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( Minjong Lee ),( Sohee Oh ),( Young Youn Cho ),( Jeong-hoon Lee ),( Su Jong Yu ),( Nam-joon Yi ),( Kwang-woong Lee ),( Jeong Min Lee ),( Jung-hwan Yoon ),( Kyung-suk Suh ),( Yoon Jun Kim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: The guidelines recommend surveillance for hepatocellular carcinoma recurrence be performed 3-monthly during 1 year after curative treatment, and 6-monthly thereafter in all patients. This strategy did not reflect individual risk based on patients’ tumor biology. We aimed to identify patients who can extend surveillance intervals 1 year after treatments. Methods: We retrospectively analyzed 1,490 patients treated with hepatectomy/radiofrequency ablation in the Barcelona Clinic Liver Cancer stage 0/A and well-preserved liver function. In patients under 3-monthly surveillance in total periods, a new model for survival was developed using multivariable analysis: the derivation (n=682)/validation set (n=341). Survival rates in low-risk patients by the new model were compared according to surveillance intervals 1 year after treatments: 3-monthly vs. 6-monthly (n=467) after propensity score matching and lead time bias correction. Results: Albumin levels, MELD score, tumor size, alpha-fetoprotein levels, and 1-year recurrence were independent factors for survival: odds ratios (OR) of 0.33, 1.12, 1.06, 1.09, and 6.99 respectively (all P<0.01). One-year recurrence showed significantly higher OR than other durations (1-2, 2-3, and >3 years, P<0.01). A new model showed AUROC of 0.81 (the derivation set) and 0.77 (the validation set). Survival rates in low-risk patients of the new model under 3-monthly surveillance 1 year after treatments were not superior to those under 6-monthly surveillance (P=0.958). Conclusions: Surveillance interval 1 year after treatments in patients with favorable tumor biology can be extended to 6-monthly interval. Surveillance schedules can be optimized to reduce radio hazard and cost without compromising benefits in low-risk patients.
Lee, Yun Bin,Jung, Eun Uk,Kim, Bo Hyun,Lee, Jeong-Hoon,Cho, Hyeki,Ahn, Hongkeun,Choi, Won-Mook,Cho, Young Youn,Lee, Minjong,Yoo, Jeong-Ju,Cho, Yuri,Lee, Dong Hyeon,Cho, Eun Ju,Yu, Su Jong,Park, Sung J American Society for Microbiology 2015 Antimicrobial Agents and Chemotherapy Vol.59 No.2
<P>Tenofovir disoproxil fumarate (TDF) monotherapy is a therapeutic option for chronic hepatitis B (CHB) patients infected with hepatitis B virus (HBV) variants resistant to lamivudine (LAM). We evaluated the antiviral efficacy and safety of TDF alone compared to those of TDF plus LAM or telbivudine (LdT) combination in patients harboring HBV variants with genotypic resistance to LAM. This multicenter retrospective study included consecutive patients who had LAM-resistant HBV variants and were treated with TDF alone (monotherapy group) or TDF combined with LAM or LdT (combination therapy group) for at least 6 months. Inverse probability of treatment weighting (IPTW) for the entire cohort was applied to control for treatment selection bias. Overall, 153 patients (33 in the monotherapy group and 120 in the combination therapy group) were analyzed. The overall probability of achieving complete virologic suppression at month 12 was 91.6%: 88.6% in the monotherapy group and 92.6% in the combination therapy group. Combination therapy was not superior to monotherapy in viral suppression before and after IPTW (<I>P</I> = 0.562 and <I>P</I> = 0.194, respectively). Hepatitis B e antigen (HBeAg) loss, biochemical response, and virologic breakthrough did not differ between treatment groups. The probabilities of complete virologic suppression were comparable between treatment groups in the subsets according to HBeAg status and HBV DNA levels at baseline. No patient experienced any significant renal dysfunction during the treatment period. In conclusion, TDF monotherapy has antiviral efficacy comparable to that of TDF plus LAM or LdT combination therapy, with a favorable safety profile in CHB patients with LAM-resistant HBV variants.</P>
HBV : The Effect of Therapeutic Vaccination in the Treatment of Chronic Hepatitis B Virus Infection
( Yun Bin Lee ),( Jeong Hoon Lee ),( Young Youn Cho ),( Won Mook Choi,),( Jeong Ju Yoo ),( Minjong Lee ),( Dong Hyeon Lee ),( Yuri Cho ),( Su Jong Yu ),( Yoon Jun Kim ),( Jung Hwan Yoon ),( Chung Yong 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1
Background/Aim: Although currently available antiviral drugs can efficiently suppress serum hepatitis B virus (HBV) viral load to an undetectable level, they usually fail to achieve seroclearance of HBV surface antigen (HBsAg) that indicates eradication of HBV infection. In this study, we compared the effect of therapeutic vaccination in patients in an inactive carrier phase with control patients. Methods: We included chronic hepatitis B (CHB) patients who were in an inactive HBsAg carrier state from January 2009 to November 2011. Seventeen patients who received therapeutic HBV vaccine were included in the vaccination group. The same number of matched patients were randomly selected and enrolled as the control group. HBsAg, HBeAg, anti-HBe, serum alanine aminotransferase and HBV DNA levels were assessed at 6 and 12 months from last administration of vaccine or from enrollment in both groups. Results: Three patients experienced HBsAg seroclearance at follow-up month 6: two patients (11.8%) in the vaccination group and one patient (5.9%) in the control group (P=1.000). At month 12, the majority of patients in both groups remained in an inactive phase (the vaccination group, 64.7% vs. the control group, 47.1%). In the vaccination group, only a low base- line HBsAg titer (≤100 IU/mL) was significantly related to a high frequency of HBsAg seroclearance (P=0.044). Conclusions: Therapeutic HBV vaccination is a potential therapeutic option for the control and eradication of CHB in inactive carriers with a low HBsAg titer. To enhance the efficacy and safety of such treatment, rational patient selection and novel therapeutic approaches are needed.
HBV : Relationship between rs12989760, one of SNP Near the IL28B Gene, and HBsAg Seroclearance
( Dong Hyeon Lee ),( Jeong Hoon Lee ),( Yuri Cho ),( Yun Bin Lee ),( Jung Ju Yoo ),( Minjong Lee ),( Young Youn Cho ),( Won Mook Choi ),( Su Jong Yu ),( Yoon Jun Kim ),( Jung Hwan Yoon ),( Chung Yong 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1
Background: Polymorphisms near the interleukin 28B (IL28B) gene have been proposed to be associated with spontaneous clearance of hepatitis C virus. In this study, we aimed to assess the relationship between rs12989760, one of IL28B alleles, and the rate of hepatitis B surface antigen (HBsAg) seroclearance by means of meta-analysis. Methods: Medline/Pubmed, EMBASE, and Google scholar were searched to identify relevant studies. Study quality was evaluated using the Newcastle-Ottawa Scale. Odds ratios (OR) and 95% confidence interval (CI) were pooled using Comprehensive meta-analysis V2. Fixed effects models were used to generate pooled OR. Subgroup analyses were performed by ethnicity. Heterogeneity and publication bias analyses were performed to validate the credibility. Results: A total of 3,874 patients with chronic hepatitis B and 2,107 spontaneously recovered patients were included from 10 studies. Meta-analysis showed that rs12989760 was not associated with HBV clearance (OR 1.013, 95% CI 0.865-1.187 in dominant model; OR 1.001, 95% CI 0.679-1.476 in recessive model; and OR 0.968, 95% CI 0.834-1.123 in allelic model). Similarly, the results of subgroup analyses by ethnicity also showed no associations in either Asian group (OR 1.114, 95% CI 0.925-1.342 in dominant model; OR 0.981, 95% CI 0.410- 2.349 in recessive model; and OR 1.048, 95% CI 0.855-1.286 in allelic model) or other ethnic group (OR 0.794, 95% CI 0.590- 1.070 in dominant model; OR 1.006, 95% CI 0.653-1.551 in recessive model; and OR 0.884, 95% CI 0.712-1.098 in allelic model). Conclusions: No significant association was identified between rs12989760 and the rate of HBsAg seroclearance.
Yu, Su Jong,Yoon, Jung-Hwan,Lee, Jeong Min,Lee, Jae Young,Kim, Se Hyung,Cho, Young Youn,Yoo, Jeong-Ju,Lee, Minjong,Lee, Dong Hyeon,Cho, Yuri,Cho, Eun Ju,Lee, Jeong-Hoon,Kim, Yoon Jun,Kim, Chung Yong,L Williams & Wilkins Co 2016 Medicine Vol.95 No.35
<▼1><P>Supplemental Digital Content is available in the text</P></▼1><▼2><P><B>Abstract</B></P><P>Although percutaneous ethanol injection therapy (PEIT) is best indicated for patients with small hepatocellular carcinoma (HCC), the survival advantage of PEIT needs confirmation in real-world practice. This study was approved by the institutional review board, and the informed consent was waived. The study included 535 consecutive patients with newly diagnosed early stage (Barcelona Clinic Liver Cancer [BCLC] 0 or A) HCC who underwent initially radiofrequency ablation (RFA) (n = 288) or PEIT (n = 247) from January 2005 to December 2010. The primary outcome was overall survival (OS) and the secondary outcome was time to progression (TTP). The longest diameters of tumors of the groups differed significantly and larger for RFA group than PEIT group (<I>P</I> < 0.001; 1.94 ± 0.65 cm vs 1.60 ± 0.50 cm, respectively). The 5-year OS rates were 72.2% in the RFA group and 67.4% in the PEIT group (<I>P</I> = 0.608). Even after propensity score matching, OS rates between the 2 groups were similar (5-year OS: 72.8% with RFA [n = 175] and 68.0% with PEIT [n = 175]) (<I>P</I> = 0.709). Moreover, in patients with the longest diameter of tumors (≤1.5 cm), multivariate Cox regression analysis showed that the treatment modality was not a significant prognosticator for OS (hazard ratio [HR], 1.690; 95% confidence interval [CI], 0.828–3.449; <I>P</I> = 0.149) and time to progression (HR, 1.160; 95% CI, 0.773–1.740; <I>P</I> = 0.474). PEIT and RFA show equal effectiveness in treating HCCs <1.5 cm in terms of OS and time to progression.</P></▼2>