Vitamin D receptor gene polymorphisms and hepatocellular carcinoma in alcoholic cirrhosis

AIM: To assess the relationship between vitamin D re-ceptor (VDR) gene polymorphisms and the presence of hepatocellular carcinoma (HCC). METHODS: Two-hundred forty patients who underwent liver transplantation were studied. The etiologies of liver disease were hepatitis C (100 patients), hepatitis B (37) and alcoholic liver disease (103). A group of 236 healthy subjects served as controls. HCC in the explanted liver was detected in 80 patients. The following single nucle-otide gene polymorphisms of the VDR were investigatedby polymerase chain reaction and restriction fragment length polymorphism: FokI C>T (F/f), BsmI A>G (B/b), ApaI T>G (A/a) and TaqI T>C (T/t) (BAT). RESULTS: The frequencies of genotypes in patients without and with HCC were for FokI F/F = 69, F/f = 73, f/f = 18 and F/F = 36, F/f = 36, f/f = 8; BsmI b/b = 45, B/b = 87, B/B = 28 and b/b = 33, B/b = 35, B/B = 12; for ApaI A/A = 53, A/a = 85, a/a = 22 and A/A = 27, A/a = 38, a/a = 15; for TaqI T/T = 44, T/t = 88, t/t = 28 and T/T = 32, T/t = 38, t/t = 10. Carriage of the b/b genotype of BsmI and the T/T genotype of TaqI was signif icantly associated with HCC (45/160 vs 33/80, P < 0.05 and 44/160 vs 32/80, P < 0.05, respectively). The absence of the A-T-C protective allele of BAT was signif i-cantly associated with the presence of HCC (46/80 vs 68/160, P < 0.05). A strong association was observed between carriage of the BAT A-T-C and G-T-T haplotypes and HCC only in alcoholic liver disease (7/46 vs 12/36 vs 11/21, P < 0.002, respectively).CONCLUSION: VDR genetic polymorphisms are sig-nificantly associated with the occurrence of HCC in patients with liver cirrhosis. This relationship is more specific for patients with an alcoholic etiology.

Risk factors for hepatocellular carcinoma recurrence after liver transplantation

Liver transplantation(LT)provides an excellent option for the long-term survival of patients with unresectable hepatocellular carcinoma(HCC)based on the Milan criteria.Despite careful selection of patients,HCC may still recur after LT,which represents the most important negative predictor of post-transplant survival.The growing demand for LT in HCC has led to the expansion of patient selection criteria,with a resultant increase in the risk of post-transplant HCC recurrence.Numerous tumor and host factors predict HCC recurrence.The morphological,histological,and serological characteristics of tumors in predicting HCC recurrence have been extensively studied.Furthermore,the type and duration of anticancer response before LT has also been considered a surrogate marker of tumor aggressiveness and is associated with the risk of recurrence.The demographic and clinical characteristics of recipients,as well as the type and duration of exposure to immunosuppressive therapy,represent the main host-related risk factors.Many studies have attempted to describe predictive models for the risk of HCC recurrence,considering evaluable parameters both before and after LT.Although many models have been proposed,relatively few have been externally validated on different patient populations.This paper aims to comprehensively summarize the available data on the predictive factors of HCC recurrence after LT,and to examine and discuss those that have been externally validated.