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Efficacy of percutaneous radiofrequency ablation for hepatocellular carcinoma treatment in patients aged≥80 years

Liver Research 2020年第4期4卷 206-211页

作者： Kyohei Tsuchiya Takamasa Ohki Koki Sato Mayuko Kondo nobuo toda Kazumi Tagawa Department of Gastroenterology Mitsui Memorial HospitalTokyoJapan Department of Gastroenterology Tokyo Metropolitan Bokuto HospitalTokyoJapan

Background:Although radiofrequency ablation(RFA)is a minimally invasive treatment for early-stage hepatocellular carcinoma(HCC),it remains unclear whether RFA achieves favorable outcomes in pa-tients aged≥80 *** study aimed to determine the efficacy and safety of RFA for HCC in patients aged≥80 ***:A total of 512 naïve patients with HCC who had undergone RFA from January 2001 to December 2016 were *** were categorized into the≥80-year-old group and the control group(aged<80 years).The primary endpoint was overall survival(OS),and the secondary endpoints were recurrence-free survival,complications associated with RFA,and cause of *** score matching was performed to adjust for patients’sex,liver function,tumor number,tumor diameter,and hepatitis C virus ***,the data of 68 patients in the≥80-year-old group and 68 in the control group were analyzed;their baseline characteristics,primary endpoint,and secondary endpoints were ***:There were significant differences in the alanine aminotransferase level and prothrombin time between the *** cumulative OS rate was not significantly different between the groups(P=0.83):98.5%,87.9%,and 50.5%in the≥80-year-old group and 94.1%,72.8%,and 49.3%in the control group at 1,3,and 5 years,***≥80 years was not significantly associated with OS in multivariate ***-related death occurred in 17 patients in the≥80 year-old group and in 16 patients in the control group(P=1.00).Conclusions:RFA is safe and effective for the treatment of patients with HCC aged≥80 years.

关键词： Hepatocellular carcinoma(HCC) Locoregional therapy Radiofrequency ablation(RFA) Elderly patients Propensity score matching

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Clinical analysis of high serum IgE in autoimmune pancreatitis

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World Journal of Gastroenterology 2010年第41期16卷 5241-5246页

作者： Kenji Hirano Minoru Tada Hiroyuki Isayama Kazumichi Kawakubo Hiroshi Yagioka Takashi Sasaki Hirofumi Kogure Yousuke Nakai Naoki Sasahira Takeshi Tsujino nobuo toda Kazuhiko Koike Department of Gastroenterology University of Tokyo 7-3-1 HongoBunkyo-ku Tokyo 113-8655 Japan De-partment of Gastroenterology University of Tokyo 7-3-1 HongoBunkyo-ku Tokyo 113-8655 Japan Department of Gastroenterology JR Tokyo General Hospital Tokyo 151-8528 Japan Department of Gastroenterology Mitsui Memo-rial Hospital Tokyo 101-8643 Japan

AIM: To clarify the clinical significance of high serum IgE in autoimmune pancreatitis (AIP). METHODS: Forty-two AIP patients, whose IgE was measured before steroid treatment, were analyzed. To evaluate the relationship between IgE levels and the disease activity of AIP, we examined (1) Frequency of high IgE (> 170 IU/mL) and concomitant allergic dis-eases requiring treatment; (2) Correlations between IgG, IgG4, and IgE; (3) Relationship between the presence of extrapancreatic lesions and IgE; (4) Re-lationship between clinical relapse and IgE in patients treated with steroids, and (5) Transition of IgE before and after steroid treatment. RESULTS: IgE was elevated in 36/42 (86%) *** allergic disease was observed in seven patients (allergic rhinitis in three, bronchial asthma in three, and urticaria in one). There were no signifi-cant correlations between IgG, IgG4, and IgE (r = -0.168 for IgG, and r = -0.188 for IgG4). There was no significant difference in IgE in the patients with and without extrapancreatic lesions (526 ± 531 IU/mL vs 819 ± 768 IU/mL, P = 0.163), with and without clini-cal relapse (457 ± 346 IU/mL vs 784 ± 786 IU/mL, P = 0.374). There was no significant difference in IgE between before and after steroid treatment (723 ± 744 IU/mL vs 673 ± 660 IU/mL, P = 0.633). CONCLUSION: Although IgE does not necessarily reflect the disease activity, IgE might be useful for the diagnosis of AIP in an inactive stage.

关键词： IgE IgG4 IgG Autoimmune pancreatitis

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Efficacy of tolvaptan in patients with refractory ascites in a clinical setting

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World Journal of Hepatology 2015年第12期7卷 1685-1693页

作者： Takamasa Ohki Koki Sato Tomoharu Yamada Mari Yamagami Daisaku Ito Koki Kawanishi Kentaro Kojima Michiharu Seki nobuo toda Kazumi Tagawa Department of Gastroenterology Mitsui Memorial Hospital

AIM: To elucidate the efficacies of tolvaptan(TLV) as a treatment for refractory ascites compared with conventional treatment. METHODS: We retrospectively enrolled 120 refractory ascites patients between January 1, 2009 and September 31, 2014. Sixty patients were treated with oral TLV at a starting dose of 3.75 mg/d in addition to sodium restriction(> 7 g/d), albumin infusion(10-20 g/wk), and standard diuretic therapy(20-60 mg/d furosemide and 25-50 mg/d spironolactone) and 60 patients with large volume paracentesis in addition to sodium restriction(less than 7 g/d), albumin infusion(10-20 g/wk), and standard diuretic therapy(20-120 mg/d furosemide and 25-150 mg/d spironolactone). Patient demographics and laboratory data, including liver function, were not matched due to the small number of patients. Continuous variables were analyzed by unpaired t-test or paired t-test. Fisher's exact test was applied in cases comparing two nominal variables. We analyzed factors affecting clinical outcomes using receiver operating characteristic curves and multivariate regression analysis. We also used multivariate Cox's proportional hazard regression analysis to elucidate the risk factors that contributed to the increased incidence of ***: TLV was effective in 38(63.3%) patients. The best cut-off values for urine output and reduced urine osmolality as measures of refractory ascites improvement were > 1800 mL within the first 24 h and > 30%, respectively. Multivariate regression analysis indicated that > 25% reduced urine osmolality [odds ratio(OR) = 20.7; P < 0.01] and positive hepatitis C viral antibodies(OR = 5.93; P = 0.05) were positively correlated with an improvement of refractory ascites, while the total bilirubin level per 1.0 mg/dL(OR = 0.57;P = 0.02) was negatively correlated with improvement. In comparing the TLV group and controls, only the serum sodium level was significantly lower in the TLV group(133 mE q/L vs 136 mE q/L; P = 0.02). However, there were n

关键词： Refractory ascites Tolvaptan Paracentesis Decompensated cirrhosis

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Improvement of prognosis for unresectable biliary tract cancer

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World Journal of Gastroenterology 2013年第1期19卷 72-77页

作者： Takashi Sasaki Hiroyuki Isayama Yousuke Nakai Naminatsu Takahara Naoki Sasahira Hirofumi Kogure Suguru Mizuno Hiroshi Yagioka Yukiko Ito Natsuyo Yamamoto Kenji Hirano nobuo toda Minoru Tada Masao Omata Kazuhiko Koike Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology Kanto Central HospitalTokyo 158-8531Japan Department of Gastroenterology JR Tokyo General HospitalTokyo 151-8528Japan Department of Gastroenterology Japanese Red Cross Medical CenterTokyo 150-8935Japan Department of Gastroenterology Mitsui Memorial HospitalTokyo 101-8643Japan Yamanashi Prefectural Hospital Organization Yamanashi 400-8506Japan

AIM:To evaluate the chemotherapeutic outcomes and confirm the recent improvement of prognosis for unresectable biliary tract ***:A total of 186 consecutive patients with unresectable biliary tract cancer,who had been treated with chemotherapy between 2000 and 2009 at five institutions in Japan,were retrospectively *** patients were divided into three groups based on the year beginning chemotherapy:Group A(2000-2003),Group B(2004-2006),and Group C(2007-2009).The data were fixed at the end of December *** survival and time-to-progression were analyzed and compared ***:No patient characteristics were significantly different among the three *** gallbladder was involved in about half of the patients in each group,and metastatic biliary tract cancer was present in three quarters of the *** Group A,5-fluorouracilbased chemotherapies were primarily selected as firstline chemotherapy,and only 24% were treated with second-line *** Group B,gemcitabine or S-1 monotherapy was mainly introduced as firstline chemotherapy,and 51% of the patients who were refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with *** Group C,the combination therapy with gemcitabine and S-1 was mainly chosen as first-line chemotherapy,and 53% of the patients refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with combination *** median timeto-progressions were 4.4 mo,3.5 mo and 5.9 mo in Groups A,B and C,respectively(4.4 mo vs 3.5 mo vs 5.9 mo,P < 0.01).The median overall survivals were 7.1,7.3,and 11.7 mo in Groups A,B and C(7.1 mo vs 7.3 mo vs 11.7 mo,P = 0.03).Induction rates of all three drugs(gemcitabine,platinum analogs,and fluoropyrimidine) in Groups A,B and C were 4%,2% and 27%(4% vs 2% vs 27%,P < 0.01).CONCLUSION:The prognosis of unresectable biliary tract cancer has improved *** three effective drugs(gemcitabine,p

关键词： Unresectable Biliary tract cancer Gemcitabine Platinum analogs Fluoropyrimidine

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Treatment outcomes of chemotherapy between unresectable and recurrent biliary tract cancer

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World Journal of Gastroenterology 2014年第48期20卷 18452-18457页

作者： Takashi Sasaki Hiroyuki Isayama Yousuke Nakai Yukiko Ito Ichiro Yasuda nobuo toda Hiroshi Yagioka Saburo Matsubara Keiji Hanada Hiroyuki Maguchi Hideki Kamada Osamu Hasebe Tsuyoshi Mukai Yoshihiro Okabe Iruru Maetani Kazuhiko Koike Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo 113-8655 Japan Department of Gastroenterology Japanese Red Cross Medical Center Tokyo 150-8935 Japan First Department of Internal Medicine Gifu University Hospital Gifu 501-1194 Japan Department of Gastroenterology Mitsui MemorialHospital Tokyo 101-8643 Japan Department of Gastroenterology JR Tokyo General Hospital Tokyo 151-8528 Japan Department of Gastroenterology Kanto Central Hospital Tokyo 158-8531 Japan Center for Gastroendoscopy Onomichi General Hospital Hiroshima 722-8508 Japan Center for Gastroenterology Teine-Keijinkai Hospital Hokkaido 006-8555 Japan Department of Gastroenterology and Neurology Faculty of Medicine Kagawa University Kagawa 761-0793 Japan Department of Gastroenterology Nagano Municipal Hospital Nagano 381-8551 Japan Department of Gastroenterology Gifu Municipal Hospital Gifu 500-8513 Japan Department of Gastroenterology Osaka Red Cross Hospital Osaka 543-8555 Japan Division of Gastroenterology Department ofInternal Medicine Toho University Ohashi Medical CenterTokyo 153-8515 Japan

AIM: To evaluate the differences in the treatment outcomes between the unresectable and recurrent biliary tract cancer patients who received chemotherapy.

关键词： Biliary tract cancer Unresectable Recurrent Pooled analysis Chemotherapy

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Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction

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World Journal of Gastroenterology 2016年第14期22卷 3793-3802页

作者： Naoki Sasahira Tsuyoshi Hamada Osamu Togawa Ryuichi Yamamoto Tomohisa Iwai Kiichi Tamada Yoshiaki Kawaguchi Kenji Shimura Takero Koike Yu Yoshida Kazuya Sugimori Shomei Ryozawa Toshiharu Kakimoto Ko Nishikawa Katsuya Kitamura Tsunao Imamura Masafumi Mizuide nobuo toda Iruru Maetani Yuji Sakai Takao Itoi Masatsugu Nagahama Yousuke Nakai Hiroyuki Isayama Department of Gastroenterology JCHO Tokyo Takanawa HospitalTokyo 108-8606Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology Saitama International Medical CenterSaitama Medical UniversitySaitama 350-1298Japan Department of Gastroenterology and Hepatology Saitama Medical University International Medical CenterSaitama 350-8550Japan Department of Gastroenterology Kitasato UniversityKanagawa 252-0375Japan Department of Gastroenterology Jichi Medical UniversityTochigi 329-0498Japan Department of Gastroenterology Tokai UniversityKanagawa 259-1193Japan Department of Gastroenterology Asahi General HospitalChiba 289-2511Japan Department of Internal Medicine Japanese Red Cross Ashikaga HospitalTochigi 326-0843Japan Department of Gastroenterology Kimitsu Central HospitalChiba 292-8535Japan Department of Gastroenterology Yokohama City University Medical CenterKanagawa 232-0024Japan Department of Gastroenterology Showa University Northern Yokohama HospitalKanagawa 242-0032Japan Department of Gastroenterology Saitama City HospitalSaitama 336-8522Japan Department of Gastroenterology Ageo Central General HospitalSaitama 362-8588Japan Division of Gastroenterology Department of MedicineShowa University School of MedicineTokyo 142-8666Japan Department of Gastroenterology Toranomon HospitalTokyo 105-0001Japan Department of Gastroenterology Gunma UniversityGunma 371-0034Japan Department of Gastroenterology Mitsui Memorial HospitalTokyo 101-8643Japan Division of Gastroenterology and Hepatology Department of Internal MedicineToho University Ohashi Medical CenterTokyo 153-0044Japan Department of Gastroenterology Chiba UniversityChiba 260-0856Japan Department of Gastroenterology Tokyo Medical UniversityTokyo 160-0023Japan Department of Gastroenterology Showa University Fujigaoka HospitalKanagawa 227-8501Japan

AIM: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary ***: Multicenter retrospective study was conducted in patients who underwent plastic stent (PS) or nasobiliary catheter (NBC) placement for resectable malignant distal biliary obstruction followed by surgery between January 2010 and March 2012. Procedure-related adverse events, stent/catheter dysfunction (occlusion or migration of PS/NBC, development of cholangitis, or other conditions that required repeat endoscopic biliary intervention), and jaundice resolution (bilirubin level < 3.0 mg/dL) were evaluated. Cumulative incidence of jaundice resolution and dysfunction of PS/NBC were estimated using competing risk analysis. Patient characteristics and preoperative biliary drainage were also evaluated for association with the time to jaundice resolution and PS/NBC dysfunction using competing risk regression ***: In total, 419 patients were included in the study (PS, 253 and NBC, 166). Primary cancers included pancreatic cancer in 194 patients (46%), bile duct cancer in 172 (41%), gallbladder cancer in three (1%), and ampullary cancer in 50 (12%). The median serum total bilirubin was 7.8 mg/dL and 324 patients (77%) had ≥ 3.0 mg/dL. During the median time to surgery of 29 d [interquartile range (IQR), 30-39 d]. PS/NBC dysfunction rate was 35% for PS and 18% for NBC [Subdistribution hazard ratio (SHR) = 4.76; 95%CI: 2.44-10.0, P < 0.001]; the pig-tailed tip was a risk factor for PS dysfunction. Jaundice resolution was achieved in 85% of patients and did not depend on the drainage method (PS or NBC).CONCLUSION: PS has insufficient patency for preoperative biliary drainage. Given the drawbacks of external drainage via NBC, an alternative method of internal drainage should be explored.

关键词： Endoscopic preoperative biliary drainage Malignant distal biliary obstruction Periampullary cancer Plastic stent Nasobiliary drainage

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