Comparison of Staging Systems of Hepatocellular Carcinoma

Many staging systems of hepatocellular carcinoma (HCC) were established; however, there is no consensus on which is proper in predicting prognosis. This study aims to evaluate various commonly used staging systems of HCC. Patients who underwent surgery during 2001–2007 were included. All patient data were retrospectively staged using six staging systems, that are American Joint Committee on Cancer (AJCC) Tumour-Node-Metastasis (TNM), Okuda staging, Cancer of the Liver Italian Program (CLIP), Barcelona Clinic Liver Cancer (BCLC), Chinese University Prognostic Index (CUPI), and Japan Integrated Staging (JIS). Child-Pugh classification was also evaluated. The staging systems were compared by mean of overall and disease-free survival. Total of 99 patient data were enrolled in the analyses. All staging systems except Okuda were significant in determining overall survival in univariate analyses. In multivariate analyses, TNM and Child-Pugh demonstrated better predictive power for overall survival. In terms of disease-free survival, univariate analyses revealed that TNM, CLIP, BCLC, CUPI, and JIS were significant, and TNM was the best predictive staging system in multivariate analyses. In our study, TNM and Child-Pugh are the representative systems in predicting survival of HCC patients who undergo surgical resection. Moreover, they are practical and easily assessable in clinical practice

Time spent in hospital after liver transplantation: Effects of primary liver disease and comorbidity.

AIM: To explore the effect of primary liver disease and comorbidities on transplant length of stay (TLOS) and LOS in later admissions in the first two years after liver transplantation (LLOS). METHODS: A linked United Kingdom Liver Transplant Audit - Hospital Episode Statistics database of patients who received a first adult liver transplant between 1997 and 2010 in England was analysed. Patients who died within the first two years were excluded from the primary analysis, but a sensitivity analysis was also performed including all patients. Multivariable linear regression was used to evaluate the impact of primary liver disease and comorbidities on TLOS and LLOS. RESULTS: In 3772 patients, the mean (95%CI) TLOS was 24.8 (24.2 to 25.5) d, and the mean LLOS was 24.2 (22.9 to 25.5) d. Compared to patients with cancer, we found that the largest difference in TLOS was seen for acute hepatic failure group (6.1 d; 2.8 to 9.4) and the largest increase in LLOS was seen for other liver disease group (14.8 d; 8.1 to 21.5). Patients with cardiovascular disease had 8.5 d (5.7 to 11.3) longer TLOS and 6.0 d (0.2 to 11.9) longer LLOS, compare to those without. Patients with congestive cardiac failure had 7.6 d longer TLOS than those without. Other comorbidities did not significantly increase TLOS nor LLOS. CONCLUSION: The time patients spent in hospital varied according to their primary liver disease and some comorbidities. Time spent in hospital of patients with cancer was relatively short compared to most other indications. Cardiovascular disease and congestive cardiac failure were the comorbidities with a strong impact on increased LOS

Obesity Significantly Affects the Incidence of Hepatic Injury in Patients with Colorectal Liver Metastasis

Objective: Surgical resection is the mainstay treatment for colorectal liver metastasis. In unresectable cases, chemotherapy is used to transform the tumor into resectable lesions, with related concerns about toxicity to nontumoral liver parenchyma. Liver toxicity, including steatosis, steatohepatitis, and sinusoidal dilation, has been reported. However, these changes are difficult to histologically distinguish from non-alcoholic fatty liver disease, which is commonly found in populations and attributed mainly to metabolic syndrome. The aim of this study was to investigate the factors associated with liver injury in patients with colorectal liver metastasis. Methods: This retrospective study included patients who underwent hepatic resection for colorectal liver metastasis at Siriraj Hospital during the 2006 to 2013 study period. Patient demographic data, clinical characteristics, and histologic changes related to liver injury were collected and analyzed. Results: Ninety-two patients (50 men, 42 women) were included, with a mean age of 59.4 years (range: 48.5-70.3). Forty-four patients (47.8%) received preoperative chemotherapy (CMT). Incidence of liver injury was not significantly different between the CMT and non-CMT groups (65.9% vs. 62.5%; p=0.902). However, incidence of liver injury was significantly higher in obese patients than in non-obese patients (82.8% vs. 55.6%; p=0.022, odds ratio=3.95). In multivariate analysis, obesity (BMI ≥25 kg/m2) was the only factor significantly associated with liver injury in patients with colorectal liver metastasis. Conclusion: Of the ten factors evaluated for association in this study, including preoperative chemotherapy, obesity was the only factor found to be significantly associated with liver injury in patients with colorectal liver metastasis

An Exploratory Study on Young Thai Women Consumer Behavior toward Purchasing Luxury Fashion Brands

Abstract Date: June 2, 2010 Program: MIMA – International Marketing Course name: Master Thesis (EFO 705) Title: An Exploratory Study on Thailand‟s Young Women: Consumer Behavior toward Purchasing Luxury Fashion Brands Authors: Kamolwan Tovikkai (851125)Wiwatchai Jirawattananukool (841111) Group number: 2462 Tutor: Konstantin Lampou Problem: If and how personal value, social recognition, and demographics impact Thai female students luxury fashion brand purchases and which marketing strategies should be used to influence their purchase intention? Purpose: -To identify what motivates Thai female students in purchasing luxury fashion brands -To identify the most effective strategies to use in penetrating the market and keeping the loyalty of customers Thailand. Method: Quantitative research method via survey was used for this research. Survey questionnaires were distributed to sample groups. The variables used in this paper personal values, social, recognition, intention to buy products, and demographics. Both primary and secondary type of data collection were used for this research. Conclusion: Based on the demographic information, there are two indicators that are significant to purchase intentions of Thai female students on luxury fashion brands. Social status is one of the significant indicators of socialiiirecognition variable. There is a strong level of relationship on Thai female students toward luxury fashion products. Personal Values‟ indicators can be utilized on Thai female students as the following; materialism, the need for uniqueness, conformity, and vanity. All of them have strong levels of significance. However, Ethnocentrism has no relationship and effect with the luxury fashion product in Thailand. Key words: Thai female students, Luxury fashion products, Luxury fashion brands, Consumer behavio

Time-varying impact of comorbidities on mortality after liver transplantation: a national cohort study using linked clinical and administrative data.

OBJECTIVE: We assessed the impact of comorbidity on mortality in three periods after liver transplantation (first 90 days, 90 days-5 years and 5-10 years). DESIGN: Prospective cohort study using records from the UK Liver Transplant Audit (UKLTA) linked to Hospital Episode Statistics (HES), an administrative database of hospital admissions in the English National Health Service (NHS). Comorbidities relevant for liver transplantation were identified from the 10th revision of the International Classification of Diseases (ICD-10) codes in HES records of admissions in the year preceding their operation. Multivariable Cox regression was used to estimate HRs for three different time periods after liver transplantation. SETTING: All liver transplant centres in the NHS hospitals in England. PARTICIPANTS: Adults who received a first elective liver transplant between April 1997 and March 2010 in the linked UKLTA-HES database. OUTCOMES: Patient mortality in three different time periods after transplantation. RESULTS: Among 3837 recipients, 45.1% had comorbidities. Recipients with cardiovascular disease had statistically significantly higher mortality in all three periods after transplantation (first 90 days: HR=2.0; 95% CI 1.4 to 2.9, 90 days-5 years: 1.6; 1.2 to 2.2, beyond 5 years: 2.8; 1.7 to 4.4). Prior congestive cardiac failure (3.2; 2.1 to 4.9) significantly increased mortality only in the first 90 days. History of non-hepatic malignancy appeared to increase risk over all periods, but significantly only in the first 90 days (1.9; 1.0 to 3.6). A diagnosis of connective tissue disease, dementia, diabetes, chronic pulmonary and renal disease did not have a significant impact on mortality in any period. CONCLUSIONS: The impact of comorbidities present at the time of transplantation changes with time after transplantation. Renal disease, pulmonary disease and diabetes had no impact on mortality in contrast to previous reports

Linkage of a national clinical liver transplant database with administrative hospital data: methods and validation.

INTRODUCTION: The UK Liver Transplant Audit (UKLTA) database contains clinical information on all liver transplants carried out in the UK. To expand its potential for research and service evaluation, we linked it to the Hospital Episode Statistics (HES), an administrative database of all admissions to English National Health Service (NHS) hospitals. MATERIALS AND METHODS: In the UKLTA database, we identified the linkable records of first liver transplantation between April 1997 and March 2010. We linked UKLTA records to HES records on the basis of NHS number, gender, date of birth, and postcode, as well as procedure codes for liver transplantation and dates of transplant. In linked records, agreement of primary liver disease diagnoses according to both databases was expressed as a proportion of the linked records and using kappa statistic. RESULTS: There were 5,815 linkable records in the UKLTA database, of which 4,959 records were successfully linked with HES (85.3%). Among these, 4,922 records (99.3%) had at least one diagnosis coded in HES relevant to an indication for liver transplantation. The overall agreement of primary liver disease diagnoses between UKLTA data and HES was 77.8% (95% CI 76.6%-79.0%) with a kappa of 0.75 (0.74-0.76). Diagnostic agreement can be further improved by using broader groupings of clinically related diagnoses. CONCLUSION: Linkage of clinical data and administrative hospital data provides a rich resource for the study of liver transplantation