Factors associated with advanced hepatic fibrosis in patients with various internal diseases: A multicenter community‐based survey

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Aims The prognosis of hepatocellular carcinoma (HCC) patients treated with transcatheter arterial chemoembolization (TACE) is still poor. We aimed to evaluate the impact of TACE combined with radiofrequency ablation (TACE+RFA) on the prognosis of HCC patients using decision‐tree analysis after propensity score matching. Methods This was a retrospective study. We enrolled 420 patients with HCC treated with TACE alone (n = 311) or TACE+RFA (n = 109) between 1998 and 2016 (median age, 72 years; male / female, 272/148; Barcelona Clinic Liver Cancer (BCLC) stage A / B, 215/205). The prognosis of patients who underwent TACE+RFA was compared to patients who underwent TACE alone after propensity score matching. Decision‐tree analysis was used to investigate the profile for prognosis of the patients. Results After propensity score matching, there was no significant difference in age, sex, BCLC stage, or albumin–bilirubin (ALBI) score between both groups. The survival rate of the TACE+RFA group was significantly higher than the TACE alone group (median survival time [MST] 57.9 months vs. 33.1 months, P < 0.001). In a stratification analysis according to BCLC stage, the overall survival rate of the TACE+RFA group was significantly higher than the TACE alone group in BCLC stage A and B (MST 57.9 and 50.7 months vs. 39.8 and 24.5 months [P = 0.007 and 0.001], respectively). Decision‐tree analysis showed that TACE+RFA was the third distinguishable factor for survival in patients with α‐fetoprotein level >7 ng/mL and ALBI <−2.08. Conclusion Decision‐tree analysis after propensity score matching showed that TACE+RFA could prolong the survival of HCC patients compared to TACE alone.

Section: Discussionmentioning

confidence: 99%

Prognostic impact of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation in patients with unresectable hepatocellular carcinoma: Comparison with TACE alone using decision‐tree analysis after propensity score matching

Shimose

Tanaka

Iwamoto

et al. 2019

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“…Hepatic fibrosis is a crucial pathology found in patients with various internal diseases. Hepatic fibrosis occurs not only in patients with chronic liver disease, including non‐alcoholic fatty liver disease (NAFLD), but also in patients with other lifestyle‐related diseases, including obesity, diabetes mellitus, hypertension, and chronic kidney injury . As hepatic fibrosis progresses, patients are at a higher risk of developing life‐threatening complications, including hepatocellular carcinoma and cardiovascular diseases .…”

Section: Introductionmentioning

confidence: 99%

“…Hepatic fibrosis occurs not only in patients with chronic liver disease, including non-alcoholic fatty liver disease (NAFLD), but also in patients with other lifestyle-related diseases, including obesity, diabetes mellitus, hypertension, and chronic kidney injury. [1][2][3] As hepatic fibrosis progresses, patients are at a higher risk of developing lifethreatening complications, including hepatocellular carcinoma and cardiovascular diseases. [4][5][6] Thus, it is important to estimate the staging of hepatic fibrosis in the management of patients with various internal diseases.…”

Section: Introductionmentioning

confidence: 99%

Profiles of advanced hepatic fibrosis evaluated by FIB‐4 index and shear wave elastography in health checkup examinees

Yamamura

Kawaguchi

Nakano

et al. 2019

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Aim Advanced hepatic fibrosis is seen in individuals with potential hepatocellular carcinoma and cardiovascular disease. Hepatic fibrosis can be assessed using a combination of the FIB‐4 index and imaging modalities, including shear wave elastography. We aimed to investigate the prevalence of advanced fibrosis in the general population and the profiles associated with advanced fibrosis using a data‐mining analysis. Methods We enrolled 1155 health checkup examinees (median age 53 years, 685 women, 470 male). Advanced fibrosis was defined by FIB‐4 index ≥1.3 and liver stiffness ≥8.07 kPa using shear wave elastography. Participants were classified as normal‐mild fibrosis (n = 1035) or advanced fibrosis (n = 120). Factors associated with advanced fibrosis were analyzed by logistic regression and decision‐tree analyses. Results Advanced fibrosis was observed in 10.4% of participants (120/1155). In the logistic regression analysis, independent factors for advanced fibrosis were age (≥75 years; OR 2.12, 95% CI 1.021–4.415; P = 0.0419) and the presence of metabolic syndrome (OR 2.51, 95% CI 1.416–4.462; P = 0.0017). The decision‐tree analysis showed two profiles associated with advanced fibrosis: profile 1 – individuals aged ≥65 years with metabolic syndrome and mild‐to‐moderate alcohol consumption (prevalence of advanced fibrosis 73.3%); and profile 2 – individuals without metabolic syndrome, aged ≥75 years, with no exercise habit (prevalence of advanced fibrosis 56.3%). Conclusions Advanced fibrosis was observed in 10.4% of health checkup examinees. Furthermore, we showed that aging, metabolic syndrome with mild‐to‐moderate alcohol consumption, and physical inactivity were associated with advanced fibrosis. Thus, prevention of metabolic syndrome and alcohol withdrawal, as well as exercise habits, might inhibit the progression of hepatic fibrosis.

“…Classification and regression trees was constructed to reveal profiles associated with the fecal load of Streptococcus , Veillonella , and Lactobacillus (analysis 1), and changes in NCT‐A 2 weeks after RFX treatment (analysis 2), as previously described . The tree plot was visualized with a regression tree model for each fecal load and the box plot shows the distribution of observations for nodes and leaves.…”

Section: Methodsmentioning

confidence: 99%

“…Classification and regression tree is a statistical method that uses a constructed model to repeatedly recursively divide the explanatory variable involved in the response. The factorial structure of the underlying data is visually represented by a “tree” . Random forest is useful technique for prediction problems.…”

Section: Introductionmentioning

confidence: 99%

Rifaximin‐altered gut microbiota components associated with liver/neuropsychological functions in patients with hepatic encephalopathy: An exploratory data analysis of phase II/III clinical trials

Kawaguchi

Suzuki

Imamura³

et al. 2019

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AimsRifaximin (RFX), a non‐systemic antibiotic, improves liver/neuropsychological functions in patients with hepatic encephalopathy (HE). We aimed to investigate the clinical profiles associated with gut bacterial loads using exploratory data analysis and the effects of RFX on the gut microbiota of patients with HE.MethodsWe analyzed the data from 17 patients with HE who underwent fecal microbiota examination in phase II/III trials in Japan. Profiles associated with genera Streptococcus, Veillonella, and Lactobacillus loads were analyzed using classification and regression trees (CART). Changes in gut microbial consortia of seven patients with HE were then assessed 2 weeks after RFX treatment by principal component analysis.ResultsIn the CART, the first and second divergence variables for each higher bacterial load were as follows: (i) in Streptococcus, the number connection test‐A ≥39.55 s and presence of portal‐systemic shunt; (ii) in Veillonella, serum potassium levels <4.75 mEq/L and total cholesterol level <129.5 mg/dL; and (iii) in Lactobacillus, white blood cell counts ≥3.4 × 103/μL and aspartate aminotransferase level ≥44.5 U/L. There was no significant change in total bacterial load before and after RFX treatment; however, there was a decrease in Streptococcus, Veillonella, and Lactobacillus counts after RFX treatment.ConclusionWe report clinical profiles associated with gut bacterial loads in patients with HE, and showed that RFX altered gut microbiota components associated with liver/neuropsychological functions. Thus, RFX could improve liver/neuropsychological functions through the regulation of the gut microbial consortia in patients with HE.