Summary The aim of the study was to determine whether past exposure to hepatitis B virus (HBV) influences the risk of the development of hepatocellular carcinoma (HCC) in Japanese patients with chronic liver disease (CLD). We conducted a hospital-based case-control study of 141 HCC patients with CLD and 151 controls with CLD but without HCC. Past exposure to HBV was assessed by antibody to hepatitis B core antigen (anti-HBc) positivity. Ninety-two patients (65%) with HCC were anti-HBc positive compared with 65 patients (43%) with CLD alone (P < 0.01). A multivariate analysis using logistic regression modelling revealed that anti-HBc positivity significantly increased the rsk of the development of HCC [odds ratio (OR) 2.0, P= 0.01]. In the anti-HBc-positive patients, a significantly increased risk of HCC was seen among the patients positive for anti-HBc alone (OR, 2.6; P < 0.01). However, a significant OR was not obtained among the patients with a transient HBV infection implied by positivity for both antibody to hepatitis B surface antigen and anti-HBc (OR, 1.5; P = 0.48). These results indicate that past exposure to HBV is a risk factor for HCC in Japanese CLD patients, especially when they have no serological evidence of immunity to HBV.Keywords: hepatocellular carcinoma; chronic liver disease; hepatitis B virus; hepatitis C virus; case-control study In Japan, the vast majority of patients with hepatocellular carcinoma (HCC) have chronic liver disease (CLD) such as chronic hepatitis and liver cirrhosis, and CLD patients frequently develop HCC during the follow-up period; patients with CLD are at increased risk of developing HCC (Ikeda et al, 1993;Tsukuma et al, 1993). Many CLD patients are, therefore, followed up periodically using ultrasonography (US) and serum a-fetoprotein (AFP) measurements to detect HCC at an early stage (Tanaka et al, 1990). Evaluation of the risk factors for HCC in CLD patients is imperative. Identification of the individuals who are at higher risk of HCC would contribute to the early diagnosis of this disease and to effective implementation of strategies for chemoprevention.Numerous epidemiological and biological studies have indicated that a chronic infection with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) plays an important role in hepatocarcinogenesis (Bruix et al, 1989;Saito et al, 1990;Kim et al, 1991). As for HBV, serum hepatitis B surface antigen (HBsAg) positivity, which indicates a chronic HBV carrier state, is a well-established risk factor for HCC (Beasley et al, 1981;Chen et al, 1991). However, only a few reports have addressed the relationship between past exposure to HBV and HCC and, as yet, no definite conclusion has been established (Chiba et al, 1996;Yu et al, 1997).This hospital-based case-control study was conducted to evaluate whether past exposure to HBV, which was assessed by antibody to hepatitis B core antigen (anti-HBc) positivity, influenced the risk of developing HCC in Japanese CLD patients. Study populationThe HCC patient group comprised 141 co...

ObjectiveThe Japan Society of Gynecologic Oncology (JSGO) published the first practice guideline for endometrial cancer in 2006. The JSGO guideline evaluation committee assessed the effect of this guideline introduction on clinical practice and patient outcome using data provided by the Japan Society of Obstetrics and Gynecology (JSOG) cancer registration system.MethodsData of patients with endometrial cancer registered between 2000 and 2012 were analyzed, and epidemiological and clinical trends were assessed. The influence of guideline introduction on survival was determined by analyzing data of patients registered between 2004 and 2009 using competing risk model.ResultsIn total, 65,241 cases of endometrial cancer were registered. Total number of patients registered each year increased about 3 times in the analyzed period, and the proportion of older patients with type II endometrial cancer rapidly increased. The frequency of lymphadenectomy had decreased not only among the low-recurrence risk group but also among the intermediate- or high-recurrence risk group. Adjuvant therapy was integrated into chemotherapy (p<0.001). Overall survival did not significantly differ before and after the guideline introduction (hazard ratio [HR]=0.891; p=0.160). Additional analyses revealed patients receiving adjuvant chemotherapy showed better prognosis than those receiving adjuvant radiation therapy when limited to stage I or II (HR= 0.598; p=0.003).ConclusionIt was suggested that guideline introduction influenced the management of endometrial cancer at several aspects. Better organized information and continuous evaluation are necessary to understand the causal relationship between the guideline and patient outcome.

SummaryThe aim of this study was to investigate the associations of adiponectin and leptin with metabolic syndrome (MetS) and coronary heart disease (CHD) in patients with various coronary risk factors. We determined serum adiponectin, leptin, and metabolic syndrome components in 104 patients (59 men and 45 women; aged 40-86 years) with various coronary risk factors at a cardiovascular out-patient clinic. Natural logarithmic transformed (ln) leptin was lower in men and smokers, and positively correlated with body mass index (BMI) (r = 0.59, P < 0.0001), waist circumference (r = 0.60, P < 0.0001), and homeostasis model assessment of insulin resistance (HOMA-IR) levels (r = 0.24, P < 0.02). Ln adiponectin was higher in women and nonsmokers, and was correlated with age and high-density lipoprotein cholesterol (HDL-C). Patients with MetS (n = 69) had significantly higher BMI, HOMA-IR, and ln leptin and lower ln adiponectin than those without Mets (Ln leptin, 2.14 ± 0.08 versus 1.30 ± 0.11; Ln adiponectin, 2.29 ± 0.06 versus 2.54 ± 0.09). In contrast, patients with coronary heart disease (CHD: n = 40) had significantly lower serum ln adiponectin concentrations than non-CHD patients (n = 64) (1.79 ± 0.12 versus 1.91 ± 0.10) as well as lower HDL-C and a higher smoking percentage. Consistent results were obtained by multivariate analyses. In conclusion, this study disclosed factors associated with the increase in serum leptin and adiponectin. Serum levels of leptin may be associated positively with MetS, whereas adiponectin levels are associated negatively with MetS and CHD, even in patients with various coronary risk factors. (Int Heart J 2011; 52: 17-22)

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