110
    Abstract: 〈 i 〉 Objectives: 〈 /i 〉 〈 sup 〉 18 〈 /sup 〉 F-fluorodeoxyglucose positron emission tomography (FDG-PET) is useful for differentiating benign from malignant lesions, evaluating tumor stage, monitoring the response to therapy and detecting tumor recurrence in a variety of malignancies. Nevertheless, its use in patients with hepatocellular carcinoma (HCC) is still uncertain. We evaluated whether FDG-PET has a role in detecting extrahepatic metastasis in pretreatment tumor staging of HCC and the characteristics of patients with extrahepatic metastasis that benefit from FDG-PET. 〈 i 〉 Methods: 〈 /i 〉 Eighty-seven patients with HCC underwent computed tomography (CT) or magnetic resonance imaging (MRI) of the abdomen and chest X-ray to evaluate pretreatment tumor staging. FDG-PET was then performed to detect extrahepatic metastasis. The power of FDG-PET to detect extrahepatic metastasis was compared with that of conventional images. In addition, we evaluated whether the detection of extrahepatic metastasis using FDG-PET changed the TNM stage. Moreover, we investigated the clinical and tumor characteristics of patients with extrahepatic HCC metastasis. 〈 i 〉 Results: 〈 /i 〉 Extrahepatic metastases were identified in 24 of 87 patients. The location and frequency of metastases were lung 12, lymph nodes 19 and bone 11. All of the extrahepatic metastases were detected by FDG-PET. In addition, FDG-PET identified 4 lymph node metastases and 6 bone metastases that were not found using conventional methods. The initial TNM stage based on the conventional staging workup was changed in 4 cases after FDG-PET. Extrahepatic metastasis was significantly more frequent in patients with intrahepatic tumor 〉 5 cm in size (p = 0.045). 〈 i 〉 Conclusions: 〈 /i 〉 FDG-PET is a useful imaging modality for identifying extrahepatic metastases which may lead to accurate staging and proper management of patients with possible extrahepatic metastases.
    Type of Medium: Online Resource
    ISSN: 0030-2414 , 1423-0232
    URL: Article
    DOI: 10.1159/000111715
    RVK:
    XH 3305
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2007
    detail.hit.zdb_id: 1483096-6
    detail.hit.zdb_id: 250101-6
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