Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesion
Liver Fibrosis: Difficulties in Diagnostic and Treatment: A Review-Crimson Pu...CrimsonGastroenterology
Early discovery of liver fibrosis and cirrhosis is becoming more relevant because of enhanced incidence of hepatocellular carcinoma. There a many underlying factors in developing liver fibrosis (i.e. viral hepatitis, steatohepatitis). Diagnosis of liver fibrosis is difficult; chronic liver failure and less distinct fibrosis stages can be underestimated, when laboratory routine parameters and native ultrasound of the liver are unsuspicious. Liver biopsy is a common element of diagnostic workup in hepatic cirrhosis, alongside clinical examination and abdominal ultrasound, and is the accepted diagnostic gold standard. But there is no unitary system of histological classification used to evaluate the degree of fibrosis, and individual systems are often validated only for individual disease entities. On the other hand liver biopsy is of less tolerance for patients. In the last years serological markers for detecting liver fibrosis were developed with different validity. Various imaging modalities have been proposed as methods for assessing liver fibrosis
by liver stiffness measurement. They are sufficient to approve the suspicious of liver fibrosis and/or to uncover unknown chronic liver failure. Studies showed the clinical usefulness of acoustic radiation force impulse shear wave elasticity imaging (ARFI-SWEI) is efficient as a preventive screening method to uncover fibrosis. The ARFI-SWEI system is integrated in an ultrasound device has a good accuracy and high reproducibility. Therapy of liver fibrosis depends on underlying disease and degree of liver failure. When liver failure can be cured liver fibrosis can regress. Direct antifibrotic drugs are
actually not available but in progress.
This document provides a summary of the November 2014 issue of the UTSW Internal Medicine Journal Watch. It includes summaries of articles on topics such as assessing acid-base disturbances, managing Staphylococcus aureus bacteremia, community acquired pneumonia, predicting hepatocellular carcinoma in hepatitis C patients, and guidelines for prioritizing patients for new hepatitis C treatments. It also reviews articles related to infectious diseases, critical care, nephrology, cardiology, and more.
This study evaluated the safety and efficacy of pegylated interferon alpha-2a (PEG-IFN) monotherapy in 78 hepatitis C virus (HCV) positive hemodialysis patients. An early viral response was seen in 61.5% of patients at 12 weeks. However, only 19.2% had undetectable HCV RNA levels at end of treatment. A sustained viral response was achieved in 14.1% of the initial population. Adherence was poor, with 32% unable to complete the 48-week treatment due to adverse effects. Adverse events were common, occurring in 83% of patients. The incidence of serious adverse events was high at 0.19 per patient-year. The study
Hepatocellular & Pancreatic CarcinomasRHMBONCO
The document discusses hepatocellular carcinoma (HCC) and pancreatic cancer, including their epidemiology, risk factors, screening, diagnosis, staging, and management. For HCC, risk factors include hepatitis and other liver diseases, while targeted therapies such as sorafenib have shown efficacy. Surgical resection can cure early HCC but recurrence is common. For pancreatic cancer, risk increases with age and genetic factors, while surgery offers the only chance for cure if the cancer is resectable.
Background: The precise evaluation of hepatic fi brosis is crucial in the management of Chronic Hepatitis C (CHC). Multiple noninvasive serological scores and devices have been used in the accurate prediction of fibrosis however; early changes in non-invasive
biomarkers of liver fibrosis following antiviral therapy are widely unknown. We aim to evaluate changes of liver stiffness and 6 noninvasive serological fibrosis scores, easy to calculate particularly in poor areas, following sofosbuvir- based treatment.
Methods: This is a cohort study that included 155 CHC Egyptian patients. Transient elastography values were recorded as well
as Aspartate Aminotransferase-To-Platelet Ratio Index (APRI), FIB-4, Lok score, fibrosis index, King Score and fibro Q score were calculated at baseline and 12 weeks post-treatment.
3TC-DTG Dual Therapy and Its Implications in Hepatic Steatosis in People Livi...semualkaira
Hepatic disease is one of the major comorbidities
in people living with HIV. We intended to define the incidence of
NAFLD and to identify any factors which may be associated with
such a condition.
Alpha-Fetoprotein and the Early Diagnosis of Hepatocellular CarcinomaJohnJulie1
Hepatocellular carcinoma is the most common primary malignant tumor of the liver. Cirrhosisis associated with its carcinogenesis, so periodic surveillance is necessary. Ultrasonography is currently the most appropriate test for screening hepatocellular carcinoma, and alpha-fetoprotein is the most used biomarker despite its low sensitivity
Alpha-Fetoprotein and the Early Diagnosis of Hepatocellular CarcinomaJapaneseJournalofGas
Hepatocellular carcinoma is the most common primary malignant tumor of the liver. Cirrhosisis associated with its carcinogenesis, so periodic surveillance is necessary. Ultrasonography is currently the most appropriate test for screening hepatocellular carcinoma, and alpha-fetoprotein is the most used biomarker despite its low sensitivity
Liver Fibrosis: Difficulties in Diagnostic and Treatment: A Review-Crimson Pu...CrimsonGastroenterology
Early discovery of liver fibrosis and cirrhosis is becoming more relevant because of enhanced incidence of hepatocellular carcinoma. There a many underlying factors in developing liver fibrosis (i.e. viral hepatitis, steatohepatitis). Diagnosis of liver fibrosis is difficult; chronic liver failure and less distinct fibrosis stages can be underestimated, when laboratory routine parameters and native ultrasound of the liver are unsuspicious. Liver biopsy is a common element of diagnostic workup in hepatic cirrhosis, alongside clinical examination and abdominal ultrasound, and is the accepted diagnostic gold standard. But there is no unitary system of histological classification used to evaluate the degree of fibrosis, and individual systems are often validated only for individual disease entities. On the other hand liver biopsy is of less tolerance for patients. In the last years serological markers for detecting liver fibrosis were developed with different validity. Various imaging modalities have been proposed as methods for assessing liver fibrosis
by liver stiffness measurement. They are sufficient to approve the suspicious of liver fibrosis and/or to uncover unknown chronic liver failure. Studies showed the clinical usefulness of acoustic radiation force impulse shear wave elasticity imaging (ARFI-SWEI) is efficient as a preventive screening method to uncover fibrosis. The ARFI-SWEI system is integrated in an ultrasound device has a good accuracy and high reproducibility. Therapy of liver fibrosis depends on underlying disease and degree of liver failure. When liver failure can be cured liver fibrosis can regress. Direct antifibrotic drugs are
actually not available but in progress.
This document provides a summary of the November 2014 issue of the UTSW Internal Medicine Journal Watch. It includes summaries of articles on topics such as assessing acid-base disturbances, managing Staphylococcus aureus bacteremia, community acquired pneumonia, predicting hepatocellular carcinoma in hepatitis C patients, and guidelines for prioritizing patients for new hepatitis C treatments. It also reviews articles related to infectious diseases, critical care, nephrology, cardiology, and more.
This study evaluated the safety and efficacy of pegylated interferon alpha-2a (PEG-IFN) monotherapy in 78 hepatitis C virus (HCV) positive hemodialysis patients. An early viral response was seen in 61.5% of patients at 12 weeks. However, only 19.2% had undetectable HCV RNA levels at end of treatment. A sustained viral response was achieved in 14.1% of the initial population. Adherence was poor, with 32% unable to complete the 48-week treatment due to adverse effects. Adverse events were common, occurring in 83% of patients. The incidence of serious adverse events was high at 0.19 per patient-year. The study
Hepatocellular & Pancreatic CarcinomasRHMBONCO
The document discusses hepatocellular carcinoma (HCC) and pancreatic cancer, including their epidemiology, risk factors, screening, diagnosis, staging, and management. For HCC, risk factors include hepatitis and other liver diseases, while targeted therapies such as sorafenib have shown efficacy. Surgical resection can cure early HCC but recurrence is common. For pancreatic cancer, risk increases with age and genetic factors, while surgery offers the only chance for cure if the cancer is resectable.
Background: The precise evaluation of hepatic fi brosis is crucial in the management of Chronic Hepatitis C (CHC). Multiple noninvasive serological scores and devices have been used in the accurate prediction of fibrosis however; early changes in non-invasive
biomarkers of liver fibrosis following antiviral therapy are widely unknown. We aim to evaluate changes of liver stiffness and 6 noninvasive serological fibrosis scores, easy to calculate particularly in poor areas, following sofosbuvir- based treatment.
Methods: This is a cohort study that included 155 CHC Egyptian patients. Transient elastography values were recorded as well
as Aspartate Aminotransferase-To-Platelet Ratio Index (APRI), FIB-4, Lok score, fibrosis index, King Score and fibro Q score were calculated at baseline and 12 weeks post-treatment.
3TC-DTG Dual Therapy and Its Implications in Hepatic Steatosis in People Livi...semualkaira
Hepatic disease is one of the major comorbidities
in people living with HIV. We intended to define the incidence of
NAFLD and to identify any factors which may be associated with
such a condition.
Alpha-Fetoprotein and the Early Diagnosis of Hepatocellular CarcinomaJohnJulie1
Hepatocellular carcinoma is the most common primary malignant tumor of the liver. Cirrhosisis associated with its carcinogenesis, so periodic surveillance is necessary. Ultrasonography is currently the most appropriate test for screening hepatocellular carcinoma, and alpha-fetoprotein is the most used biomarker despite its low sensitivity
Alpha-Fetoprotein and the Early Diagnosis of Hepatocellular CarcinomaJapaneseJournalofGas
Hepatocellular carcinoma is the most common primary malignant tumor of the liver. Cirrhosisis associated with its carcinogenesis, so periodic surveillance is necessary. Ultrasonography is currently the most appropriate test for screening hepatocellular carcinoma, and alpha-fetoprotein is the most used biomarker despite its low sensitivity
This document discusses non-alcoholic fatty liver disease (NAFLD), which ranges from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. It occurs without significant alcohol use or other known causes. Risk factors include obesity, dyslipidemia, and type 2 diabetes. Due to the rise in metabolic syndrome, NAFLD is now the most common cause of chronic liver disease. Genetic and metabolic factors like insulin resistance and inflammation contribute to its development and progression. Liver biopsy is still the gold standard for diagnosis but carries risks, so noninvasive imaging methods are being developed and studied.
Cirrhosis is a dynamic disease with varying prognosis depending on clinical stage. It results from mechanisms leading to necroinflammation and fibrogenesis. Later stages are characterized by portal hypertension, ascites, encephalopathy, and risk of hepatocellular carcinoma. Treatment and prevention of complications, including screening and cause-specific therapies, can improve outcomes for patients with cirrhosis.
Kumpulan abstrak penelitian hepatologiDesiPurnama2
This document contains 10 abstracts related to hepatology research. The first abstract summarizes a study analyzing quantitative hepatitis B surface antigen (HBsAg) as a predictor of liver fibrosis in hepatitis B patients. The study evaluated the diagnostic value of quantitative HBsAg levels and liver fibrosis assessed by transient elastography. The second abstract examines the correlation between serum vascular endothelial growth factor (VEGF) level, portal vein diameter, portal flow velocity, and the severity of liver cirrhosis based on Child-Turcotte-Pugh score. The third abstract analyzes the correlation between APRI test score and serum hyaluronic acid level with the degree of hepatic fibrosis in hepatitis C patients assessed by transient elastography.
This study aimed to determine the frequency of steatosis in 158 hepatitis C patients and examine its relationship to fibrosis. The key findings were:
1) Steatosis was present in 45% of liver biopsies. A strong correlation was observed between increasing steatosis and worsening fibrosis.
2) No significant relationship was found between steatosis and either BMI or age.
3) The results suggest steatosis may play a role in accelerating liver disease progression in hepatitis C by fueling free radical production, amplifying the virus's cytopathic effect. Efforts to control steatosis may help slow disease progression.
This study examined 158 hepatitis C patients to determine the frequency of liver fat (steatosis) and its relationship to fibrosis severity. The results showed:
1) Steatosis was present in 45% of patients and ranged from mild to severe.
2) A strong correlation was found between increasing steatosis severity and worsening fibrosis stage.
3) No significant relationships were found between steatosis and either patient age or BMI. This suggests steatosis may play a role in accelerating liver disease progression in hepatitis C.
This study examined 158 hepatitis C patients to determine the frequency of liver fat (steatosis) and its relationship to fibrosis severity. The results showed:
1) Steatosis was present in 45% of patients and ranged from mild to severe.
2) A strong correlation was found between increasing steatosis severity and worsening fibrosis stage.
3) No significant relationships were found between steatosis and either patient age or BMI. This suggests steatosis may play a role in accelerating liver disease progression in hepatitis C.
This document summarizes primary and secondary liver malignancies, their management, and principles of liver resection. It covers hepatocellular carcinoma (HCC), the most common primary liver cancer, risk factors, presentation, diagnosis, staging, and treatment options. Intrahepatic cholangiocarcinoma and metastatic tumors to the liver are also discussed. Surgical resection is the main curative treatment for early-stage HCC and intrahepatic cholangiocarcinoma when possible.
Gemcitabine and Cisplatin In Metastatic Carcinoma Gallbladder. A Single Insti...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This lecture was part of an educational course performed by the IATTGI group this August in Buenos Aires and describes novel targets and novel drugs in hepatocellular carcinoma.
HCC Clinical update and hints from AASLD 2017 guidelines mainly about surveillance, diagnosis and treatment of Hepatocellular carcinoma in different stages.
Gastrointestinal Cancer: Research & Therapy is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Gastrointestinal Cancer.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Gastrointestinal Cancer. Gastrointestinal Cancer: Research & Therapy accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Gastrointestinal Cancer.
Gastrointestinal Cancer: Research & Therapy strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Comparative Study of Hscrp in Chronic Kidney Diseaseiosrphr_editor
Chronic kidney disease (CKD) is a global threat to health mainly in developing countries because therapy is expensive and lifelong. over 1 million people worldwide are on dialysis or with a functioning graft. Early detection of Chronic kidney disease (CKD) and its consequent complications can prevent its grave complications . It causes not only significant morbidity but also it causes high mortality. Because of increase in incidence of Diabetes mellitus, hypertension, obesity and an aging population there is increase in progression of chronic kidney disease to end stage renal disease (ESRD). . Cardiovascular disease (CVD) is the major cause of mortality in haemodialysis patients and so it has become imperative to have a screening programme at all levels to detect CKD at an early stage and to initiate specific therapy to reduce the progression of renal disease and also the burden of ESRD (1). High sensitive C-Reactive protein (Hs CRP) assay is useful for sensitive detection of inflammatory state (2,3). This study aims at estimating Hs CRP as a marker of inflammation in CKD patients...
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Lung cancer is the second common malignancy and the most aggressive cancer worldwide with late diagnosis and poor prognosis. The search for biomarkers that promote early diagnosis and improve therapeutic strategies focuses to the understanding of the mechanisms underlying cancer development and progression. The deregulation of gene expression is one of the cancer hallmarks reflected to the stability...
A 43-Year-Old Male with PCM1-JAK2 Gene Fusion Experienced T-Lymphoblastic Lym...daranisaha
Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely,
Stereotactic Radiation Therapy of Lung Cancers and Subsequent Parenchymal Alt...daranisaha
Stereotactic body radiation therapy (SBRT) is one of the standard radical treatments in stage I nonsmall cell lung cancer (NSCLC) and an option for lung metastases. The pulmonary parenchymal CT alterations at 3, 6 and 12 months are the object of a prospective analysis in patients submitted to SBRT, to define factors affecting the different radiological alterations...
Higher Rates of Helicobacter Pylori Infection and Gastric Intestinal Metaplas...daranisaha
The rate of Helicobacter pylori (H. pylori) infection is higher in minority patients in the United States [1]. Gastric intestinal metaplasia (IM) is associated with H. pylori infection and carries an increased risk for gastric cancer over time, in particular for patients from regions of high gastric cancer incidence [2]. We aimed to compare the rates of Helicobacter pylori infection and gastric intestinal metaplasia...
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...daranisaha
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies...
Myelomastocytic leukemia is a very rare variant of myeloid leukemia, behaves clinically very aggressive and belongs to the group of so-called metachromatic leukemias. Metachromatic leu- kemias comprise leukemias with at least 10 to 20% tumor cells exhibiting metachromatic gran- ules: mast cell leukemia...
Cavernous Sinus Metastasis of Leiomyosarcoma with Orbital Extension along the...daranisaha
Leiomyosarcoma (LMS) metastasis in the central nervous system is extremely rare. Metastatic LMSs have been described in the orbit, meninges, and skull base, however there are no reports of LMS metastasis into the cavernous sinuswith primary origin from lower extremity and long silent disease period of 7 years..
Analysis of Treatment Option for Synchronous Liver Metastases and Colon Recta...daranisaha
Colorectal or bowel cancer is one of the major cause of cancer worldwide. Research has shown that 15 to 20 % colorectal cancer patients are also diagnosed with synchronous liver metastases (LM) at presentation and about one third eventually develop liver lesions (Leporrier, Maurel, Chiche, Bara, Segol, and Launoy, 2006; Manfredi, Lepage, Hatem, Coatmeur, Faivre, and Bou-vier, 2006)...
An Adrenal Mass in a Patient with Lynch Syndromedaranisaha
Adrenocortical cancer (ACC) is a rare malignancy (estimated annual incidence 0.7 to 2.0 cases per million individuals worldwide) with a poor prognosis. In contrast, Lynch Syndrome (LS) is a much more commonly encountered hereditary syndrome that predisposes individuals to colon cancer and multiple other malignancies...
Racial Differences in Accepting Pegfilgrastim Onpro Kit (On-Body Injector) Us...daranisaha
Neulasta Onpro kit eliminates need for additional clinic visit after chemotherapy. Given the racially diverse population in our institution, we investigated acceptance of Onpro kit among patients on chemotherapy.Single-institution, retrospective review conducted in patients with GI tumors who received Onpro kit within 1 hour of completion of systemic chemotherapy from Jan 2014 through Jan 2018...
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This document discusses non-alcoholic fatty liver disease (NAFLD), which ranges from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. It occurs without significant alcohol use or other known causes. Risk factors include obesity, dyslipidemia, and type 2 diabetes. Due to the rise in metabolic syndrome, NAFLD is now the most common cause of chronic liver disease. Genetic and metabolic factors like insulin resistance and inflammation contribute to its development and progression. Liver biopsy is still the gold standard for diagnosis but carries risks, so noninvasive imaging methods are being developed and studied.
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This document contains 10 abstracts related to hepatology research. The first abstract summarizes a study analyzing quantitative hepatitis B surface antigen (HBsAg) as a predictor of liver fibrosis in hepatitis B patients. The study evaluated the diagnostic value of quantitative HBsAg levels and liver fibrosis assessed by transient elastography. The second abstract examines the correlation between serum vascular endothelial growth factor (VEGF) level, portal vein diameter, portal flow velocity, and the severity of liver cirrhosis based on Child-Turcotte-Pugh score. The third abstract analyzes the correlation between APRI test score and serum hyaluronic acid level with the degree of hepatic fibrosis in hepatitis C patients assessed by transient elastography.
This study aimed to determine the frequency of steatosis in 158 hepatitis C patients and examine its relationship to fibrosis. The key findings were:
1) Steatosis was present in 45% of liver biopsies. A strong correlation was observed between increasing steatosis and worsening fibrosis.
2) No significant relationship was found between steatosis and either BMI or age.
3) The results suggest steatosis may play a role in accelerating liver disease progression in hepatitis C by fueling free radical production, amplifying the virus's cytopathic effect. Efforts to control steatosis may help slow disease progression.
This study examined 158 hepatitis C patients to determine the frequency of liver fat (steatosis) and its relationship to fibrosis severity. The results showed:
1) Steatosis was present in 45% of patients and ranged from mild to severe.
2) A strong correlation was found between increasing steatosis severity and worsening fibrosis stage.
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This study examined 158 hepatitis C patients to determine the frequency of liver fat (steatosis) and its relationship to fibrosis severity. The results showed:
1) Steatosis was present in 45% of patients and ranged from mild to severe.
2) A strong correlation was found between increasing steatosis severity and worsening fibrosis stage.
3) No significant relationships were found between steatosis and either patient age or BMI. This suggests steatosis may play a role in accelerating liver disease progression in hepatitis C.
This document summarizes primary and secondary liver malignancies, their management, and principles of liver resection. It covers hepatocellular carcinoma (HCC), the most common primary liver cancer, risk factors, presentation, diagnosis, staging, and treatment options. Intrahepatic cholangiocarcinoma and metastatic tumors to the liver are also discussed. Surgical resection is the main curative treatment for early-stage HCC and intrahepatic cholangiocarcinoma when possible.
Gemcitabine and Cisplatin In Metastatic Carcinoma Gallbladder. A Single Insti...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This lecture was part of an educational course performed by the IATTGI group this August in Buenos Aires and describes novel targets and novel drugs in hepatocellular carcinoma.
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Gastrointestinal Cancer: Research & Therapy is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Gastrointestinal Cancer.
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
2. clinicsofoncology.com 2
Volume 5 Issue 3 -2021 Research Article
etiology (chronic viral hepatitis, alcoholic liver disease, metabolic
disturbances, autoimmune liver diseases etc.) represents an im-
portant risk factor for HCC as all etiologic forms of cirrhosis may
be complicated by tumor formation [3].
Long-term follow-up studies have found that approximately 1–8%
of patients with liver cirrhosis develop HCC per year, especially
those with features of severe liver disease and/or significant portal
hypertension [3]. Patients at high risk of developing HCC, such as
cirrhotics, should be entered into surveillance programs in order to
find HCC at early stages in which potentially curative treatments
are feasible. Liver ultrasound every six months, with or without
concomitant use of serum a-fetoprotein (AFP) levels, is strongly
recommended by EASL/AASLD/APASL guidelines for all cir-
rhotic patients participating in HCC surveillance programs [3, 4,
5]. Data concerning the utility of several proposed tumor biomark-
ers for accurate early HCC detection are still lacking.
Tumor microenvironment is the major site for tumor cell prolifer-
ation and differentiation that significantly affects carcinogene-
sis, vascular invasion/metastasis and response to therapy [6]. The
HCC tumor microenvironment is divided into cellular (liver sinu-
soidal endothelial cells, hepatic stellate cells etc) and non-cellular
components. Moreover, infiltrating immune cells are present in
HCC (neutrophils, lymphocytes, tumor-associated macrophages,
dendritic cells, myeloid-derived suppressor cells), creating a
unique microenvironment that determines tumor growth as well
as prognosis and response to immunotherapy [7]. Fibrinogen-like
protein 2 (FGL-2) is a member of the fibrinogen-like protein fam-
ily that holds a central role in both innate and adaptive immunity.
Soluble fibrinogen-like protein 2 (sFGL-2) is the soluble form of
fibrinogen-like protein 2, that is mainly secreted by regulatory T
cell (Treg) populations and creates a potently immunosuppres-
sive microenvironment, so sFGL-2 might play a role in inhibit-
ing endogenous antitumor immune responses [8]. A recent study
suggests that FGL-2 may promote the growth of hepatocellular
carcinoma by promoting the accumulation of myeloid-derived
suppressor cells in the tumor microenvironment [9].
Data concerning soluble FGL-2 levels in patients with chronic
hepatitis B [10], chronic hepatitis C [8], liver cirrhosis and HCC
[11] suggest that there is a significant correlation between them
and the progression and severity of underlying liver disease as
well as with the clinical outcome. A study in cirrhotic patients with
HCC concluded that sFGL-2 protein is a novel effector molecule
of activated hepatic stellate cells, which suppresses CD8 T cell
proliferation and interferon-gamma production and it subsequent-
ly might contribute to immune suppression during liver fibrosis
and carcinogenesis [11]. To our knowledge the role of soluble
FGL-2 levels in the prediction of hepatocellular carcinoma among
cirrhotic patients under HCC surveillance program has not been
investigated yet.
The aim of our study was to evaluate the predictive value of the
biomarkers AFP and FGL-2 in the appearance of HCC among
Caucasian cirrhotic patients of various etiologies who were fol-
lowed-up according to an HCC surveillance program.
3. Materials & Methods
3.1. Patients: We prospectively evaluated serum FGL-2 levels of
consecutive compensated or decompensated Caucasian cirrhotic
patients with or without concomitant HCC presenting in the outpa-
tient Hepatology Unit of General and Oncology Hospital of Kifisia
‘‘Agioi Anargyroi”. Patient inclusion commenced in September
2014 and ended in January 2015. All patients included had histo-
ry of chronic liver disease of various etiologies and diagnosis of
compensated (confirmed by either liver biopsy or transient elas-
tography) or decompensated liver cirrhosis. All cirrhotic patients
with chronic HCV infection participated in the study had received
antiviral treatment in the past and exhibited sustained virological
response (undetectable serum HCV-RNA twelve weeks follow-
ing treatment cessation and at least once annually). Moreover, all
HBV-related cirrhotic patients participated were appropriately vi-
rologically suppressed (undetectable serum HBV-DNA levels us-
ing a sensitive PCR assay with a cut-off of 13 IU/ml at least once
annually) with long term nucleos(t)ide analogues therapy (ente-
cavir or tenofovir). Cirrhotic patients of any etiology who declare
current alcohol use were also excluded.
Decompensated liver cirrhosis was defined by a history of at least
one major cirrhosis-related complication, such as portal hyperten-
sion related bleeding, hepatic encephalopathy, ascites with Serum
AscitesAlbumin Gradient (SAAG) >1.1 g/dL or jaundice.Absence
of bacterial infection was based on clinical examination, absence of
findings on chest X-ray suggestive of lower respiratory tract infec-
tions and negativity of blood, urine and ascitic fluid cultures. The
neutrophil count in ascitic fluid (<250/mm³) was also evaluated to
exclude spontaneous bacterial peritonitis in cirrhotic patients with
ascites. For the baseline characteristics of the study population,
demographic data were collected through medical history, while
hematological and biochemical tests were performed using stan-
dard laboratory methods. For the assessment of severity of chron-
ic liver disease, well defined scores for cirrhotic patients, such as
Child-Pugh (CP) and MELD, were used. Contrast enhanced CT or
MRI were available, within the last 6 months prior to the baseline
visit, in all the included patients in order to suspect or to exclude
cirrhotic patients with concurrent HCC. Histological confirmation
of HCC was done in all patients with suspected lesions at baseline
evaluation. Patients with HCC were further staged according to the
Barcelona Clinic Liver Cancer (BCLC) staging system.
Cirrhotic patients without confirmed HCC at baseline were further
followed up every six months with liver ultrasound and serum a-fe-
toprotein levels, according to the HCC surveillance program that
is used in our Department. Patients with new lesions suggestive
3. Volume 5 Issue 3 -2021 Research Article
clinicsofoncology.com 3
of HCC during the surveillance program were further evaluated
with contrast enhanced CT or MRI and histological confirmation
of HCC was established with imaging guided biopsy of the lesion.
Written informed consent was collected from all patients partici-
pating in the current study. The study protocol was in accordance
with the Declaration of Helsinki and was evaluated and approved
by the Ethics Committee of the School of Health Sciences of the
National and Kapodistrian University of Athens, Greece.
3.2. Collection of Samples and Measurements: Collection of
samples was performed when the patients presented in the out-
patient Hepatology Unit, at the same time as demographical data
were recorded and routine laboratory tests were ordered. Whole
blood (approximately 10ml) was collected from peripheral veins
of patients and serum as well as plasma was immediately separated
and stored frozen at -80o C until further analysis. Soluble FGL-2
levels were measured from plasma samples using a commercial-
ly available ELISA kit (Cloud-Clone Corp, Houston, TX 77084,
USA) following the specific instructions of the manufacturer.
3.3. Statistical Analysis: Continuous variables are presented as
mean (standard deviation) or median (range), while categorical
variables are presented as numbers (percentages).
We used the Kolmogorov-Smirnov test (p>0.05 for all variables)
and normal Q-Q plots to test the normality assumption. Univar-
iate analysis between demographic and clinical data and HCC
appearance included chi-square test, chi-square trend test and
independent samples t-test. Also, the relation between biomark-
ers and HCC appearance was assessed with Mann-Whitney test
since biomarkers did not follow normal distribution. We applied
multivariate logistic regression analysis with HCC appearance
as the dependent variable to eliminate cofounding. In that case,
we estimated odds ratios, 95% confidence intervals and p-values.
P-values of less than 0.05 were considered significant. Statistical
analysis was performed with the Statistical Package for Social Sci-
ences software (IBM Corp. Released 2012. IBM SPSS Statistics
for Windows, Version 21.0. Armonk, NY: IBM Corp.)
4. Results
Between September 2014 and January 2015, 112 consecutive
Caucasian cirrhotic patients (81 males) presenting in the outpa-
tient Hepatology Unit of General and Oncology Hospital of Kifisia
‘‘Agioi Anargyroi” were evaluated. Sixty-eight of them (60.7%)
were categorized at CP-A score and 44 (39.3%) at CP-B/C score
whereas the median CP score of the whole population was 6 and
the median MELD score was 9. Twenty-eight out of 112 cirrhot-
ic patients (25%) were diagnosed with imaging and histologically
confirmed concurrent HCC at baseline. Six of them were catego-
rized at stage A, 4 at stage B, 12 at stage C and the rest 6 at stage D,
according to BCLC staging system, whereas half of HCC patients
(14/28, 50%), presented with portal vein thrombosis.
Overall, mean plasma FGL-2 levels were 4.04±3.80 pg/ml in the
whole cirrhotic population but were significantly higher in patients
with CP-B/C cirrhosis (6.07±4.80 pg/ml) compared to those with
CP-A liver disease (2.82±2.27 pg/ml, p<0.0001). Additionally,
mean plasma FGL-2 levels were significantly elevated in 28 cir-
rhotic patients with HCC at baseline (6.41±4.20 pg/ml) compared
to 84 cirrhotic patients without HCC (3.24±3.29 pg/ml, p=0.001).
Moreover, CP-B/C cirrhotic patients with HCC (n=18) exhibited
significantly higher FGL-2 levels (7.84±4.24 pg/ml) compared to
25 CP-B/C cirrhotic patients without HCC at baseline (4.87±5.20
pg/ml, p=0.024). Patients categorized at advanced and terminal
(BCLC-C/D) HCC stages (n=18) exhibited the highest plasma
FGL-2 levels (8.17±4.31 pg/ml) that were remarkably higher to
the corresponding ones of those of the earlier (BCLC-A/B) HCC
stages (3.53±2.20 pg/ml, p=0.008). It seems that the presence of
HCC as well as the stage of the disease according to BCLC sys-
tem (which includes the Child-Pugh score) significantly influences
plasma FGL-2 levels in cirrhotic patients.
Eighty-four cirrhotic patients (57 males) without HCC at base-
line control were followed-up from January 2015 until December
2020 according to the HCC surveillance program (liver ultrasound
and serum AFP levels every 6 months). Diabetes was present in
21 (25%) and esophageal varices in 41 (49%) of them. The main
cause of the underlying chronic liver disease was chronic hepatitis
C virus infection in 31/84 (37%) of cases, chronic hepatitis B virus
infection in 10/84 (12%) of cases, non-alcoholic and/or alcoholic
liver disease in 28/84 (33%) of cases and autoimmune liver disease
in 13/84 (15%) of them. The vast majority of cirrhotic patients
(59/84, 70%) were categorized as CP-A and the rest 25 (30%) as
CP-B/C (19 CP-B and 6 CP-C).
Fourteen patients (14/84, 16.6%) developed HCC during the
5-years follow-up period (HCC group) and 70 (83.3%) did not
(control group). HCC diagnosis was supported by compatible dy-
namic CT and MRI findings and was also histological confirmed
in all cases. Demographic and clinical data of the 14 patients who
developed HCC during surveillance as well as HCC stage at diag-
nosis were presented in table 1. As expected the majority of HCC
cases appeared in CP-B/C cirrhotic patients (9/14, 64%). Nine out
of 25 CP-B/C cirrhotic patients (36%) developed HCC during the
follow-up period in contrast to only 5/59 (8.5%) CP-A patients. It
is important to note that all five patients who were categorized as
CP-A cirrhotics at baseline and developed HCC during the sur-
veillance period were categorized in very early (BCLC-0, n=2) or
early (BCLC-A, n=3) HCC stage and were treated with potentially
curative procedures (2 with liver resection and 3 with radiofre-
quency ablation). Three of them were alive without HCC recur-
rence or liver disease deterioration at the end of follow-up and
the other 2 died from liver-related complications following HCC
recurrence. On the other hand the majority of cirrhotic patients
categorized at CP-B/C stage (6/9, 66.6%) at baseline were staged
at intermediate BCLC-B (n=3) or advanced BCLC-C (n=3) stage
4. Volume 5 Issue 3 -2021 Research Article
clinicsofoncology.com 4
at the time of HCC diagnosis and only 3 of them at early BCLC-A
stage. Only two of them are still alive (one following successful
orthotopic liver transplantation and one following locoregional
treatment, both at BCLC-A stage) whereas 7 have died from liver
related events and/or HCC progression during follow-up period.
Demographic, clinical and laboratory data among patients from the
HCC group and control group are presented in table 2. As we can
clearly see from this table patients age (p=0.60), gender (p=0.20),
etiology of chronic liver disease (p=0.90), presence of diabetes
(p=0.10) or varices (p=0.07) as well as MELD score were compa-
rable between the two groups. In the univariate analysis only the
Child-Pugh score (CP-B/C vs A, p=0.006) and the platelet count
(p=0.008) were significantly correlated with HCC appearance.
Patients from HCC group had significantly lower platelet count
(mean 98.700 vs 147.400, p=0.008) and were frequently catego-
rized at CP B/C stage (64.3% vs 22.9%, p=0.006) at baseline com-
pared to control group. Concerning plasma FGL-2 and serum AFP
levels at baseline, only FLG-2 levels (p=0.01) but not AFP levels
(p=0.15) significantly differed between the two groups of patients.
The median values of FGL-2 and AFP among patients from HCC
and control group were (3.6 pg/ml vs 2.1 pg/ml, p=0.01) and (6.0
ng/ml vs 4.0 ng/ml, p=0.15), respectively.
In order to evaluate the impact of liver disease severity in HCC
appearance as well as its influence on the levels of biomarkers we
continue a multivariate, logistic regression analysis taking into ac-
count patient age, gender, platelet count, Child-Pugh score, MELD
score as well as baseline FGL-2 and AFP levels as linear or dichot-
omous variable using the median values (3.6 pg/ml for FGL-2 and
6 ng/ml for AFP). In the multivariate logistic regression analysis,
only patients gender (OR=20.801, 95%CI: 1.504-287.7, p=0.024),
platelets (OR=0.980, 95%CI:0.964-0.997, p=0.025) and base-
line CP score (CP-B/C vs A, OR=27.184, 95%CI:2.815-262.5,
p=0.004) were significantly correlated with HCC appearance
during the follow-up period, as shown in table 3. In this analysis
plasma FGL-2 levels did not relate with HCC appearance either
using them as linear (OR=1.16, 95%CI:0.96-1.41, p=0.13) or as
dichotomous variable (OR=4.18, 95%CI:0.79-22.14, p=0.093) in
the multivariate model.
Table 1: Characteristics of 14 patients who developed HCC during surveillance
Age Gender Etiology ChildPugh score Meld score BCLC at HCC diagnosis
1 56 M HCV A5 7 0
2 55 M ALD A5 9 A
3 68 M HBV A5 10 A
4 68 M HCV B7 10 A
5 60 M HCV B7 13 C
6 76 M HCV A6 8 A
7 62 M HBV B7 8 B
8 74 M ALD C11 18 B
9 71 F PBC B8 8 C
10 78 M NAFLD A5 6 0
11 60 M ALD B7 13 B
12 60 F PBC B8 10 A
13 74 M ALD C13 19 C
14 70 M NAFLD B8 13 B
MELD score: Model For End-Stage Liver Disease, BCLC: Barcelona Clinic Liver Cancer, HCC : hepatocellular carcinoma,
HCV: hepatitis C virus, ALD: alcoholic liver disease, HBV: hepatitis B virus, PBC: primary biliary cholangitis, NAFLD:
nonalcoholic fatty liver disease
Table 2: Demographic, clinical and laboratory baseline data among cirrhotic patients under HCC surveillance
HCC
p-value
NO (n=70) YES (n=14)
Ν % Ν %
Gender 0.2a
Male 45 78.9 12 21.1
Female 25 92.6 2 7.4
Age b
63.5 11.2 65.1 6.9 0.6c
Cirrhosis Etiology 0.9
HCV 27 87.1 4 12.9
HBV 8 80 2 20
NASH/ALD 22 78.6 6 21.4
AH/PBC 11 84.6 2 15.4
CRYPTOGENIC 2 100 0 0
Diabetes 0.1a
No 55 87.3 8 12.7
Yes 15 71.4 6 28.6
5. Volume 5 Issue 3 -2021 Research Article
clinicsofoncology.com 5
Decompensation 0.001a
No 55 91.7 5 8.3
Yes 15 62.5 9 37.5
CTP Score 0.006d
A 54 91.5 5 8.5
B 12 63.2 7 36.8
C 4 66.7 2 33.3
Varices 0.07a
No 39 90.5 4 9.5
Yes 31 75.6 10 24.4
PLTsb
(K/μl) 147.4 62.6 98.7 51.1 0.008c
MELD scoreb
9.7 5 10.9 3.9 0.4c
FGL-2 0.01e
Median value (range) (pg/ml) 2.1 (18.4) 3.6 (16.7)
AFP 0.15e
Median value (range) (ng/ml) 4.0 (73.8) 6(126.0)
a
chi-square test b
mean, standard deviation c
independent samples t-test d
chi-square trend test e
Mann-Whitney test
HCC: hepatocellular carcinoma, HBV: hepatitis B virus, HCV: hepatitis C virus, NAFLD: non -alcoholic fatty liver disease, ALD: alcoholic liver
disease, AH: autoimmune hepatitis, PBC: primary biliary cholangitis, CTP score: ChildTurcotte-Pugh score, MELD score: Model For End-Stage
Liver Disease score, PLTs: platelets, FGL-2: fibrinogen like protein-2, AFP: a-fetoprotein
Table 3: Logistic Regression Analysis with HCC appearance as the dependent variable
Odds ratio 95% confidence interval p-value
PLTs 0.980 0.964 – 0.997 0.025
MELD 0.764 0.583 – 1.002 0.051
AGE 1.047 0.962 – 1.139 0.286
GENDER (Males
vs. females)
20.801 1.504 – 287.7 0.024
CTP B-C vs Α 27.184 2.815 – 262.5 0.004
FGL-2 2.834 0.497 – 16.15 0.241
AFP 5.455 0.878 – 33.87 0.069
CTP score: Child-Turcotte-Pugh score, MELD: Model For End-Stage Liver Disease, PLTs: platelets, FGL-2: fibrinogen like protein-2,
AFP: a-fetoprotein
5. Discussion
The vast majority of HCC cases occur in the setting of severe
chronic liver disease of any etiology and liver cirrhosis is the stron-
gest risk factor of HCC emergence [12]. The cirrhotic background
seems to play a crucial role in the development and progression of
HCC as chronic liver disease deranges hepatic immune tolerogen-
ic network facilitating tumor development [13]. Cytotoxic T Lym-
phocytes (CTLs) and Natural Killer (NK) cells are antitumor im-
mune cells that play an integral role in cancer immune surveillance
and eradication of tumor cells whereas accumulation of regulatory
T cells (Tregs) that frequently occurs in HCCs, is associated with
CTLs and NK cells dysfunction, tumor invasiveness as well as
progression, and poor patient outcomes [12, 13]. Fibrinogen-like
protein 2 (FGL-2), that is mainly secreted by regulatory T cells,
has been demonstrated to promote tumor progression by regulat-
ing cellular components of the tumor microenvironment [9, 13]. In
our study we evaluate soluble FGL-2 levels in Caucasian cirrhotic
patients with or without HCC as well as their predictive value for
HCC emergence during the surveillance program.
Our results are in accordance with other studies [8, 10] which con-
clude that liver disease severity is significantly related to plasma
FGL-2 levels. Patients with liver cirrhosis exhibited higher FGL-
2 levels compared to non-cirrhotics with chronic hepatitis C [8]
or chronic hepatitis B [10] but levels were comparable among
patients with HBV-related cirrhosis with or without HCC [10],
suggesting that mainly cirrhotic background significantly affects
them. Additionally, in a study with a small sample size, among 21
HCC patients, those with cirrhosis (n=10) exhibited significantly
higher levels of sFGL-2 compared to 11 non-cirrhotic individuals
[11]. In our study patients with advanced liver cirrhosis (Child-
Pugh stage B/C) with HCC exhibited significantly higher FGL-2
levels (7.84±4.24 pg/ml) compared to CP-B/C cirrhotic patients
without HCC (4.87±5.20 pg/ml, p=0.024) and patients at advanced
or terminal (BCLC-C/D) HCC stages exhibited the highest plasma
FGL-2 levels (8.17±4.31 pg/ml) that were remarkably higher to
the corresponding ones of those of earlier (BCLC-A/B) HCC stag-
es (3.53±2.20 pg/ml, p=0.008). It seems that the interaction of ad-
vanced liver disease with the high tumor burden and/or vascular in-
vasion observed in HCC cirrhotic patients of advanced (BCLC-C)
or terminal (BCLC-D) stage significantly affects plasma FGL-2
levels. It is important to note that portal vein thrombosis was ob-
served only in 14 cirrhotic patients with HCC at baseline control,
who by definition were categorized as advanced or terminal stage
(BCLC-C/D), so it was impossible to evaluate the specific impact
of this major event and its possible consequences (aggravation of
6. Volume 5 Issue 3 -2021 Research Article
clinicsofoncology.com 6
portal hypertension, bacterial translocation etc.) on FGL-2 levels.
Surveillance programs for hepatocellular carcinoma aim to detect
liver tumors at an early stage when they are amenable to potentially
curative therapy that is known to improve patient’s survival [14].
Based on HCC volume doublingtime? EASL/AASLD recommen-
dations support a 6-month screening interval, mainly with abdom-
inal ultrasound as the primary surveillance test recommended [3,
4].Although ultrasound has an acceptable sensitivity (84%) for de-
tecting HCC at any stage, its sensitivity for detection of early stage
HCC is significantly lower (47%) and did not always translate into
survival benefit [15]. The latter could be influenced by the cirrhot-
ic background of patients with HCC, as classical scores for liver
cirrhosis severity such as Child-Pugh score are taken into account
in BCLC staging of HCC and impact patients’ prognosis. In our
study, remarkable survival was observed only in CP-A cirrhotic
patients at baseline who finally developed HCC were categorized
at BCLC-0/A stage, so liver resection or locoregional therapies
with favorable outcome could be implemented. On the contrary
intermediate or advanced BCLC staging and poor clinical outcome
was noticed in the majority of CPB/C cirrhotic patients with HCC
emergence during the surveillance period. For these reasons most
clinical practice guidelines [3, 4, 5] did not suggest HCC screen-
ing in patients with decompensated cirrhosis (especially those of
ChildPugh C stage and/or MELD score above 20), unless they are
listed for liver transplantation, because they are unlikely to benefit
from HCC treatment. All patients with liver cirrhosis do not have
the same risk of developing HCC and it remains difficult to assess
the specific risk at an individual level [16]. In order to improve the
sensitivity for early HCC detection in cirrhotic patients, several
serum biomarkers (AFP, lectin-bound AFP, des-gamma carboxy
prothrombin etc.) as well as combinations of them with clinical
and routine laboratory data in panels (GALAD, BALAD-2) have
been evaluated [17].
Serum AFP levels exhibit poor sensitivity for early HCC detec-
tion, when used alone. At a cut-off value of 20 ng/mL, the most
commonly used cut-off value in clinical practice, AFP has a sen-
sitivity and specificity of approximately 60% and 80% for HCC,
respectively [18]. The accuracy of serum AFP levels for the de-
tection of HCC is limited especially in cirrhotic patients with
chronic HCV infection [18]. Concomitant use of liver ultrasound
and AFP improved the sensitivity of early HCC detection (63%)
compared to ultrasound alone (45%) [19]. Inclusion of serial AFP
measurements further improves the predictive value of HCC risk
in patients with HCV related cirrhosis. A model that incorporates
the rate of AFP change along with the most recent value of AFP
taking into account also patient age, serum alanine aminotrans-
ferase levels and platelet count is associated with improved sen-
sitivity for early HCC detection compared to the standard of care
surveillance program [20]. To our knowledge this study is the first
which tries to evaluate the predictive value of plasma FGL-2 levels
for HCC emergence among cirrhotic patients. It was hypothesized
that cirrhotic patients without HCC but with relatively elevated
FGL-2 levels could have created a potentially immunosuppressive
microenvironment that could facilitate tumor development in the
near future. Eighty-four cirrhotic patients, mainly with compen-
sated Child-Pugh A liver cirrhosis (70%), joined a 5-year follow-
up for HCC emergence. Baseline serum AFP levels did not differ
between the HCC group and the control group whereas there was
a significant difference between the two groups concerning plasma
FGL-2 levels. In the multivariate analysis, taking into account sev-
eral parameters that reflect liver failure and/or portal hypertension,
such as platelet count, MELD score and Child-Pugh score, the sta-
tistical significance of plasma FGL-2 levels was lost, suggesting
once again that liver disease severity probably influences them.
The higher levels of baseline FGL2 in patients who develop HCC
compared to ones who did not, could be explained by the obser-
vation that the majority of patients who finally developed HCC
(64%) were categorized in Child-Pugh B/C score. As expected
only male gender, Child-Pugh B/C score and low platelet count (as
an indirect marker of significant portal hypertension) could predict
HCC emergence.
Limitations of our study were the relative small sample size or
small number of patients, the mixed etiology of advanced liver
disease of patients, the relatively small proportion of those who
finally develop HCC, especially from the subgroup of cirrhotic
patients with compensated liver disease (Child-Pugh A5), as well
as the calculation of FGL-2 levels only at the baseline visit. Thus,
random error as indicating by wide confidence intervals in mul-
tivariate logistic regression model was unavoidable. This neces-
sitates the replication of the results in larger samples of cirrhotic
patients with long-term follow-up and recording of HCC events
as well as clinical outcomes. On the other hand this small pilot
study was performed in a single Hepatogastroenterology Unit of
a General and Oncology Hospital, with the same experts in Hepa-
tology, Gastroenterology, Liver imaging and Liver Histopathology
and all the measurements were done in the same laboratory, which
possibly reduces observer biases and somehow outweighs the lim-
itations of the study.
In conclusion, plasma FGL-2 levels are significantly elevated in
cirrhotic patients with decompensated liver disease compared to
those with compensated cirrhosis and presence of HCC as well as
HCC staging, according to the BCLC staging system, seems to sig-
nificantly further influence them. Liver disease severity, according
to Child-Pugh scoring system as well as low platelet count, but not
baseline plasma FGL-2 or serum AFP levels, could predict HCC
emergence among Caucasian cirrhotic patients.
7. Volume 5 Issue 3 -2021 Research Article
clinicsofoncology.com 7
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