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( Myung Ji Goh ),( Joo Hyun Oh ),( Yewan Park ),( Jihye Kim ),( Dong Hyun Sinn ),( Wonseok Kang ),( Geum-youn Gwak ),( Yong-han Paik ),( Moon Seok Choi ),( Joon Hyeok Lee ),( Kwang Cheol Koh ),( Seung 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Some young adults with chronic hepatitis B virus (HBV) infection might be at high risk for hepatocellular carcinoma (HCC), enough to justify regular HCC surveillance despite the young age of the patients. However, ways to identify at-risk individuals who may benefit from HCC surveillance need further evaluations. Methods: A hospital-based retrospective cohort of 2,612 chronic HBV mono-infected young adults (median age: 36 years, males 46%) were analyzed. The primary outcome was the development of HCC at a young age. Young-onset HCC was defined in males aged < 40 and females aged < 50 years. We calculated the HCC incidence/1000 person-years in the overall cohort and pre-defined subgroups of patients, assessed the independent risk factors, and tested criteria that can be used to identify surveillance targets. Results: The HCC incidence was low (2.89/1000 person-years) in the overall cohort. However, the HCC incidence varied widely according to baseline characteristics: lowest among young adults with FIB-4 ≤ 0.70 (0.22/1000 person-years), and highest in young adults with radiological cirrhosis (22.5/1000 person-years). The sensitivity of radiologic cirrhosis was sub-optimal (73.5%) for identifying young adults who may develop young-onset HCC. When the FIB-4 index was added, the sensitivity increased (91.2%) with an acceptable tradeoff in specificity (89.5% to 85.9%). Conclusions: Among young Asian adults with chronic HBV infections, some subgroups were at high risk of developing young-onset HCC that justify HCC surveillance, and could be identified by using FIB-4 index, along with radiologic cirrhosis.
Statin and aspirin for chemoprevention of hepatocellular carcinoma: Time to use or wait further?
Myung Ji Goh,Dong Hyun Sinn 대한간학회 2022 Clinical and Molecular Hepatology(대한간학회지) Vol.28 No.3
Preclinical studies highlighted potential therapeutic applications of aspirin and statins as anticancer agents based on their pleiotropic effects. Epidemiologic studies suggested the role of aspirin and statins in the chemoprevention of hepatocellular carcinoma (HCC). However, observational data is prone to bias, and no prospective randomized trials are currently available to assess the risks and benefits of statin or aspirin therapy for chemoprevention of HCC. It is therefore important for clinicians and researchers to be aware of the quality of current evidence regarding this issue. In this review, we summarize currently available evidence to assist clinicians with their decision to use statin or aspirin and provide information for further clinical investigations.
Myung Ji Goh,강원석,신동현,곽금연,백용한,최문석,이준혁,고광철,백승운 대한간암학회 2020 대한간암학회지 Vol.20 No.2
Transarterial radioembolization (TARE) with yttrium-90 microspheres has become widely utilized in managing hepatocellular carcinoma (HCC). The utility of TARE is expanding with new insights through experiences from real-world practice and clinical trials, and recently published data suggest that TARE in combination with sorafenib may improve the overall survival in selected patients. Here, we report a case of advanced stage HCC that was successfully treated with TARE and sorafenib. The patient achieved complete response (CR) at 12 months after the initial treatment with TARE and sorafenib, followed by additional transarterial chemoembolization and proton beam therapy for local tumor recurrence at 19-month post-TARE. The patient was followed up every 3 months thereafter and still achieved CR both biochemically and radiologically for the following 12 months. A combination strategy of TARE and systemic therapy may be a useful alternative treatment option for selected patients with advanced stage HCC.
Clinical practice guideline and real-life practice in hepatocellular carcinoma: A Korean perspective
Myung Ji Goh,Dong Hyun Sinn,Jong Man Kim,Min Woo Lee,Dong Ho Hyun,Jeong Il Yu,Jung Yong Hong,Moon Seok Choi 대한간학회 2023 Clinical and Molecular Hepatology(대한간학회지) Vol.29 No.2
Hepatocellular carcinoma (HCC) is a major cause of death in many countries, including South Korea. To provide useful and sensible advice for clinical management of patients with HCC, the Korean Liver Cancer Association and National Cancer Center Korea Practice Guideline Revision Committee have recently revised the practice guidelines for HCC management. However, there are some differences between practice guidelines and real-life clinical practice. In this review, we describe some key recommendations of the 2022 version of practice guidelines and the real-life clinical situation in South Korea, together with discussion about efforts needed to reduce the difference between guidelines and real-life clinical practice.
Goh Myung Ji,Kim Jihye,Chang Won Hyuk,Sinn Dong Hyun,Gwak Geum-Yeon,Paik Yong-Han,Choi Moon Seok,Lee Joon Hyeok,Koh Kwang Cheol,Paik Seung Woon,Kim Jong Man,Kang Wonseok 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.5
Background/Aims: This study aimed to investigate whether pretransplant frailty can predict postoperative morbidity and mortality after liver transplantation (LT) in patients with cirrhosis. Methods: We retrospectively reviewed 242 patients who underwent LT between 2018 and 2020 at a tertiary hospital in Korea. Results: Among them, 189 patients (78.1%) received LT from a living donor. Physical frailty at baseline was assessed by the Short Physical Performance Battery (SPPB), by which patients were categorized into two groups: frail (SPPB <10) and non-frail (SPPB ≥10). Among the whole cohort (age, 55.0±9.2 years; male, 165 [68.2%]), 182 patients were classified as non-frail and 60 patients were classified as frail. Posttransplant survival was shorter in the frail group than the non-frail group (9.3 months vs 11.6 months). Postoperative intensive care unit stay was longer in the frail group than in the non-frail group (median, 6 days vs 4 days), and the 30-day complication rate was higher in the frail group than in the non-frail group (78.3% vs 59.3%). Frailty was an independent risk factor for posttransplant mortality (adjusted hazard ratio, 2.38; 95% confidence interval, 1.02 to 5.57). In subgroup analysis, frail patients showed lower posttransplant survival regardless of history of hepatocellular carcinoma and donor type. Conclusions: Assessment of pretransplant frailty, as measured by SPPB, provides important prognostic information for clinical outcomes in cirrhotic patients undergoing LT.
Bong Kyung Bae(Bong Kyung Bae),Jeong Il Yu(Jeong Il Yu),Hee Chul Park(Hee Chul Park),Myung Ji Goh(Myung Ji Goh),Yong-Han Paik(Yong-Han Paik) 대한방사선종양학회 2023 Radiation Oncology Journal Vol.41 No.2
Purpose: To report the trends of radiotherapy in the management of elderly patients with hepatocellular carcinoma (HCC). Materials and Methods: We retrospectively reviewed patients who entered HCC registry of Samsung Medical Center between 2005 and 2017. Patients who were 75 years or older at the time of registration were defined as elderly. They were categorized into three groups based on the year of registration. Radiotherapy characteristics were compared between the groups to observe differences by age groups and period of registration. Results: Out of 9,132 HCC registry patients, elderly comprised 6.2% (566 patients) of the registry, and the proportion increased throughout the study period (from 3.1% to 11.4%). Radiotherapy was administered to 107 patients (18.9%) in elderly group. Radiotherapy utilization in the early treatment process (within 1 year after registration) has rapidly increased from 6.1% to 15.3%. All treatments before 2008 were delivered with two-dimensional or three-dimensional conformal radiotherapy, while more than two-thirds of treatments after 2017 were delivered with advanced techniques such as intensity-modulated radiotherapy, stereotactic body radiotherapy, or proton beam therapy. Overall survival (OS) of elderly was significantly worse than younger patients. However, for patients who received radiotherapy during the initial management (within one month after registration), there was no statistically significant difference in OS between age groups. Conclusion: The proportion of elderly HCC is increasing. Radiotherapy utilization and adoption of advanced radiotherapy technique showed a consistently increasing trend for the group of patients, indicating that the role of radiotherapy in the management of elderly HCC is expanding.
( Joo Hyun Oh ),( Jihye Kim ),( Myung Ji Goh ),( Yewan Park ),( Dong Hyun Sinn ),( Wonseok Kang ),( Geum-youn Gwak ),( Moon Seok Choi ),( Joon Hyeok Lee ),( Kwang Cheol Koh ),( Seung Woon Paik ),( Yon 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Controlled attenuation parameter (CAP) by transient elastography (TE) can precisely evaluate hepatic steatosis in patients with chronic hepatitis B (CHB) while the prognostic value is unclear. We aimed to determine whether CAP can predict hepatocellular carcinoma (HCC) in patients with CHB. Methods: The performance of CAP for predicting HCC was analyzed in CHB patients who took antiviral therapy (AVT) and maintained viral suppression (HBV DNA <2000 IU/mL) between January 2012 and September 2016. Results: Of the 935 patients, HCC occurred in 55 patients during median 6.1 years of follow-up (range: 4.1-6.5 years). In the multivariate analysis, age, bilirubin, and liver stiffness measurement (LSM) were independent predictor of HCC. However, CAP score was not an independent factor of HCC in overall patients. When stratified into two groups using known cutoff value (10 kPa) of LSM, the prognostic value of CAP was different between the two groups. In patients with low LSM (<10 kPa), hepatic steatosis (CAP ≥222 dB/m) was significantly associated with higher incidence of HCC (adjusted hazard ratio (HR) 2.67, 95% confidence interval (CI) 1.01-7.11). On the other hand, hepatic steatosis was associated with lower incidence of HCC in patients with higher LSM (≥10 kPa) (Adjusted HR 0.34, 95% CI 0.15-0.76). Conclusions: CAP score showed different prognostic role for prediction of HCC in CHB patients according to LSM value. CAP can be a useful predictor of HCC development in CHB patients on AVT.
( Jihye Kim ),( Dong Hyun Sinn ),( Yewan Park ),( Myung Ji Goh ),( Joo Hyun Oh ),( Wonseok Kang ),( Geum-youn Gwak ),( Yong-han Paik ),( Moon Seok Choi ),( Joon Hyeok Lee ),( Kwang Cheol Koh ),( Seung 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are potent nucleoside analogues (NAs) recommended as firstline monotherapies for chronic hepatitis B. There have been some hot debates on the clinical outcomes of the two agents regarding hepatocellular carcinoma (HCC) occurrence or recurrence among chronic hepatitis B patients. The objective of this study was to compare the survival of hepatitis B virus (HBV)-related HCC patients who started ETV or TDF at the time of HCC diagnosis. Methods: A total of 1,031 consecutive antiviral treatment-naive patients who started ETV (n=516) or TDF (n=515) monotherapy during two months before and after the initial HCC diagnosis between September 2012 and December 2017 were analyzed. Patients who had hepatitis C co-infection or received liver transplantation as the initial cancer-specific treatment were excluded. Overall survival of patients were compared between ETV and TDF groups. Results: The median age of the study patients was 55 years, and 80.3% were male. Barcelona Clinic Liver Cancer (BCLC) stage 0 and A patients were 42.0%, B for 14.5%, C for 40.8%, and D for 2.7%. Most (85.4%) had Child-Pugh class A. Hepatitis B e antigen-positive patients was 36.3%. There were no differences between ETV and TDF groups in the baseline characteristics. During a median follow-up period of 28.0 months (range: 0.1 - 92.1 months), 441 (42.8%) patients died. Entecavir group and tenofovir group did not show any difference in overall survival (median 28.0 vs 29.0 months, P=0.972). When stratified with BCLC stage, the results were similar. By both univariable and multivariable cox regression analysis, the type of NA was not an independent factor for overall survival, while male sex, albumin-bilirubin grade, fibrosis-4 score, serum alpha-fetoprotein, and BCLC stage were revealed to be significant factors. Conclusions: Among antiviral treatment-naïve patients newly diagnosed with HBV-related HCC, ETV and TDF therapy did not differ for overall survival.