Hepatocellular Carcinoma Surveillance and Treatment:A Way to Reduce Cancer-related Mortality in Cirrhotic Patients

In the issue of Gastroenterology published October 2018,the article by Moon et al.1 demonstrated that screening patients with cirrhosis for hepatocellular carcinoma(HCC)by ultrasound scan(USS),measurement of serumα-fetoprotein(AFP),each alone or in combination,was not associated with the decreased HCC-related mortality.In this matched case control study,all the study patients were registered in detail in the U.S.Department of Veterans Affairs.The study included 238 cases who died of HCC with cirrhosis,and the same number of matched controls with cirrhosis who had been enrolled in U.S.Department of Veterans Affairs care for the 4 years before the index date and alive at the time of their matched case's death.The study retrospectively collected each case's USS and AFP screening data for 4 years before the date of HCC diagnosis or the equivalent index date in controls.Authors found that there was no significant difference of frequency of routine screening between the cases and controls.Therefore,the authors interpreted these results as indicating that the routine screening would not reduce cancer-related mortality.

Relationship between the Level of Serum Golgi Protein 73 and the Risk of Short-term Death in Patients with ALD-ACLF

Background and Aims:As a hepatocellular carcinoma biomarker,serum Golgi protein 73(GP73)is reportedly related to inflammation.Acute-on-chronic liver failure(ACLF)is characterized by severe systemic inflammation.In this study,we aimed to explore the association between the GP73 level and short-term mortality in patients with alcohol-associated liver disease-related ACLF(ALD-ACLF).Methods:This retrospective cohort study involved 126 Chinese adults with ALD-ACLF.Baseline serum GP73 level was measured using enzymelinked immunosorbent assay.Patients were followed-up for 90 d and outcomes were assessed.Data were analyzed using multivariate Cox regression and piecewise linear regression analyses.The predictive value of GP73 and classic models for the short-term prognosis of participants were evaluated and compared using receiver operating characteristic curves.Results:The serum GP73 level was independently associated with an increased mortality risk in patients with ALD-ACLF.Compared with the lowest tertile,the highest serum GP73 level predisposed patients with ALD-ACLF to a higher mortality risk in the fully adjusted model[at 28 days:hazard ratio(HR):4.29(0.99–18.54),p=0.0511;at 90 days:HR:3.52(1.15–10.79),p=0.0276].Further analysis revealed a positive linear association.GP73 significantly improved the accuracy of the Child-Turcotte-Pugh score,model for end-stage liver disease score,and model for end-stage liver diseasesodium score in predicting short-time prognosis of patients with ALD-ACLF.Conclusions:The serum GP73 level is a significant predictor of the subsequent risk of death in patients with ALD-ACLF.GP73 improved the predictive value of classic prognostic scores.