AIM： To prospectively long term clinical impact evaluate the short and of selective transarterial chemoembolization （TACE） on fiver function in patients with hepatocellular carcinoma （HCC）. To assess side effects...AIM： To prospectively long term clinical impact evaluate the short and of selective transarterial chemoembolization （TACE） on fiver function in patients with hepatocellular carcinoma （HCC）. To assess side effects in relation to treatments. To analyze the overall survival and HCC progression free survival probability. METHODS： One hundred and seventeen cirrhotic patients with HCC were enrolled. Baseline liver function included Child-Pugh score and serum levels of alanine- aminotransferase （ALT）, prothrombin time （PT） and bilirubin. According to Cancer Liver Italian Program （CLIP） and Barcelona Clinic Liver Cancer （BCLC） staging systems, 71 patients were eligible for TACE; 32 had previously received treatment for HCC. No significant differences in liver function were observed between previously treated and not treated patients. TACE was performed by selective catheterization of the arteries nourishing the lesions. While hospitalized, patients underwent clinical, hematologic and ultrasonographic assessments. One month after TACE a CT scan was performed to assess tumor response. A second TACE was performed ＂on demand＂ Liver function tests were checked in all patients every four months. RESULTS： After first TACE, the mean Child-Pugh score increased from a mean baseline 5.62 ±1.12 to 6.11 ±1.57 at discharge time （P 〈 0.0001）, decreasing after four months to 5.81 ± 0.73 （not significant）. ALT, PT and bilirubin significantly （P 〈 0.0001） increased 24 h after TACE and progressively decreased until discharge. After the second TACE, variations in Child-Pugh score, ALT, PT and bilirubin were comparable to that described after the first TACE. No major complications were observed. The mean follow-up was 14.7 ＋ 6.3 mo （median： 16 mo）. Only one patient died. No other patient experienced important long term worsening of clinical status. The overall survival probability at twenty-four months was 98.18% with a correspondent HCC progression free survival probability of 69%. CONCLUSION： Selective TACE may produce significant, but transitory increases in ALT values, with no major impact on liver function and Child-Pugh score. Preservation of liver function is achievable also in patients previously treated with other therapeutic modalities and in patients undergoing multiple TACE cycles. Liver function can remain stable in the long-term, with optimal medium term survival. This result can be achieved through rigorous patient selection on the basis of tumour characteristics and clinical conditions.展开更多
Inflammatory bowel diseases(IBDs) are characterized by a chronic course with an alternation of relapses and remissions.Questions about prognosis are important for the patient who wants to know how the disease will aff...Inflammatory bowel diseases(IBDs) are characterized by a chronic course with an alternation of relapses and remissions.Questions about prognosis are important for the patient who wants to know how the disease will affect his/her life and also for clinicians to make management decisions.Correct selection of the patients is the basis for good methodological studies on the course of IBD.A great proportion of data on the course of IBD is derived from a limited number of cohort studies.Studies help to define the endpoints for clinical trials and to identify subsets of patients in whom the prognosis of the disease can be stratified according to clinical features.Specific scientific requirements for high-quality studies on prognosis are the following:use of inception cohort,description of referral patterns,completeness of follow-up,objective outcome criteria,blind outcome assessment,adjustment for extraneous prognostic factors and statistical issues.We analyzed each of these requirements in studies on IBDs.To date,prospective and populationbased cohort studies are the standard for an unbiased assessment of prognosis.A better knowledge of the course of disease of chronic disorders ideally requires:(1) data from population-based studies,to avoid selection bias from referral centers in which patients with a more severe disease are usually treated;(2) inclusion of patients seen at the onset of the disease excluding misdiagnosed cases;and(3) follow-up from the onset of the disease to the end without dropouts.展开更多
文摘AIM： To prospectively long term clinical impact evaluate the short and of selective transarterial chemoembolization （TACE） on fiver function in patients with hepatocellular carcinoma （HCC）. To assess side effects in relation to treatments. To analyze the overall survival and HCC progression free survival probability. METHODS： One hundred and seventeen cirrhotic patients with HCC were enrolled. Baseline liver function included Child-Pugh score and serum levels of alanine- aminotransferase （ALT）, prothrombin time （PT） and bilirubin. According to Cancer Liver Italian Program （CLIP） and Barcelona Clinic Liver Cancer （BCLC） staging systems, 71 patients were eligible for TACE; 32 had previously received treatment for HCC. No significant differences in liver function were observed between previously treated and not treated patients. TACE was performed by selective catheterization of the arteries nourishing the lesions. While hospitalized, patients underwent clinical, hematologic and ultrasonographic assessments. One month after TACE a CT scan was performed to assess tumor response. A second TACE was performed ＂on demand＂ Liver function tests were checked in all patients every four months. RESULTS： After first TACE, the mean Child-Pugh score increased from a mean baseline 5.62 ±1.12 to 6.11 ±1.57 at discharge time （P 〈 0.0001）, decreasing after four months to 5.81 ± 0.73 （not significant）. ALT, PT and bilirubin significantly （P 〈 0.0001） increased 24 h after TACE and progressively decreased until discharge. After the second TACE, variations in Child-Pugh score, ALT, PT and bilirubin were comparable to that described after the first TACE. No major complications were observed. The mean follow-up was 14.7 ＋ 6.3 mo （median： 16 mo）. Only one patient died. No other patient experienced important long term worsening of clinical status. The overall survival probability at twenty-four months was 98.18% with a correspondent HCC progression free survival probability of 69%. CONCLUSION： Selective TACE may produce significant, but transitory increases in ALT values, with no major impact on liver function and Child-Pugh score. Preservation of liver function is achievable also in patients previously treated with other therapeutic modalities and in patients undergoing multiple TACE cycles. Liver function can remain stable in the long-term, with optimal medium term survival. This result can be achieved through rigorous patient selection on the basis of tumour characteristics and clinical conditions.
文摘Inflammatory bowel diseases(IBDs) are characterized by a chronic course with an alternation of relapses and remissions.Questions about prognosis are important for the patient who wants to know how the disease will affect his/her life and also for clinicians to make management decisions.Correct selection of the patients is the basis for good methodological studies on the course of IBD.A great proportion of data on the course of IBD is derived from a limited number of cohort studies.Studies help to define the endpoints for clinical trials and to identify subsets of patients in whom the prognosis of the disease can be stratified according to clinical features.Specific scientific requirements for high-quality studies on prognosis are the following:use of inception cohort,description of referral patterns,completeness of follow-up,objective outcome criteria,blind outcome assessment,adjustment for extraneous prognostic factors and statistical issues.We analyzed each of these requirements in studies on IBDs.To date,prospective and populationbased cohort studies are the standard for an unbiased assessment of prognosis.A better knowledge of the course of disease of chronic disorders ideally requires:(1) data from population-based studies,to avoid selection bias from referral centers in which patients with a more severe disease are usually treated;(2) inclusion of patients seen at the onset of the disease excluding misdiagnosed cases;and(3) follow-up from the onset of the disease to the end without dropouts.
