Clinical and Molecular Hepatology

"Risk factor"

Original Article

Normal-weight MASLD: reclassification, characteristics, and adverse liver outcomes across diverse populations: Sherlot Juan Song, Eileen Laureal Yoon, Vincent Wai-Sun Wong, Ae Jeong Jo, Grace Lai-Hung Wong, Jimmy Che-To Lai, Dae Won Jun, Terry Cheuk-Fung Yip; Received July 28, 2025 Accepted December 9, 2025 Published online December 12, 2025; DOI: https://doi.org/10.3350/cmh.2025.0851 [Accepted]

Abstract
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Background & Aims
Previous studies have identified a substantial degree of agreement between the non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) populations, but the same notion may not apply to normal-weight patients with a lower cardiometabolic risk burden. This study aims to investigate the CMRF distributions between normal-weight and overweight/obese MASLD, the agreement between historical NAFLD and MASLD, and to compare the risk of liver-related events (LREs) and all-cause mortality in normal-weight versus overweight or obese MASLD.
Methods
This study included participants with steatotic liver disease (SLD) from five cohorts in Hong Kong, South Korea, and the United States. Participants were recruited from settings including both hospitals and communities. Individuals were classified into normal-weight and overweight/obese groups.
Results
This study included 33,793 participants with SLD from five cohorts, of whom 20,893 and 20,701 patients met the diagnosis of NAFLD and MASLD, respectively. Normal-weight patients with NAFLD demonstrated a lower CMRF distribution compared to those with overweight/obese NAFLD. In the community-based cohorts, the proportions of 0 CMRF ranged from 9.0-26.7% among normal-weight NAFLD, representing the discrepancy between MASLD and NAFLD definitions. Compared with the overweight/obese MASLD, the normal-weight MASLD had increased all-cause mortality (normal-weight vs. overweight/obese, 23.44 and 13.80 per 1000 person-years; p<0.001) but not LREs (2.81 and 2.59 per 1000 person-years; p=0.54) in the HK CDARS cohort.
Conclusions
Normal-weight individuals with NAFLD demonstrated a lower distribution of CMRFs, resulting in the incomplete agreement between historical NAFLD and MASLD.
Ethical Compliance
For all involved cohorts, the study protocols conformed to the ethical guidelines of the 1975 Declaration of Helsinki and were approved by the appropriate clinical research ethics committee and/or institutional review board, which provided either written consent or a waiver of informed consent.

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Editorials

Viral hepatitis

MASLD after hepatitis C virus eradication: Do not overlook the cardiometabolic risk factors: Editorial on “Dynamic change of metabolic dysfunction-associated steatotic liver disease in chronic hepatitis C patients after viral eradication: A nationwide registry study in Taiwan”: Rex Wan-Hin Hui, Lung-Yi Mak; Clin Mol Hepatol 2025;31(1):290-292.
Published online August 7, 2024; DOI: https://doi.org/10.3350/cmh.2024.0630

Citations

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Steatotic liver disease in chronic hepatitis C related hepatocellular carcinoma: Inflictor or bystander?: Correspondence to editorial on “Dynamic change of metabolic dysfunction-associated steatotic liver disease in chronic hepatitis C patients after vira
Chung-Feng Huang, Ming-Lun Yeh, Chia-Yen Dai, Jee-Fu Huang, Wan-Long Chuang, Ming-Lung Yu
Clinical and Molecular Hepatology.2025; 31(1): e64. CrossRef
Reply to comment on “Posttreatment FIB-4 score change predicts hepatocellular carcinoma in chronic hepatitis C patients: Findings from the Taiwan hepatitis C registry program”
Hung-Wei Wang, Cheng-Yuan Peng, Ming-Lung Yu
Journal of the Formosan Medical Association.2025;[Epub] CrossRef

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Crossref

Steatotic liver disease

Clinical impact of five cardiometabolic risk factors in metabolic dysfunction-associated steatotic liver disease (MASLD): Insights into regional and ethnic differences: Joo Hyun Oh, Dae Won Jun; Clin Mol Hepatol 2024;30(2):168-170.
Published online March 5, 2024; DOI: https://doi.org/10.3350/cmh.2024.0140

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Special Review

Steatotic liver disease

Waiting for the changes after the adoption of steatotic liver disease: Eileen L. Yoon, Dae Won Jun; Clin Mol Hepatol 2023;29(4):844-850.
Published online September 6, 2023; DOI: https://doi.org/10.3350/cmh.2023.0291

Abstract
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Steatotic liver disease was suggested as an overarching term encompassing various etiologies of hepatic steatosis. Experts from multinational liver societies went through the Delphi process, including four rounds of surveys, and consented to adopt a new nomenclature and definition instead of the conventional nonalcoholic fatty liver disease (NAFLD). This was to improve the understanding of the patients and primary care physicians, with an explanation of the pathophysiology in the name of the disease. Also, it could minimize the stigmatization of patients by using the histological neutral term “steatosis” instead of “fatty”. Herein, we will discuss the changes and continuity between the two nomenclatures, metabolic dysfunction-associated steatotic liver disease (MASLD) and NAFLD, as well as the challenges to MASLD which need to be addressed in future.

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Correspondence

Steatotic liver disease

Correspondence on Letter regarding “Risk factors in nonalcoholic fatty liver disease”: Eileen L. Yoon, Dae Won Jun; Clin Mol Hepatol 2023;29(4):1050-1051.
Published online August 29, 2023; DOI: https://doi.org/10.3350/cmh.2023.0310

Citations

Citations to this article as recorded by

Reply to correspondence on “Prognosis of biopsy-confirmed metabolic dysfunction-associated steatotic liver disease: A sub-analysis of the CLIONE study”
Eileen Laurel Yoon, Dae Won Jun
Clinical and Molecular Hepatology.2024; 30(4): 1033. CrossRef

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Editorial

Steatotic liver disease

Non-obese or lean nonalcoholic fatty liver disease matters, but is it preventable or inevitable in light of its risk factors?: Heejoon Jang, Won Kim; Clin Mol Hepatol 2023;29(2):381-383.
Published online March 9, 2023; DOI: https://doi.org/10.3350/cmh.2023.0088

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Lurao Li, Xiawen Shu, Yun Yi, Chun Wang, Jianghui Li, Yang Ding, Jin Li, Ying Chang
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Review

Steatotic liver disease

Causes and risk profiles of mortality among individuals with nonalcoholic fatty liver disease: Peter Konyn, Aijaz Ahmed, Donghee Kim; Clin Mol Hepatol 2023;29(Suppl):S43-S57.
Published online November 22, 2022; DOI: https://doi.org/10.3350/cmh.2022.0351

Abstract
PDF

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States and worldwide. Though nonalcoholic fatty liver per se may not be independently associated with an increased risk for all-cause mortality, it is associated with a number of harmful metabolic risk factors, such as type 2 diabetes mellitus, hyperlipidemia, obesity, a sedentary lifestyle, and an unhealthy diet. The fibrosis stage is a predictor of all-cause mortality in NAFLD. Mortality in individuals with NAFLD has been steadily increasing, and the most common cause-specific mortality for NAFLD is cardiovascular disease, followed by extra-hepatic cancer, liver-related mortality, and diabetes. High-risk profiles for mortality in NAFLD include PNPLA3 I148M polymorphism, low thyroid function and hypothyroidism, and sarcopenia. Achieving weight loss through adherence to a high-quality diet and sufficient physical activity is the most important predictor of improvement in NAFLD severity and the benefit of survival. Given the increasing health burden of NAFLD, future studies with more long-term mortality data may demonstrate an independent association between NAFLD and mortality.

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Letter to the Editor

Liver fibrosis, cirrhosis, and portal hypertension

Correspondence on Letter regarding “Impacts of muscle mass dynamics on prognosis of outpatients with cirrhosis”: Tae Hyung Kim, Young Kul Jung, Hyung Joon Yim; Clin Mol Hepatol 2023;29(1):173-175.
Published online November 15, 2022; DOI: https://doi.org/10.3350/cmh.2022.0372

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Frontiers in Genetics.2023;[Epub] CrossRef

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Original Article

Liver Transplantation

Outcomes after liver transplantation in Korea: Incidence and risk factors from Korean transplantation registry: Jong Man Kim, Deok Gie Kim, Jihyun Kim, Keunsung Lee, Kwang-Woong Lee, Je Ho Ryu, Bong-Wan Kim, Dong Lak Choi, Young Kyoung You, Dong-Sik Kim, Yang Won Nah, Koo Jeong Kang, Jai Young Cho, Geun Hong, Hee Chul Yu, Ju Ik Moon, Dongho Choi, Shin Hwang, Myoung Soo Kim; Clin Mol Hepatol 2021;27(3):451-462.
Published online February 2, 2021; DOI: https://doi.org/10.3350/cmh.2020.0292

Background/Aims
To analyze the incidence and risk factors of outcomes after liver transplantation (LT) in the Korean population.
Methods
This study analyzed data from the liver cohort of Korean Organ Transplantation Registry (KOTRY) who had LT between May 2014 and December 2017. Study measures included the incidence of post-LT outcomes in recipients of living donor LT (LDLT) and deceased donor LT (DDLT). Cox multivariate proportional hazards model was used to determine the potential risk factors predicting the outcomes.
Results
A total of 2,563 adult recipients with LT (LDLT, n=1,956; DDLT, n=607) were included, with mean±standard deviation age of 53.9±8.9 years, and 72.2% were male. The post-LT outcomes observed in each LDLT and DDLT recipients were death (4.0% and 14.7%), graft loss (5.0% and 16.1%), rejection (7.0% and 12.0%), renal failure (2.7% and 13.8%), new onset of diabetes (12.5% and 15.4%), and hepatocellular carcinoma (HCC) recurrence (both 6.7%). In both LDLT and DDLT recipients, the most common post-LT complications were renal dysfunction (33.6% and 51.4%), infection (26.7% and 48.4%), and surgical complication (22.5% and 23.9%). Incidence of these outcomes were generally higher among recipients of DDLT than LDLT. Multivariate analysis indicated recipient age and DDLT as significant risk factors associated with death and graft loss. DDLT and ABO incompatible transplant were prognostic factors for rejection, and HCC beyond Milan criteria at pre-transplant was a strong predictor of HCC recurrence.
Conclusions
This study is a good indicator of the post-LT prognosis in the Korean population and suggests a significant burden of post-LT complications.

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Special topic: Alcoholic liver diseases
The 14th International Symposium on Alcoholic Liver and Pancreatic Diseases and Cirrhosis (ISALPDC)

Hepatic neoplasm

Alcohol and hepatocarcinogenesis: Makiko Taniai; Clin Mol Hepatol 2020;26(4):736-741.
Published online October 1, 2020; DOI: https://doi.org/10.3350/cmh.2020.0203

Abstract
PDF

An excessive alcohol intake may result in fatty liver, acute/chronic hepatitis, cirrhosis, and lead to hepatocellular carcinoma (HCC). The aim of this review is to clarify the present condition and the mechanisms of alcohol-related hepatocarcinogenesis and clinical risk factors for alcohol-related HCC. There are several possible mechanisms through which alcohol may induce hepatocarcinogenesis, including the mutagenic effects of acetaldehyde toxicity through the formation of protein and DNA adducts and the production of reactive oxygen species due to the excessive hepatic deposition of iron, changes to lipid peroxidation and metabolism, inflammation and an impaired immune response and modifications to DNA methylation. Furthermore, it has been reported that alcohol accelerates liver carcinogenesis through several signaling pathways including gut-liver axis. From a clinical perspective, it is well known that alcohol interacts with other factors, such as age, gender, viral hepatitis, obesity, and diabetes leading to an increased risk of HCC.

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Review

Drug induced liver injury

Factors affecting drug-induced liver injury: antithyroid drugs as instances: Reza Heidari, Hossein Niknahad, Akram Jamshidzadeh, Narges Abdoli; Clin Mol Hepatol 2014;20(3):237-248.
Published online September 25, 2014; DOI: https://doi.org/10.3350/cmh.2014.20.3.237

Abstract
PDF

Methimazole and propylthiouracil have been used in the management of hyperthyroidism for more than half a century. However, hepatotoxicity is one of the most deleterious side effects associated with these medications. The mechanism(s) of hepatic injury induced by antithyroid agents is not fully recognized yet. Furthermore, there are no specific tools for predicting the occurrence of hepatotoxicity induced by these drugs. The purpose of this article is to give an overview on possible susceptibility factors in liver injury induced by antithyroid agents. Age, gender, metabolism characteristics, alcohol consumption, underlying diseases, immunologic mechanisms, and drug interactions are involved in enhancing antithyroid drugs-induced hepatic damage. An outline on the clinically used treatments for antithyroid drugs-induced hepatotoxicity and the potential therapeutic strategies found to be effective against this complication are also discussed.

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Original Article

Liver fibrosis, cirrhosis, and portal hypertension

Predictive factors that influence the survival rates in liver cirrhosis patients with spontaneous bacterial peritonitis: Pei Chuan Tsung, Soo Hyung Ryu, In Hye Cha, Hee Won Cho, Jin Nam Kim, You Sun Kim, Jeong Seop Moon; Clin Mol Hepatol 2013;19(2):131-139.
Published online June 27, 2013; DOI: https://doi.org/10.3350/cmh.2013.19.2.131

Abstract
PDF

Background/Aims

Spontaneous bacterial peritonitis (SBP) has been known to greatly influence the survival rate of patients with liver cirrhosis. However, the factors that affect the survival rate in patients with SBP need to be clarified.

Methods

This study enrolled 95 liver cirrhosis patients diagnosed with SBP. The laboratory findings of their serum and ascitic fluid were examined and the characteristics of the isolated microorganisms in their peritoneal fluid were analyzed.

Results

The proportion of patients with culture-positive SBP was 41.1%, and 47 microorganisms were isolated from the ascitic fluid. The proportions of cultured bacteria that were Gram negative and Gram positive were 57.4% and 40.4%, respectively. The proportions of Escherichia coli, Klebsiella species, and Streptococcus species were 25.5%, 19.1%, and 19.1%, respectively. Enterococcus species represented 12.8% of the microorganisms cultured. The overall survival rates at 6, 12, and 24 months were 44.5%, 37.4%, and 32.2%, respectively. There was no relationship between the bacterial factors and the survival rate in SBP. Multivariate analysis revealed that the presence of hepatocellular carcinoma (HCC; P=0.001), higher serum bilirubin levels (≥3 mg/dL, P=0.002), a prolonged serum prothrombin time (i.e., international normalized ratio >2.3, P<0.001), renal dysfunction (creatinine >1.3 mg/dL, P<0.001), and lower glucose levels in the ascitic fluid (<50 mg/dL, P<0.001) were independent predictive factors of overall survival rate.

Conclusions

HCC, higher serum bilirubin levels, a prolonged serum prothrombin time, renal dysfunction, and lower ascitic glucose levels are associated with higher mortality rates in cirrhotic patients with SBP.

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Current status of Liver diseases in Korea: Hepatocellular carcinoma: Il Han Song , Kyung Sik Kim; Korean J Hepatol 2009;15(60):50-59.
Published online December 31, 2009; DOI: https://doi.org/10.3350/kjhep.2009.15.S6.S50

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Original Articles

Risk factors for early recurrence after surgical resection for hepatocellular carcinoma: Ui Jun Park, M.D., Yong Hoon Kim, M.D., Koo Jeong Kang, M.D., Tae Jin Lim, M.D.; Korean J Hepatol 2008;14(3):371-380.
Published online September 30, 2008; DOI: https://doi.org/10.3350/kjhep.2008.14.3.371

Abstract
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Background/Aims
Early recurrence (ER) after liver resection is one of the most important factors impacting the prognosis and survival of patients with hepatocellular carcinoma (HCC). This study aimed to identify the factors associated with ER after curative hepatic resection for HCC. Methods: From the July 2000 to July 2006, 144 patients underwent hepatic resection for HCC at a single institution. After excluding those with ruptured HCC, combined or mixed HCC, and who died during admission, 116 patients were analyzed. Patients with ER (defined as within 1 year) were compared with those who remained free of disease for more than 1 year. Various clinical characteristics including tumor and operative factors were evaluated to determine the factors predicting postoperative ER using univariate and multivariate analyses. Results: ER occurred in 51 patients (44%). In the univariate analysis, tumor size (P=0.001), microvascular invasion (P=0.003), portal vein invasion (P=0.001), TNM stage (P=0.010), serum levels of alpha-fetoprotein (AFP) (P=0.002) and aspartate aminotransferase (AST) (P=0.011), and operative time (P=0.033) were significantly associated with ER. AFP and AST were the independent predictors of ER in the multivariate analysis (P<0.05). Conclusions: Preoperative serum AFP and AST levels were the independent risk factors for ER after surgical resection for HCC. Close postoperative surveillance is recommended for early detection of recurrence and additional treatments in patients with these factors. (Korean J Hepatol 2008;14:371-380)

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The impact of curative conversion therapy aimed at a cancer‐free state in patients with hepatocellular carcinoma treated with atezolizumab plus bevacizumab
Shigeo Shimose, Hideki Iwamoto, Tomotake Shirono, Masatoshi Tanaka, Takashi Niizeki, Masahiko Kajiwara, Satoshi Itano, Yoichi Yano, Satoru Matsugaki, Etsuko Moriyama, Yu Noda, Masahito Nakano, Ryoko Kuromatsu, Hironori Koga, Takumi Kawaguchi
Cancer Medicine.2023; 12(11): 12325. CrossRef
Prognostic Analysis of Postoperative Survival for Ruptured Hepatocellular Carcinoma with or without Cirrhosis
Feng Xia, Peng Zhu, Xiao-Ping Chen, Bi-Xiang Zhang, Ming-Yu Zhang, Subhadeep Roy
Journal of Oncology.2022; 2022: 1. CrossRef
Hepatocellular carcinoma: preoperative gadoxetic acid–enhanced MR imaging can predict early recurrence after curative resection using image features and texture analysis
Su Joa Ahn, Jung Hoon Kim, Sang Joon Park, Seung Tack Kim, Joon Koo Han
Abdominal Radiology.2019; 44(2): 539. CrossRef
Alpha fetoprotein mediates HBx induced carcinogenesis in the hepatocyte cytoplasm
Chao Zhang, Xiangmei Chen, Hui Liu, Hui Li, Wei Jiang, Wenting Hou, Michael A. McNutt, Fengmin Lu, Gang Li
International Journal of Cancer.2015; 137(8): 1818. CrossRef
Metabolic profiling study of early and late recurrence of hepatocellular carcinoma based on liquid chromatography-mass spectrometry
Lina Zhou, Yuan Liao, Peiyuan Yin, Zhongda Zeng, Jia Li, Xin Lu, Limin Zheng, Guowang Xu
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Comparing Staging Systems for Predicting Prognosis and Survival in Patients with Hepatocellular Carcinoma in Egypt
Asmaa Ibrahim Gomaa, Mohamed Saad Hashim, Imam Waked, Ferruccio Bonino
PLoS ONE.2014; 9(3): e90929. CrossRef
Early diffuse recurrence of hepatocellular carcinoma after percutaneous radiofrequency ablation: analysis of risk factors
Hee Young Lee, Hyunchul Rhim, Min Woo Lee, Young-sun Kim, Dongil Choi, Min Jung Park, Young Kon Kim, Seong Hyun Kim, Hyo Keun Lim
European Radiology.2013; 23(1): 190. CrossRef
Diffusion-weighted imaging of hepatocellular carcinoma for predicting early recurrence and survival after hepatectomy
Ali Muhi, Tomoaki Ichikawa, Utaroh Motosugi, Katsuhiro Sano, Zareen Fatima, Masanori Matsuda, Hideki Fujii, Nobuyuki Enomoto, Tsutomu Araki
Hepatology International.2013; 7(2): 662. CrossRef
Localized Uterine Recurrence of Hepatocellular Carcinoma 4 Years after Curative Resection
Sang Jin Lee, Jung Woo Shin, Neung Hwa Park, Yang Won Nah, Hang Jo Yoo, Yoong Ki Jung, Hye Jeong Choi
Korean Journal of Medicine.2012; 82(5): 603. CrossRef
Impact of intracellular alpha fetoprotein on retinoic acid receptors‐mediated expression of GADD153 in human hepatoma cell lines
Chaoying Li, Shanshan Wang, Wei Jiang, Hui Li, Zhongmin Liu, Chao Zhang, Michael A. McNutt, Gang Li
International Journal of Cancer.2012; 130(4): 754. CrossRef
The Survival Benefit of Liver Transplantation for Hepatocellular Carcinoma Patients with Hepatitis B Virus Infection and Cirrhosis
Qing Zhang, Xinguo Chen, Yunjin Zang, Li Zhang, Hong Chen, Letian Wang, Yujian Niu, Xiuyun Ren, Zhongyang Shen, Lei Shang, Michael Bouchard
PLoS ONE.2012; 7(12): e50919. CrossRef
Risk Factors for Intrahepatic Recurrence after Resection of Hepatocellular Carcinomas in Patients with Hepatitis B Virus Infection
Myung Hee Yoon, Young Il Choi, Kwang Kuk Park, Dong Hoon Shin, Chung Han Lee
Korean Journal of Hepato-Biliary-Pancreatic Surgery.2011; 15(2): 83. CrossRef

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Natural history of gastric varices and risk factors for bleeding: Choong Hyeon Lee, M.D., Joon Hyoek Lee, M.D., Ph.D., Yong Sung Choi, M.D., Seung Woon Paik, M.D., Dong Hyun Sinn, M.D., Choon Young Lee, M.D., Kwang Cheol Koh, M.D., Geum-Youn Gwak, M.D., Moon Seok Choi, M.D., Byung Chul Yoo, M.D.; Korean J Hepatol 2008;14(3):331-341.
Published online September 30, 2008; DOI: https://doi.org/10.3350/kjhep.2008.14.3.331

Abstract
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Background/Aims
Gastric varices (GV) are one of the most serious complications of portal hypertension, but there is limited information on the clinical course of GV in Korea. The aim of this study was to elucidate the natural history of GV bleeding in Korean patients. Methods: Of 604 patients with GV diagnosed between May 1995 and May 2005 at the Samsung Medical Center, 237 patients without a history of variceal bleeding or previous intervention for varices were investigated. The cumulative incidence rates of GV bleeding, long-term survival rates, and risk factors for GV bleeding were evaluated. Results: The cumulative incidence rates of GV bleeding were 4.8%, 19.9%, and 23.2% at 1, 3, and 5 years after diagnosis, respectively. The overall survival rates were 88.6%, 53.2%, and 37.2% at 1, 5, and 10 years. In the univariate analysis, fundal varices, large (F3) GV, red color sign, and poor liver function (Child-Pugh class B or C) were significant risk factors for GV bleeding. In the multivariate analysis, large GV (hazard ratio 2.49) and poor liver function (hazard ratio 3.95) were the independent risk factors. Conclusions: GV bleeding was more frequent in patients with fundal varices than in patients with type 1 gastroesophageal varices, and large GV and poor liver function were risk factors for GV bleeding. Close observation and prophylaxis for variceal bleeding might be warranted in high-risk patients. (Korean J Hepatol 2008;14:331-341)

Citations

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Variceal Hemorrhage: Decompression, Obliteration, or Both?
Benjamin J. McCafferty, Husamedin El Khudari, Aliaksei Salei, Andrew J. Gunn
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Conventional versus selective balloon-occluded retrograde transvenous obliteration of gastric varices
Ramy Ahmed, Hiro Kiyosue, Hiromu Mori, Samy Abdelaziz, Moustafa Othman, Sherif Abdel-Aal, Miyuki Maruno, Shunro Matsumoto
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Louisa J Vine, Mohsan Subhani, Juan G Acevedo
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Endoscopic Cyanoacrylate Glue Injection in Management of Gastric Variceal Bleeding: US Tertiary Care Center Experience
Subhash Chandra, Adrian Holm, Rami G. El Abiad, Henning Gerke
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Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Variceal Hemorrhage
Min-Yung Chang, Man-Deuk Kim, Taehwan Kim, Wonseon Shin, Minwoo Shin, Gyoung Min Kim, Jong Yun Won, Sung Il Park, Do Yun Lee
Korean Journal of Radiology.2016; 17(2): 230. CrossRef
Clinical features and outcomes of gastric variceal bleeding: retrospective Korean multicenter data
Moon Young Kim, Soon Ho Um, Soon Koo Baik, Yeon Seok Seo, Soo Young Park, Jung Il Lee, Jin Woo Lee, Gab Jin Cheon, Joo Hyun Sohn, Tae Yeob Kim, Young Suk Lim, Tae Hyo Kim, Tae Hee Lee, Sung Jae Park, Seung Ha Park, Jin Dong Kim, Sang Young Han, Chang Soo
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Basic and Applied Pathology.2009; 2(1): 44. CrossRef

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Establishment of Individual Prediction Model According to Risk Factorsfor Development of Hepatocellular Carcinoma in Korea : Establishment of Individual Prediction Model for Hepatocellular Carcinoma: Jae Youn Cheong, M.D., Kwang-Hyub Han, M.D., Dong Kee Kim, Ph.D.*, Sang Hoon Ahn, M.D., Ki Jun Song, M.S.*, Yong Han Paik, M.D., Chang Hwan Choi, M.D., Hyun Woong Lee, M.D., Young Soo Park, M.D., Chae Yoon Chon, M.D., and Young Myoung Moon, M.D.,; Korean J Hepatol 2001;7(4):449-458.

Abstract
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Background
/ Aim : We identified risk factors for hepatocellular carcinoma(HCC)through a nine-year follow-up study, ending last year, of 4,339 patients with chronic liver disease. The aim of this study was to establish an individual prediction model according to risk factors for the development of HCC. Methods : We studied a total of 1994 patients who had regular check-ups from January 1990 to December 1998. We analyzed the risk factors and established the individual prediction model to predict the risk rate for HCC using logistic regression analysis. We applied the model to patients who were enrolled over the next two years. Results : 90(9.05%) out of 994 patients developed HCC during a mean of 33 months of follow-up. The risk index for individual patients was made by considering the relative risk level of statistically significant risk factors. From 1999 to 2000, 480 patients were newly enrolled and divided into a low risk group(less than 5% probability), an intermediate risk group(5% to 10% probability), and a high risk group(more than 10% probability). According to this classification, 1 of 191 patients in the low risk group(0.523%), 5 of 176 patients intermediate risk group(2.84%), and 21 of 113 patients in the high risk group(18.6%) were diagnosed with HCC. Conclusion : We confirmed the reliability of the newly established individual prediction model for the screening of HCC. This model may help screening programs to be done effectively by focusing on high risk groups for HCC. (Korean J Hepatol 2001;7 :449- 458)

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Risk Factors of Morbidity and Mortality Following Surgical Resection for Hepatocellular Carcinoma: Wan Wook Kim, M.D., Kwang-Woong Lee, M.D., Sung Ho Choi, M.D., Jin Seok Heo, M.D., Yong Il Kim, M.D., Sung Ju Kim, M.D., Dae Sung Lee, M.D., Hwan Hyo Lee, M.D., Seung Woon Paik, M.D.1, Kwang Cheol Koh, M.D.1, Joon Hyoek Lee, M.D.1, Moon Seok Choi, M.D.1 , Byung Chul Yoo, M.D.1 and Jae Won Joh, M.D.; Korean J Hepatol 2004;10(1):51-61.

Abstract
PDF

Background/Aims
Recently, mortality following surgical resection for hepatocelluar carcinoma has been reduced significantly. Morbidity, however, is still significant. This study evaluated the risk factors leading to morbidity and mortality. Methods: 510 patients who had a hepatic resection form Nov. 1994 to Dec. 2001 were included. The patient demographics showed a mean age of 51.6 years with a male to female ratio of 4:1. The HBsAg was positive in 76.0% and the anti-HCV was positive in 8.2%. The mean tumor size was 5.2 cm, 26.2% of patients had preoperative transcatheter arterial embolization (TAE), and 8.7% had preoperative percutaneous transhepatic portal embolization (PTPE). Limited resection was performed in 259 cases (50.7%), and major resection was conducted in 251 cases (49.1%). Risk factors included age, sex, laboratory findings (liver function test, prothrombin time, albumin, glucose, α-fetoprotein, ICG test), preoperative TAE, PTPE, operation type, operation time, intraoperative transfusion, tumor size, and cirrhosis.
Results
The morbidity was 10.5% (54 cases). Operative death occurred in 5 cases (1.0%). Hospital death, including operative death, occurred in 6 cases (1.2%). Five cases were associated with hepatic failure and 1 case was associated with aspiration pneumonia accompanying hepatic failure. Transfusion (P=0.002), glucose (P=0.002), and prothrombin time (P=0.038) were significantly related to morbidity. Age (P=0.028), glucose (P=0.011), and TAE (P=0.046) were significantly related to mortality. Conclusions: Intraoperative transfusion, which is mainly related to intraoperative bleeding, should be reduced if possible to decrease morbidity. Diabetes mellitus patients and the elderly need careful perioperative management.(Korean J Hepatol 2004;10:51-61)

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Hepatology Elsewhere

The Korean Journal of Serum Hepatitis B Virus DHA Level and Hepatocellulor Carcinoma: Seong Gyu Hwang; Korean J Hepatol 2006;12(4):583-586.

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