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( Takuji Torimura ),( Hideki Iwamoto ) 대한간학회 2021 Clinical and Molecular Hepatology(대한간학회지) Vol.27 No.2
Hepatocellular carcinoma (HCC) is usually accompanied by chronic liver damage, which sometimes influences the selection of HCC treatment. The Barcelona Clinic Liver Cancer (BCLC) staging system, which was first introduced in 1999, is the most commonly used worldwide. Although the intermediate-stage (BCLC stage B) includes the largest number and heterogeneous HCC patients, the recommended treatment option is transarterial chemoembolization (TACE) only. However, recent progress in radical treatments such as hepatic resection, liver transplantation, radiation therapy, and percutaneous therapy has made it possible to treat selected patients with BCLC stage B HCC. Radical treatments are expected to prolong survival time. To-date, TACE has also progressed. In addition to conventional TACE, balloon-occluded TACE and drug-eluting beads TACE are available. These new modalities of TACE will improve therapeutic efficacy and reduce adverse events. One of the most serious concerns of TACE is that repeated TACE reduces the treatment effect and induces liver function impairment. The decision on when TACE should be interrupted is complex. Many molecular targeted agents are now available, and immune checkpoint inhibitors will soon be available for HCC patients with Child- Pugh class A worldwide. Under these circumstances, in patients with TACE unsuitability, switching to molecular targeted agents before deterioration of liver function might improve the prognosis compared to repeated TACE. We should pay attention to stop TACE in TACE-unsuitable HCC patients as it can induce the deterioration of liver function. (Clin Mol Hepatol 2021;27:236-245)
MAFLD enhances clinical practice for liver disease in the Asia-Pacific region
Takumi Kawaguchi,Tsubasa Tsutsumi,Dan Nakano,Mohammed Eslam,Jacob George,Takuji Torimura 대한간학회 2022 Clinical and Molecular Hepatology(대한간학회지) Vol.28 No.2
Fatty liver is now a major cause of liver disease in the Asia-Pacific region. Liver diseases in this region have distinctive characteristics. First, fatty liver is frequently observed in lean/normal-weight individuals. However, there is no standard definition of this unique phenotype. Second, fatty liver is often observed in patients with concomitant viral hepatitis. The exclusion of viral hepatitis from non-alcoholic fatty liver disease limits its value and detracts from the investigation and holistic management of coexisting fatty liver in patients with viral hepatitis. Third, fatty liver-associated hepatocellular carcinoma (HCC) is generally categorized as non-B non-C HCC. Fourth, the population is aging rapidly, and it is imperative to develop a practicable, low-intensity exercise program for elderly patients. Fifth, most patients and nonspecialized healthcare professionals still lack an awareness of the significance of fatty liver both in terms of intrahepatic and extrahepatic disease and cancer. Recently, an international expert panel proposed a new definition of fatty liver: metabolic dysfunction-associated fatty liver disease (MAFLD). One feature of MAFLD is that metabolic dysfunction is a prerequisite for diagnosis. Pertinent to regional issues, MAFLD also provides its diagnostic criteria in lean/normal-weight individuals. Furthermore, MAFLD is independent of any concomitant liver disease, including viral hepatitis. Therefore, MAFLD may be a more suitable definition for fatty liver in the Asia-Pacific region. In this review, we introduce the regional characteristics of fatty liver and discuss the advantages of MAFLD for improving clinical practice for liver disease in the region.
( Yoichi Yano ),( Tatsuyuki Tonan ),( Yuriko Koga ),( Toru Nakamura ),( Mitsuhiko Abe ),( Yu Ikezono ),( Michio Sata ),( Takuji Torimura ),( Si Won Lee ),( Mi Hong Choi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Liver stiffness is sometimes occured in patient with HCV-associated to HIV-positive. Reduction of immune system, the patient might has been got HCV easily. Early detection and treatment should be done to ensure that the patient can be healed. The earlier we can detect, the higher possibility they can be cured. Therefore, nowadays researchers and clinicians focused in the development of diagnostic tools with high sensitivity and specifi city. The noninvasive measurement of liver stiffness (LS) now can be evaluated by transient elastography (fibroScan). Methods: We evaluated 35 patients with chronic viral hepatitis, 69% were male, 31% were female. We divided them into 3 groups, (1) no fi brosis group (2) mild until moderate (3) severe HCV with extensive fi brosis and liver stiffness. All subject (100%) were evaluated by fibroScan, 15 patients (43%) also got liver biopsy, and 31 patients (88%) also got MRI. Study design is cross-sectional with simple random sampling. Results: In TE, the degree of liver fi brosis were calculated by velocity of low-frequency transient wave produced by mechanical-probe. Comparing to liver biopsy, TE has demonstrated both high specifi city and sensitifi ty. The specifi cty of TE is 94.29% to (95%CI: 93.15%-96.7%) and sensitifi ty of TE is 82.85% (95% CI: 79,87%-85,76%). Conclusions: Real-time TE is a reliable surrogate marker of liver fi brosis, with high specifi city and sensitifi ty for early detection in mild fi brosis. However, the applicability of TE is limited to non-obese patients (BMI < 30 kg/m2) and without any ascites. If TE has already predicted liver fi brosis, biposy may not be necessary.