59% were diabetic, 44% hypertensive, 33% smokers and 26% hyperlip

59% were diabetic, 44% hypertensive, 33% smokers and 26% hyperlipidaemic. 53% of the patients had ≤2 of these risk factors. There was no difference in age, sex, BMI, number of HCC’s or other metabolic risk factors between the cirrhotic and non-cirrhotic patients. Non-cirrhotics

had a significantly larger mean tumour diameter than cirrhotics (p = 0.041) and were more likely to have HCC outside of Milan criteria for transplantation (p = 0.034). Multivariate analysis did not identify any other patient characteristics that predicted size of hepatomas, but having diabetes (p = 0.03) or more than 2 risk factors (p = 0.03) correlated with having more numerous HCCs. Conclusions: This study demonstrates that HCC can develop in NAFLD without cirrhosis or obesity; and tumours in non-cirrhotics

are GW-572016 price larger conferring a poorer prognosis. The fact that smaller HCC were detected in the cirrhotic patients is likely due to formal HCC screening in this patient group. Thus, urgent studies are needed to clarify the role of HCC screening in non-cirrhotic NAFLD. T HONG,1 A THOMPSON,1 P GOW,2 M FINK,8 M RYAN,1 A DEV,3 I KRONBORG,4 N ARACHCHI,4 J LUBEL,5,9 A NICOLL,6 S ROBERTS,7 P DESMOND,1 S BELL1 With the Melbourne collaboration for the study of hepatocellular Selleck ATM/ATR inhibitor carcinoma (MESH) Departments of Gastroenterology & Hepatology, 1St Vincent’s Hospital, Melbourne, Australia. 2The Austin Hospital, Melbourne, Australia. 3Monash Medical Centre, Melbourne, Australia. 4Western Health, Melbourne, Australia. 5Eastern Health, Melbourne, Australia. 6The Royal Melbourne Hospital, Melbourne, Australia. 7The Alfred Hospital, Melbourne, Australia., 8Department of

Surgery, The Austin Hospital, Melbourne, Australia. Background: Recent studies suggest that the incidence of hepatocellular carcinoma (HCC) is rising rapidly. Australian epidemiological data are currently derived from cancer registries, which classify HCC according to histology. However, HCC is now a radiological diagnosis, with histology reserved for a minority of cases. Cancer registry data may therefore underestimate the true incidence of HCC. We have therefore performed the first population-based Niclosamide study of HCC incidence in Australia using current diagnostic criteria. Method: New diagnoses of HCC were prospectively collected between July 2012 and June 2013 at all tertiary hospital services in Melbourne. Cases were identified using capture-recapture methodology from multiple sources including public hospital HCC multi-disciplinary meetings, medical coding, radiology, pathology and pharmacy databases. Private gastroenterologists and hepato-pancreato-biliary surgeons were surveyed to confirm that all private cases were referred to one of the participating centres for discussion, radiology or surgery. Case definition was based on AASLD clinico-radiological criteria or histological verification.

82 fold, p=004) and citrulline (075 fold, p=003) were decrease

82 fold, p=0.04) and citrulline (0.75 fold, p=0.03) were decreased in NASH vs. NAFL subjects. (5) Glycine, serine and threonine pathway: Betaine was decreased (0.80 fold, p=0.048 NASH vs. control and p=0.03 NASH vs. NAFL) in NASH subjects. (6) Lysine (0.84 fold, p=0.01) and methionine (0.85 fold, p=0.018) concentrations related to lysine and cysteine, methionine, S-adenosyl methionine (SAM), and taurine pathways, were significantly Talazoparib nmr low in NASH subjects vs. NAFL. Pathway enrichment and pathway impact analysis: While the most enriched pathway in NASH was lysine

degradation (>6-folds) with 3-4-folds enrichment in betaine, aspartate and methionine metabolism, the most pathway impact was by arginine and proline, and glycine, serine and threonine pathways. CONCLUSION: Plasma amino acid metabolome highlights several amino acids and its metabolite abnormalities in NAFLD. Lysine degradation pathway is highly enriched and arginine and proline pathway has most impact in NASH. Disclosures: Puneet Puri – Advisory Committees or Review Panels: Health Diagnostic Laboratory Inc.; Consulting: NPS Pharmaceuticals Inc. Andrew R. Joyce – Independent Contractor:

Venebio selleck chemicals llc Group, LLC; Management Position: Venebio Group, LLC Arun J. Sanyal – Advisory Committees or Review Panels: Bristol Myers, Gilead, Abbott, Ikaria; Consulting: Salix, Immuron, Exhalenz, Nimbus, Genentech, Echo-sens, Takeda; Grant/Research Support: Salix, Genentech, Genfit, Intercept, Ikaria, Takeda, GalMed, Novartis, Gilead; Independent Contractor: UpToDate, Elsevier The following people have nothing to disclose: Velimir A. Luketic, Mohammad S. Siddiqui, Sherry L. Boyett, Jolene Schlosser, Carol Sargeant, Kalyani Daita, Hae-Ki Min, Faridoddin Mirshahi Background and aim: Nonalcoholic fatty liver disease (NAFLD) and its progressive form, nonalcoholic steatohepatitis

acetylcholine (NASH), are rapidly being a worldwide health concern. Epidemiological studies have shown that the prevalence of NAFLD is higher in men than women. This gender difference disappears after menopause. Estrogen therapy has been shown to be protective against NAFLD/NASH after menopause. Whereas the administration of exogenous estrogens resulted in some potential risks, such as uterus cancer, limiting their clinical use. However, selective estrogen receptor modulator (SERM), acts in distinct ways and exert tissue-specific responses by interacting with estrogen receptors. Raloxifene, a second-generation of SERM which has been used for treatment of breast cancer and postmenopausal osteoporosis, has been shown to decrease serum cholesterol, low-density lipoprotein cholesterol. Here, we aimed to investigate the therapeutic effect of ralxofiene on NASH induced by choline deficient and high fat (CDHF) diet in ovariectomized (OVX) mice, a model of menopause.

It is postulated that this longer exposure of FVIII to the immune

It is postulated that this longer exposure of FVIII to the immune system may result in improved immune tolerance. Another postulate relates to substances

such as anti-idiotypic antibodies, cytokines and ‘other’ (as yet unidentified) proteins which may be present in pdVWF/FVIII concentrate but not in recombinant products. These other substances may have a role in affecting the immune system and conferring an advantage over recombinant products for purposes of immune tolerance. The RES.I.ST studies commenced in 2009 with the primary objective of determining whether pdVWF/FVIII concentrate is more effective than rFVIII concentrate for use in ITI therapy for patients with haemophilia [23]. Two studies are ongoing, which have been labelled ‘RES.I.ST-naïve’ and ‘RES.I.ST-experienced’. Patients eligible for inclusion in the RES.I.ST-naïve study are those with high-titre inhibitors who have not Pexidartinib previously received ITI therapy and have poor prognostic risk features for treatment this website success. In this study, patients are being randomly allocated to receive either pdVWF/FVIII or rFVIII, in both cases at a dose of 200 IU kg−1 day−1. Patients are followed

on a monthly basis to monitor response (Fig. 4). Treatment success is defined in the same manner as in the International ITI Study [15]. Treatment can extend for up to 33 months after which a patient will be declared to have failed if an inhibitor is still present. Patients with successful outcomes

will have their ITI therapy dose tapered to a prophylaxis regimen of 25–40 IU kg−1 (three times a week). The RES.I.ST-experienced study involves patients with high-titre inhibitors who have previously failed conventional ITI therapy with rFVIII. The design of this study is similar to that in RES.I.ST-naïve patients with the exception that patients are not randomized. Patients, as a cohort, will ADAMTS5 receive pdVWF/FVIII at the dose of 200 IU kg−1 day−1. The primary question these studies are trying to answer is: which is the most effective factor concentrate for ITI therapy? This is an important clinical question. Despite the importance of the question, multicentre studies on immune tolerance therapy in inhibitor patients are difficult to perform due to the small number of potential patients within any one centre and the difficulties with instituting studies including the process of obtaining institutional ethics approval. So far the RES.I.ST studies have enrolled 16 patients in centres in four countries (Italy, Spain, USA, Canada) (personal communication, A. Gringeri, December 2011). Given the importance of determining the ‘best’ factor for immune tolerance, clinicians are encouraged to enrol their patients into the RES.I.ST study to find the answer. At present there are two main weapons in the treatment of VWD. One is DDAVP, which releases endogenous VWF from vascular endothelial cells.

In our HCC cohort, BCL9 was located in the amplification peak at

In our HCC cohort, BCL9 was located in the amplification peak at 1q21.1,

which is highly amplified in 8.7% of HCCs (Table 2 and Supporting Table 3). There was a significant correlation between its somatic copy number and gene expression in primary HCCs (Fig. 2A), and protein expression measured by immunohistochemical (IHC) staining (Supporting Materials; Supporting Fig. 5A) correlated well with mRNA expression (Fig. 2B; Supporting Table 7). Transient transfection of siRNA SMARTpool for BCL9 significantly selleck chemicals reduced gene expression of BCL9 in all four cell lines tested (Fig. 2C,D) and significantly decreased cell growth and survival in both proliferation assays (Fig. 2E) and colony formation assays (CFAs) (Fig. 2F) in MHCC97H and MHCC97L, the two

cell lines with BCL9 gene amplification (Supporting Fig. 6). By contrast, siRNA-mediated inhibition of BCL9 gene expression had minimal effect on the SK-HEP-1 cell line, which is copy number neutral for BCL9, although the other BCL9 copy-number–neutral cell line (HUH6) showed significant growth inhibition GSK-3 inhibitor review upon BCL9 knockdown, suggesting that mechanisms other than BCL9 amplification may confer dependence on BCL9 expression. Our analysis also identified a peak at 8q22.1 containing a single gene (MTDH), which encodes metadherin. MTDH has been implicated as an oncogene in a number of cancer types, including HCC.[19] However, previous work in HCC has not yet established the dependency of MTDH-driven tumorigenesis on MTDH focal amplification, especially in relevant preclinical models that harbor the MTDH amplification. In our study, MTDH was highly amplified in 12.9% of HCCs (Table 2 and Supporting Table 3). There was a significant cis-correlation between somatic

copy number and mRNA expression of MTDH in primary HCCs (Fig. 3A), and protein expression by IHC (Supporting Fig. 5B) correlated well with mRNA expression (Fig. 3B; and Supporting Table 8). We further identified Thiamine-diphosphate kinase two HCC models (MHCC97H and SNU-398) with amplification of the MTDH locus (Supporting Fig. 6). Transient transfection of siRNA SMARTpool for MTDH significantly reduced the gene expression levels of MTDH in all four cell lines tested (Fig. 3C,D). In the two MTDH amplified HCC models, siRNA-mediated inhibition of MTDH gene expression significantly decreased cell growth and survival in both proliferation assays (Fig. 3E) and CFAs (Fig. 3F), whereas knockdown had a less-prominent effect on the two MTDH copy-number–neutral lines (L-02 and SMMC-7721). Our study represents one of the most comprehensive characterizations of the genomic landscape in a large primary HCC cohort and models.

We found that the multidrug resistance gene 1

(MDR1) tran

We found that the multidrug resistance gene 1

(MDR1) transporter was responsible for the efflux of Hoechst from SP cells in our MYC-driven model. Accordingly, SP cells and their tumor-initiating http://www.selleckchem.com/products/H-89-dihydrochloride.html subset were more resistant than non-SP cells to chemotherapeutics that are effluxed by MDR1. Conclusion: The oncogenotype of a tumor can promote a specific mechanism of chemoresistance that can contribute to the survival of hepatic CSCs. Under circumstances that promote differentiation of CSCs into more mature tumor cells, the chemoresistance can be quickly lost. Elucidation of the mechanisms that govern chemoresistance in these mouse models may illuminate the genesis of chemoresistance in human liver cancer. (HEPATOLOGY 2012) Liver cancer is the fifth most common and third deadliest cancer in the world.1 Primary liver cancer in adults is usually caused by viral infections or sustained chemical or alcohol exposure.2 Chemotherapy is a standard method of treatment for unresectable tumors, but meta-analysis of chemotherapy has revealed little statistical benefit in 1-year survival rates.3 Understanding how chemoresistance arises in hepatic tumors may lead to improvements in therapy. A major mechanism of chemoresistance in cancers, including those of hepatic origin, is the aberrant expression of ATP binding cassette Enzalutamide (ABC) transporters.4 ABC transporter proteins are composed of a single or multiple sets of transmembrane

domains and nucleotide binding domains.5 Various substrates, including ions, sugars, proteins, metabolites, and hydrophobic drugs are effluxed through the transmembrane domains, whereas the nucleotide binding domains hydrolyze ATP and power Thiamine-diphosphate kinase the efflux. ABC transporters prevent the accumulation of toxic compounds in normal cells. High expression of these proteins can also impair chemotherapy in cancer cells,

including cancer stem cells (CSCs).6 CSCs have been identified in a number of solid cancer models, including liver cancer.7 CSCs are characterized as having enhanced tumor-initiating capabilities compared to other tumor cells.8 Furthermore, these cells are often described as maintaining markers and molecular properties similar to undifferentiated adult stem or progenitor cells for the tissue of origin. Notable surface markers for hepatic CSCs that were previously identified in hepatic progenitor cells include CD90, CD44, CD133, and EpCAM.9-12 Metabolic markers such as aldehyde dehydrogenase (ALDH) activity have also been associated with hepatic CSCs.13 CSCs frequently display enhanced chemoresistance, which may contribute to the survival of tumor-initiating cells and the recurrence of tumors following chemotherapy.7 One approach to identify CSCs exploits enhanced chemoresistance through fractionation of cancer cells based on the efflux of Hoechst 33342.6 Subsets of cells that efflux Hoechst 33342 at a greater rate than the rest of the cell population can by identified by flow cytometry as a poorly stained side population (SP) of cells.

The prophylaxis regimens employed have been designed for joint pr

The prophylaxis regimens employed have been designed for joint protection, with relatively high doses of concentrate such as 50 IU kg−1 three times per week. Because they are usually introduced at or just after the first significant joint bleed, the FVIII is being introduced at a time when there are strong immunological danger signals present, to an immune system which has already been ‘primed’ by previous on-demand therapy. Therefore, prophylaxis might start too late to prevent inhibitor formation.

An effective prophylactic regimen for the treatment of PUPs without the development of inhibitors must take into account and avoid known danger signals, such as bleeding associated with tissue damage, immunological challenges DNA Synthesis inhibitor such as

vaccination, or infection. This would permit the immune system to develop tolerance to the foreign protein in a ‘non-threat’ situation. The results of this study demonstrate that this approach with an early start of low dose prophylaxis once weekly might have the capacity to dramatically reduce the incidence of inhibitors, even in high-risk patients, from the normally expected level, which in PUPs has been around 30% [1,13]. It remains difficult to judge which parameters of the new prophylaxis regimen were of major influence on inhibitor Ceritinib molecular weight development: the low number of on-demand exposures before prophylaxis, the low dose/frequency of the clonidine prophylaxis regimen, the young age at start of prophylaxis or a combination of some or of all of them. The avoidance of first FVIII exposure during a severe bleeding episode might be a

direct protector from inhibitor development whereas the age, however, might play only an indirect role as the earlier prophylaxis is started the more likely the PUP can reach >50 ‘tolerizing’ EDs without the need for intensive treatment due to a severe joint bleed. However future studies will have to evaluate the significance of single treatment-related factors and further refine the optimal regimen for inducing immunotolerance. We are aware of the fact that our results can only be considered as hypothesis generating and need to be confirmed in a larger prospective clinical study. Our results also suggest that early introduction of FVIII is a more satisfactory way of avoiding inhibitors than attempting to delay the use of FVIII, for example by treating bleeds with rFVIIa [19]. Starting with prophylaxis early in life, in our study at a median age of 10.7 months, was not associated with an increased inhibitor risk, a finding that is well in line with other recent studies [20,21]. A low dose, escalating regimen may also provide a better long-term outcome for patients, with less frequent joint bleeds and better joint scores, due to the earlier start on prophylaxis.

Kesli et al compared histology and rapid urease test to monoclon

Kesli et al. compared histology and rapid urease test to monoclonal SAT enzyme immunoassays (EIAs), Premier Platinum HpSA Plus EIA (Meridian Diagnostics Inc, Cincinatti, OH, USA) and H. pylori CDK inhibitor review Antigen test (Dia.Pro Diagnostic Bioprobes Sri, Milano, Italy) and one immunochromatographic assay (Vegal Farmaceutica, Madrid, Spain) for the diagnosis of H. pylori infection in 168 Turkish adults with dyspepsia before eradication therapy. All had a similar specificity of about 92%, but the Premier Platinum EIA had

the highest sensitivity at 90% (Table 1) [41]. Falaknazi et al.[42] determined the value of the HpSA polyclonal Premier Platinum EIA in Iranian patients with chronic renal failure undergoing renal dialysis pre-and post-H. pylori eradication treatment. The pre-eradication sensitivity (87%) was lower, and specificity (94%) was higher than in a previous comparative study [43]. In this small series, two of the seven remaining positive by UBT post-treatment gave a false-negative HpSA [42].

Several groups have evaluated the different this website diagnostic tests in their local populations. Zalabska in a series of 300 Czech patients, and Kalem et al. in a Turkish series of 103, found that the Meridian HpSA EIA (Meridian Diagnostics) detected more positive H. pylori patients than other invasive biopsy-based tests including culture, a rapid urease test, and histology [44,45]. In a small series of 59 Japanese patients postdistal gastrectomy, Yan et al.[46] found the Premier Platinum HpSA test (Meridian Diagnostics) to be more accurate than the UBT with a sensitivity and specificity of 100% and 90.5%. They suggested that the 59.1% specificity obtained

with the UBT in this setting may well be due to the altered intragastric environment. Kalach et al. evaluated the rapid in-office monoclonal enzyme immunoassay stool antigen test (Rapid HpStAR; Oxoid Ltd.) in 108 children (16 H. pylori positive). The SB-3CT overall sensitivity, specificity, and positive and negative predictive values were higher than in previous studies reported in the review published last year [47] 87.5%, 97.8%, 87.5%, and 97.8%, respectively, with an accuracy of 96.2%. Prell et al.[48] also evaluated this Rapid Hp STAR test (Oxoid Ltd.) using culture plus histology and RUT as the gold standard. They found a higher sensitivity but lower specificity in this larger series (Table 1). Raguza et al.[49] found that the Amplified IDEIA™ Hp STAR (Dako Cytomation Ltd, Hamburg, Germany) had 100% sensitivity but a lower specificity of 76.2% using the manufacturer’s cut-off; therefore, they suggested increasing the cut-off to 0.400 after re-analysis using a receiver operating characteristic (ROC) curve, leading to a specificity of 97.7% in this large series.

Kesli et al compared histology and rapid urease test to monoclon

Kesli et al. compared histology and rapid urease test to monoclonal SAT enzyme immunoassays (EIAs), Premier Platinum HpSA Plus EIA (Meridian Diagnostics Inc, Cincinatti, OH, USA) and H. pylori C646 Antigen test (Dia.Pro Diagnostic Bioprobes Sri, Milano, Italy) and one immunochromatographic assay (Vegal Farmaceutica, Madrid, Spain) for the diagnosis of H. pylori infection in 168 Turkish adults with dyspepsia before eradication therapy. All had a similar specificity of about 92%, but the Premier Platinum EIA had

the highest sensitivity at 90% (Table 1) [41]. Falaknazi et al.[42] determined the value of the HpSA polyclonal Premier Platinum EIA in Iranian patients with chronic renal failure undergoing renal dialysis pre-and post-H. pylori eradication treatment. The pre-eradication sensitivity (87%) was lower, and specificity (94%) was higher than in a previous comparative study [43]. In this small series, two of the seven remaining positive by UBT post-treatment gave a false-negative HpSA [42].

Several groups have evaluated the different Venetoclax diagnostic tests in their local populations. Zalabska in a series of 300 Czech patients, and Kalem et al. in a Turkish series of 103, found that the Meridian HpSA EIA (Meridian Diagnostics) detected more positive H. pylori patients than other invasive biopsy-based tests including culture, a rapid urease test, and histology [44,45]. In a small series of 59 Japanese patients postdistal gastrectomy, Yan et al.[46] found the Premier Platinum HpSA test (Meridian Diagnostics) to be more accurate than the UBT with a sensitivity and specificity of 100% and 90.5%. They suggested that the 59.1% specificity obtained

with the UBT in this setting may well be due to the altered intragastric environment. Kalach et al. evaluated the rapid in-office monoclonal enzyme immunoassay stool antigen test (Rapid HpStAR; Oxoid Ltd.) in 108 children (16 H. pylori positive). The Exoribonuclease overall sensitivity, specificity, and positive and negative predictive values were higher than in previous studies reported in the review published last year [47] 87.5%, 97.8%, 87.5%, and 97.8%, respectively, with an accuracy of 96.2%. Prell et al.[48] also evaluated this Rapid Hp STAR test (Oxoid Ltd.) using culture plus histology and RUT as the gold standard. They found a higher sensitivity but lower specificity in this larger series (Table 1). Raguza et al.[49] found that the Amplified IDEIA™ Hp STAR (Dako Cytomation Ltd, Hamburg, Germany) had 100% sensitivity but a lower specificity of 76.2% using the manufacturer’s cut-off; therefore, they suggested increasing the cut-off to 0.400 after re-analysis using a receiver operating characteristic (ROC) curve, leading to a specificity of 97.7% in this large series.

These results also support the idea that CBR1 is a key contributo

These results also support the idea that CBR1 is a key contributor to drug resistance in human HCC toward DNR. The protein levels of CBR1 vary in different human HCC cells. Although CBR1 has been shown to be decreased in HCC by immunohistochemical analysis,34 other biochemical

analyses have revealed the opposite change.35 In this study, we analyzed a total of 59 cases of human HCC. CBR1 was down-regulated in 30 (50.8%) and up-regulated in 8 (13.6%) and was similar to corresponding nontumor tissues in 21 cases (35.6%; Supporting Information Fig. 8); this calls into Caspase phosphorylation question whether the combination of EGCG with DNR can be of general use to HCC patients. EGCG enhanced the antitumor effects of DNR in cell toxicity assays and in animal xenograft models using cells with high expression of CBR1 (SMMC7721). However, we found that although EGCG did not bring additional benefits to DNR with respect to the inhibition of tumor growth, it clearly decreased the cardiotoxicity of DNR in Hep3B and SMMC7721 xenografts independently of CBR1 expression levels. We speculate that the reduction of DNR occurs not only in tumor cells but also in normal liver cells that contribute to the reduction

of DNR to DNROL and hence the cardiotoxicity of DNR. The ability of EGCG to enhance the anticancer activity Y-27632 chemical structure of DNR, together with its known safety and pharmacological properties, renders EGCG a generally applicable component of a combination therapy using DNR and EGCG for HCC. Additional Supporting Information may be found in the online version of this article. “
“Systemic amyloidosis is characterized by the extracellular deposition of abnormal fibrillar

protein. There are different types of amyloid, defined by their respective fibril precursor proteins. The pattern of organ involvement and dysfunction varies substantially, not only between different amyloid types, but also within each type. The relative rarity, along with varied clinical presentations and requirement for a correctly stained Pazopanib in vitro histological specimen, make diagnosis of amyloidosis challenging. The possibility of systemic amyloidosis is often overlooked, leading to a substantial delay in diagnosis and a high index of suspicion is thus required. Treatment revolves around eliminating or reducing the supply of precursor protein so that amyloidogenesis is switched off and regression of existing deposits can occur. Meticulous supportive care of organ function during treatment is imperative. “
“Functions of p53 during mitosis reportedly include prevention of polyploidy and transmission of aberrant chromosomes. However, whether p53 plays these roles during genomic surveillance in vivo and, if so, whether this is done via direct or indirect means remain unknown.

2%)

2%) learn more of 110 showed complete secondary

effectiveness with follow-up CT of 1 year or more. Of 115 tumors with complete primary effectiveness, local tumor progression was identified in four (3.4%) at follow-up CT from 4–11 months (mean, 8.2 months) after RFA. Cumulative rates of local tumor progression, estimated at 1 and 3 years, were 4.8% and 4.8%, respectively. No further local tumor progression was detected after month 11. One (25%) of four locally progressive tumors was treated again with percutaneous RFA. Of the remaining three, one was treated with PEI, one with surgical resection and one with hepatic arterial infusion therapy. All four of these patients developed local tumor progression within 12 months. Cumulative disease-free survival rates estimated at 3 and 5 years were 34.0% and 24.0%, respectively (Fig. 2). Univariate analysis identified tumor size, tumor number, AFP, serum albumin level, platelet count, indocyanine green 15-min retention rate (ICG-R15)

and hepatitis B virus (HBV) infection as significant determinants of disease-free survival. Multivariate analysis identified tumor number as the only statistically significant determinant of disease-free survival (solitary, hazards ratio [HR] = 2.465, 95% confidence interval check details [CI] = 1.170–5.191, P = 0.018). Of a total of 88 patients, 17 (19.3%) died due to HCC (n = 5), hepatic failure or complications of cirrhosis (n = 6) and other causes (n = 6). Cumulative overall survival rates estimated at 3 and 5 years were 83.0% and 70.0%, respectively (Fig. 3). Univariate analysis identified sex, age, serum bilirubin level, serum albumin level, and (ICG-R15; %) as significant

determinants of overall survival. Multivariate analysis identified age and ICG-R15 as the statistically significant determinants of overall survival (aged < 70 years; HR = 2.341, 95% CI = 1.101–4.977, P = 0.027; and ICG-R15 < 15%; HR = 3.621, 95% CI = 1.086–12.079, P = 0.036). Table 2 summarizes the characteristics of the 43 (48.8%) of 88 patients with recurrence during the follow-up period after RFA, classified according to time to recurrence into early Racecadotril (n = 18) and late recurrence (n = 25) subgroups. Correlations between time to recurrence from RFA and prognosis were analyzed. Kaplan–Meier curves for overall survival after RFA according to time to recurrence are shown in Figure 4. Overall survival of patients with early recurrence was significantly worse than that of patients with late recurrence (P = 0.014). On subgroup analysis, tumor size showed a significant association with early recurrence (P = 0.031). Multivariate analysis identified tumor size of more than 2 cm (risk ratio [RR] = 4.629, 95% CI = 1.241–17.241, P = 0.023) as the only independent risk factor for early recurrence of HCC after RFA. Of all patients with recurrence, four developed local tumor progression, all of whom were in the early recurrence group.