2024/05/21 更新

写真a

ミズノ カズユキ
水野 和幸
MIZUNO Kazuyuki
所属
医学部附属病院 化学療法部 病院助教
職名
病院助教
外部リンク
 

論文 29

  1. Risk factors for decreased bone mineral density in patients with metabolic dysfunction-associated steatotic liver disease: A cross-sectional study at a health examination center

    Yokoyama S., Honda T., Ishizu Y., Imai N., Ito T., Yamamoto K., Mizuno K., Kojima T., Kariya N., Nakamura M., Kawashima H.

    Clinical Nutrition   43 巻 ( 6 ) 頁: 1425 - 1432   2024年6月

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    記述言語:英語   出版者・発行元:Clinical Nutrition  

    Background & aims: Steatotic liver disease (SLD) is often detected in health examinations. However, although individuals with metabolic dysfunction-associated SLD (MASLD) may have decreased bone mineral density (BMD), the specific risk factors remain unclarified. The objective of this study was to identify the factors associated with decreased BMD in patients with MASLD. Methods: Individuals who underwent abdominal ultrasonography and BMD measurements at our healthcare center were included. The BMD of the calcaneus was assessed using an AOS-10SA bone densitometer. Decreased BMD was defined as a T-score below −1.0 SD or the administration of osteoporosis treatment. SLD was diagnosed based on specific ultrasonographic criteria. Results: A total of 1410 patients were diagnosed with MASLD. The median age was 52 years. Multivariate analysis using a logistic regression model revealed that the independent predictors of decreased BMD were a low body mass index (BMI) or a small waist circumference (odds ratio (OR): 0.48, 95% confidence interval (CI): 0.34–0.67), hypertriglyceridemia (OR: 1.29, 95% CI: 1.00–1.65), and a weak grip strength (OR: 0.98, 95% CI: 0.97–1.00). Subgroup analyses of individuals aged 50 years or older, men, and individuals with a FIB-4 index of 1.3 or greater revealed that the absence of a high BMI or a large waist circumference was associated with decreased BMD. The subgroup analysis of men revealed that a weaker grip strength was associated with decreased BMD. Conclusion: The present study suggested several potential risk factors for decreased BMD in patients with MASLD. Individuals with the abovementioned risk factors should be encouraged to undergo BMD measurement from the perspective of preventive medicine.

    DOI: 10.1016/j.clnu.2024.04.034

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  2. Outcomes of immune checkpoint inhibitor-induced liver toxicity managed by hepatologists in a multidisciplinary toxicity team

    Ito, T; Mizuno, K; Yamamoto, T; Yasuda, T; Yokoyama, S; Yamamoto, K; Imai, N; Ishizu, Y; Honda, T; Hama, M; Kataoka, T; Shimokata, T; Ando, Y; Kawashima, H

    HEPATOLOGY RESEARCH     2024年4月

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    記述言語:英語   出版者・発行元:Hepatology Research  

    Aim: To detect immune-related adverse events (irAEs) early and treat them appropriately, our institute established an irAE-focused multidisciplinary toxicity team in cooperation with various departments. This study aimed to evaluate a consultation system involving a team of hepatologists in terms of its utility for the management of severe immune checkpoint inhibitor (ICI)-induced liver toxicity. Methods: To analyze the diagnosis and treatment of severe ICI-induced liver toxicity (Grade 2 requiring corticosteroid therapy and Grade 3 or higher), we examined patients' clinical courses before and after the hepatologist consultation system was established (pre-period, September 2014 to February 2019; post-period, March 2019 to March 2023). Results: The median follow-up period was 392 days. Of the 1247 patients with advanced malignancies treated with ICIs, 66 developed severe ICI-induced liver toxicity (n = 22 and 44 in the pre- and post-periods, respectively). In the pre-period, hepatologist consultations were sought for 15/22 patients, whereas in the post-period, 42/44 patients were referred to and treated by hepatologists. The time from the onset of liver toxicity to the consultation was significantly shorter in the post-period than in the pre-period (mean 1.9 vs. 6.5 days, respectively; p = 0.012). The number of patients with a biopsy-confirmed diagnosis of ICI-induced liver toxicity was significantly higher in the post-period than in the pre-period (n = 22 vs. n = 3, respectively; p = 0.006). Finally, there were no cases of immune-related cholangitis in the pre-period, compared to five cases in the post-period. Conclusion: A hepatologist consultation system in an irAE-focused multidisciplinary toxicity team is useful for managing severe ICI-induced liver toxicity.

    DOI: 10.1111/hepr.14043

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  3. 特集 肝疾患-診療のチェックポイント2023 第Ⅰ部 診断のチェックポイント 第5章 肝疾患鑑別診断のチェックポイント 1.薬物性肝障害が疑われるとき

    伊藤 隆徳, 山本 崇文, 水野 和幸, 石上 雅敏, 川嶋 啓揮

    臨床消化器内科   38 巻 ( 7 ) 頁: 799 - 806   2023年6月

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    出版者・発行元:日本メディカルセンター  

    DOI: 10.19020/cg.0000002668

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  4. Serum osteopontin predicts the response to atezolizumab plus bevacizumab in patients with hepatocellular carcinoma

    Yamauchi, R; Ito, T; Yoshio, S; Yamamoto, T; Mizuno, K; Ishigami, M; Kawashima, H; Yasuda, S; Shimose, S; Iwamoto, H; Yamazoe, T; Mori, T; Kakazu, E; Kawaguchi, T; Toyoda, H; Kanto, T

    JOURNAL OF GASTROENTEROLOGY   58 巻 ( 6 ) 頁: 565 - 574   2023年6月

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    記述言語:英語   出版者・発行元:Journal of Gastroenterology  

    Background: Combination therapy with anti-programmed death-ligand 1 and anti-vascular endothelial growth factor (VEGF) antibodies has become the standard treatment for un-resectable hepatocellular carcinoma (uHCC). We aimed to identify predictive circulating biomarkers for the outcome/response of the combination therapy in uHCC patients. Methods: This prospective multicenter study enrolled 70 patients with uHCC who received atezolizumab and bevacizumab (Atez/Bev). We evaluated 47 circulating proteins in sera before and after 1 and 6 weeks of Atez/Bev therapy by multiplex bead-based immunoassay and ELISA. As controls, we analyzed the sera from 62 uHCC patients before treatment of lenvatinib (LEN) and healthy volunteers (HVs). Results: The disease control rate was 77.1%. Median progression-free survival (PFS) was 5.7 months (95% confidence interval [CI] = 3.8–9.5). The pretreatment levels of osteopontin (OPN), angiopoietin-2, VEGF, S100–calcium-binding protein A8/S100–calcium-binding protein A9, soluble programmed cell death-1, soluble CD163, and 14 cytokines/chemokines were higher in patients with uHCC than in HVs. Among these, pretreatment OPN levels were higher in PD group than in non-PD group for Atez/Bev. The PD rate was higher in high OPN group than in low OPN group. Multivariate analysis identified high pretreatment OPN and high α‐fetoprotein levels as independent predictors of PD. In the sub-analysis of Child–Pugh class A patients, PFS was also shorter in the high OPN group than in the low OPN group. Pretreatment OPN level was not associated with treatment response for LEN. Conclusion: High serum OPN levels were associated with poor response to Atez/Bev in patients with uHCC.

    DOI: 10.1007/s00535-023-01985-w

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  5. Abdominal pain accompanied by elevated serum inflammatory markers and biliary enzymes for diagnosing immune checkpoint inhibitor-induced sclerosing cholangitis

    Yamamoto, T; Mizuno, K; Ito, T; Yokoyama, S; Yamamoto, K; Imai, N; Ishizu, Y; Honda, T; Ishikawa, T; Kanamori, A; Yasuda, S; Toyoda, H; Yokota, K; Hase, T; Nishio, N; Maeda, O; Ishii, M; Sone, M; Ando, Y; Akiyama, M; Ishigami, M; Kawashima, H

    INVESTIGATIONAL NEW DRUGS   41 巻 ( 3 ) 頁: 512 - 521   2023年6月

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    記述言語:英語   出版者・発行元:Investigational New Drugs  

    Immune-related sclerosing cholangitis (irSC) is relatively rare and its clinical characteristics are not well known. In this study, we aimed to summarize the clinical features of irSC. Clinical data were collected retrospectively from 1,393 patients with advanced malignancy treated with immune-checkpoint inhibitors (ICIs) between August 2014 and October 2021. We analyzed patients with immune-related adverse events of liver injury (liver-irAEs) and compared irSC and non-irSC groups. Sixty-seven patients (4.8%) had a liver-irAE (≥ grade 3) during the follow-up period (median, 262 days). Among these, irSC was observed in eight patients (11.9%). All patients in the irSC group were treated with anti-PD-1/PD-L1 antibodies. Compared with the non-irSC group, the irSC group showed mainly non-hepatocellular liver injury (87.5 % vs 50.8 %, P = 0.065), and had elevated serum inflammatory markers (e.g., CRP and NLR) and biliary enzymes (e.g., GGTP and ALP) at the onset of liver-irAEs. Furthermore, most patients with irSC had abdominal pain. In the non-irSC group, the liver injury of 23 patients improved only with the discontinuation of ICIs, and 22 patients improved with medication including prednisolone (PSL). Conversely, almost all patients (n=7) in the irSC group were treated with PSL, but only two patients experienced an improvement in liver injury. We found that irSC is characterized by a non-hepatocellular type of liver injury with abdominal pain and a high inflammatory response and is refractory to treatment. Further examination by imaging is recommended to detect intractable irSC in cases with these characteristics.

    DOI: 10.1007/s10637-023-01366-3

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  6. Pretreatment Proteinuria Predicts the Prognosis of Patients Receiving Systemic Therapy for Unresectable Hepatocellular Carcinoma

    Mizuno, K; Imai, N; Yamamoto, T; Yokoyama, S; Yamamoto, K; Ito, T; Ishizu, Y; Honda, T; Kuzuya, T; Ishigami, M; Kawashima, H

    CANCERS   15 巻 ( 10 )   2023年5月

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    記述言語:英語   出版者・発行元:Cancers  

    Background: Proteinuria is a common adverse event in systemic therapy for hepatocellular carcinoma (HCC). However, whether the presence of pretreatment proteinuria affects the clinical course is still unclear. Method: From 2011 to 2022, 321 patients with unresectable HCC who were treated with systemic therapy as first-line treatment were enrolled in this study. We retrospectively analyzed the presence of pretreatment proteinuria and the treatment course of systemic therapy. Results: In the cohort, 190 patients were tested for proteinuria qualitatively within 3 months before systemic therapy; 75 were treated with sorafenib, 72 were treated with lenvatinib, and 43 were treated with atezolizumab plus bevacizumab. Overall survival tended to be longer for patients treated with lenvatinib and significantly longer with atezolizumab plus bevacizumab in patients without pretreatment proteinuria but not for those treated with sorafenib. Further analysis was performed in 111 patients treated with lenvatinib or atezolizumab plus bevacizumab who had proteinuria measured quantitatively. Multivariate analysis including proteinuria, liver function, and HCC stage revealed that the severity of proteinuria was an independent predictor of prognosis. Conclusion: Pretreatment proteinuria predicts a poorer prognosis in patients with unresectable HCC treated with lenvatinib or atezolizumab plus bevacizumab but not in those treated with sorafenib.

    DOI: 10.3390/cancers15102853

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  7. Clustering using unsupervised machine learning to stratify the risk of immune-related liver injury

    Yamamoto, T; Morooka, H; Ito, T; Ishigami, M; Mizuno, K; Yokoyama, S; Yamamoto, K; Imai, N; Ishizu, Y; Honda, T; Yokota, K; Hase, T; Maeda, O; Hashimoto, N; Ando, Y; Akiyama, M; Kawashima, H

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   38 巻 ( 2 ) 頁: 251 - 258   2023年2月

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    記述言語:英語   出版者・発行元:Journal of Gastroenterology and Hepatology (Australia)  

    Background and Aim: Immune-related liver injury (liver-irAE) is a clinical problem with a potentially poor prognosis. Methods: We retrospectively collected clinical data from patients treated with immune checkpoint inhibitors between September 2014 and December 2021 at the Nagoya University Hospital. Using an unsupervised machine learning method, the Gaussian mixture model, to divide the cohort into clusters based on inflammatory markers, we investigated the cumulative incidence of liver-irAEs in these clusters. Results: This study included a total of 702 patients. Among them, 492 (70.1%) patients were male, and the mean age was 66.6 years. During the mean follow-up period of 423 days, severe liver-irAEs (Common Terminology Criteria for Adverse Events grade ≥ 3) occurred in 43 patients. Patients were divided into five clusters (a, b, c, d, and e). The cumulative incidence of liver-irAE was higher in cluster c than in cluster a (hazard ratio [HR]: 13.59, 95% confidence interval [CI]: 1.70–108.76, P = 0.014), and overall survival was worse in clusters c and d than in cluster a (HR: 2.83, 95% CI: 1.77–4.50, P < 0.001; HR: 2.87, 95% CI: 1.47–5.60, P = 0.002, respectively). Clusters c and d were characterized by high temperature, C-reactive protein, platelets, and low albumin. However, there were differences in the prevalence of neutrophil count, neutrophil-to-lymphocyte ratio, and liver metastases between both clusters. Conclusions: The combined assessment of multiple markers and body temperature may help stratify high-risk groups for developing liver-irAE.

    DOI: 10.1111/jgh.16038

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  8. A case of antiprogrammed death-ligand 1 antibody-induced multisystem immune-related adverse events with pancreatitis and steroid-resistant sclerosing cholangitis

    Yamamoto, T; Ito, T; Mizuno, K; Shinya, Y; Yamamoto, K; Imai, N; Ishizu, Y; Honda, T; Kawashima, H; Matsui, T; Hase, T; Hashimoto, N; Ishigami, M

    JOURNAL OF DIGESTIVE DISEASES   23 巻 ( 7 ) 頁: 404 - 409   2022年7月

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    記述言語:英語   出版者・発行元:Journal of Digestive Diseases  

    DOI: 10.1111/1751-2980.13122

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  9. Immune-related Liver Injury is a Poor Prognostic Factor in Patients with Nonsmall Cell Lung Cancer Treated with Immune Checkpoint Inhibitors

    Yamamoto, T; Ito, T; Hase, T; Ishigami, M; Mizuno, K; Yamamoto, K; Imai, N; Ishizu, Y; Honda, T; Shibata, H; Hatta, T; Yogo, N; Yasuda, S; Toyoda, H; Abe, T; Kawashima, H; Hashimoto, N; Fujishiro, M

    CANCER INVESTIGATION   40 巻 ( 2 ) 頁: 189 - 198   2022年2月

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    記述言語:英語   出版者・発行元:Cancer Investigation  

    It remains unclear whether severe liver immune-related adverse events (liver-irAEs) can affect the prognosis in nonsmall cell lung carcinoma (NSCLC) patients. Of the 365 NSCLC patients treated with immune checkpoint inhibitors (ICIs), 19 suffered from severe liver-irAEs (grade ≥3). The median time-to-onset of liver-irAEs was 53 days postinjection of the first ICI. The progression-free survival and overall survival of the liver-irAEs group (median 69 and 262 days, respectively) were significantly worse than the nonliver-irAEs group (128 and 722 days; P = 0.010 and P = 0.007; respectively). In conclusion, liver-irAEs were associated with poor prognosis in NSCLC patients.

    DOI: 10.1080/07357907.2021.1994586

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  10. Clinical course of liver injury induced by immune checkpoint inhibitors in patients with advanced malignancies

    Ito, T; Ishigami, M; Yamamoto, T; Mizuno, K; Yamamoto, K; Imai, N; Ishizu, Y; Honda, T; Kawashima, H; Yasuda, S; Toyoda, H; Yokota, K; Hase, T; Nishio, N; Maeda, O; Kato, M; Hashimoto, N; Hibi, H; Kodera, Y; Sone, M; Ando, Y; Akiyama, M; Shimoyama, Y; Fujishiro, M

    HEPATOLOGY INTERNATIONAL   15 巻 ( 5 ) 頁: 1278 - 1287   2021年10月

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    記述言語:英語   出版者・発行元:Hepatology International  

    Background: The clinical course of liver injury induced by immune checkpoint inhibitors (ICIs) varies among individuals, and there were few reports on the therapeutic effects of corticosteroids based on the patterns of liver injury. Methods: We evaluated the characteristics and clinical course of immune-related liver injury in 1214 patients treated with ICIs for advanced malignancies except for hepatocellular carcinoma between August 2014 and May 2021. Results: During the follow-up period (median, 252 days), 58 patients (4.8%) had an immune-related liver injury (≥ Grade 3). The liver-injury patterns were hepatocellular (n = 26, 44.8%), mixed (n = 11, 19.0%), or cholestatic (n = 21, 36.2%), and the median time to onset of liver injury was 39, 81, and 53 days, respectively; the hepatocellular pattern occurred earlier than the other types (p = 0.047). Corticosteroids were administered to 30 (51.7%) patients; while liver injury was improved in almost all patients with the hepatocellular pattern (n = 13/14, 92.9%), that failed to show improvement in over half of the patients with the non-hepatocellular patterns, and three patients with mixed patterns needed secondary immunosuppression with mycophenolate mofetil. Liver biopsies performed in 13 patients mainly showed lobular injury, endothelialitis, and spotty necrosis with infiltration of T cells positive for CD3 and CD8, but not CD4 or CD20. Conclusion: The incidence pattern and therapeutic response to corticosteroids in immune-related liver injury differ according to the injury type. Although corticosteroids were effective for the hepatocellular pattern, an additional strategy for refractory non-hepatocellular patterns is needed.

    DOI: 10.1007/s12072-021-10238-y

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  11. Bioinformatics and Functional Analyses Implicate Potential Roles for EOGT and <i>L</i>-fringe in Pancreatic Cancers

    Barua, R; Mizuno, K; Tashima, Y; Ogawa, M; Takeuchi, H; Taguchi, A; Okajima, T

    MOLECULES   26 巻 ( 4 )   2021年2月

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    記述言語:英語   出版者・発行元:Molecules  

    Notch signaling receptors, ligands, and their downstream target genes are dysregulated in pancreatic ductal adenocarcinoma (PDAC), suggesting a role of Notch signaling in pancreatic tumor development and progression. However, dysregulation of Notch signaling by post-translational modification of Notch receptors remains poorly understood. Here, we analyzed the Notch-modifying glycosyltransferase involved in the regulation of the ligand-dependent Notch signaling pathway. Bioinformatic analysis revealed that the expression of epidermal growth factor (EGF) domain-specific O-linked N-acetylglucosamine (EOGT) and Lunatic fringe (LFNG) positively correlates with a subset of Notch signaling genes in PDAC. The lack of EOGT or LFNG expression inhibited the proliferation and migration of Panc-1 cells, as observed by the inhibition of Notch activation. EOGT expression is significantly increased in the basal subtype, and low expression of both EOGT and LFNG predicts better overall survival in PDAC patients. These results imply potential roles for EOGT- and LFNG-dependent Notch signaling in PDAC.

    DOI: 10.3390/molecules26040882

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  12. Real world data of liver injury induced by immune checkpoint inhibitors in Japanese patients with advanced malignancies

    Mizuno, K; Ito, T; Ishigami, M; Ishizu, Y; Kuzuya, T; Honda, T; Kawashima, H; Inukai, Y; Toyoda, H; Yokota, K; Hase, T; Maeda, O; Kiyoi, H; Nagino, M; Hibi, H; Kodera, Y; Fujimoto, Y; Sone, M; Gotoh, M; Ando, Y; Akiyama, M; Hasegawa, Y; Fujishiro, M

    JOURNAL OF GASTROENTEROLOGY   55 巻 ( 6 ) 頁: 653 - 661   2020年6月

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    記述言語:英語   出版者・発行元:Journal of Gastroenterology  

    Background: Liver injury induced by immune checkpoint inhibitors (ICIs) is an immune-related adverse event (irAE) whose incidence has increased with the broader use of ICIs in clinical practice. However, the incidental risk factors of immune-related liver injury are unknown. We investigated the clinical characteristics of immune-related liver injury. Methods: A total of 546 patients treated with ICIs for advanced malignancies between September 2014 and February 2019 were included retrospectively. Factors associated with immune-related liver injury were determined. Results: Immune-related liver injury (≥ Grade 3) occurred in 29 (5.3%) patients (Grade 3, n = 20; Grade 4, n = 8; Grade 5, n = 1) during the follow-up period (median 153 days). The patterns of liver injuries were hepatocellular, n = 6 (20.7%); cholestatic, n = 17 (58.6%); and mixed, n = 6 (20.7%). The median period between the initial administration of ICIs and the incidence of irAEs was 52 days. Of 29 patients with immune-related liver injury (≥ Grade 3), four showed immune-related cholangitis with non-obstructive dilation of the bile ducts. Factors that were significantly associated with the incidence of immune-related liver injury in multivariate analysis were use of ipilimumab, anti-cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) agent [hazard ratio [HR] 4.22, 95% confidence interval (CI) 1.65–10.80, P = 0.003], and fever over 38 °C within 24 h of initial ICI administration (HR 6.21, 95% CI 2.68–14.40, P < 0.001). Conclusions: We found that the use of ipilimumab and the presence of fever within 24 h of initial ICI administration were predictive factors for immune-related liver injury.

    DOI: 10.1007/s00535-020-01677-9

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  13. Dynamic Evaluation of Liver Fibrosis to Assess the Risk of Hepatocellular Carcinoma in Patients With Chronic Hepatitis C Who Achieved Sustained Virologic Response

    Toyoda, H; Tada, T; Yasuda, S; Mizuno, K; Ito, T; Kumada, T

    CLINICAL INFECTIOUS DISEASES   70 巻 ( 6 ) 頁: 1208 - 1214   2020年3月

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    記述言語:英語   出版者・発行元:Clinical Infectious Diseases  

    Background: Liver fibrosis is an important risk factor for the development of hepatocellular carcinoma (HCC) after sustained virologic response (SVR) in patients with persistent hepatitis C virus (HCV) infection. However, as the degree of liver fibrosis changes following the eradication of HCV after SVR, it is unclear whether the prediction of HCC development based on liver fibrosis at baseline remains valid. Methods: In 522 patients who achieved SVR by interferon-based anti-HCV therapy, the Fibrosis-4 Index for Liver Fibrosis (FIB-4 index) was updated annually by recalculation based on laboratory values after SVR. The incidence of HCC was reassessed annually based on the updated FIB-4 index. Results: The percentage of patients with mild liver fibrosis (FIB-4 index <1.45) increased annually after SVR, whereas the percentage of patients with advanced liver fibrosis (FIB-4 index ≥3.25) decreased. The incidences of HCC based on the FIB-4 index remained constant between the time of SVR and subsequent annual updates. No patients developed HCC after SVR if the FIB-4 index decreased to <1.45. Conclusions: The FIB-4 index retained its predictive ability for the risk of HCC when recalculated after SVR, despite the decrease in patients with high FIB-4 index values. Dynamic assessment of the FIB-4 index can be useful in the surveillance of HCC after SVR. Patients with a FIB-4 index <1.45 did not develop HCC even by the regression from advanced fibrosis after SVR. Further studies will be necessary to confirm these findings, which may result in a decrease in the number of patients in whom surveillance is required.

    DOI: 10.1093/cid/ciz359

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  14. The emergence of non-hypervascular hypointense nodules on enhanced MRI in patients with chronic hepatitis C

    Toyoda, H; Tada, T; Yasuda, S; Mizuno, K; Sone, Y; Kaneoka, Y; Maeda, A; Akita, T; Tanaka, J; Kumada, T

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS   50 巻 ( 11-12 ) 頁: 1232 - 1238   2019年12月

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    記述言語:英語   出版者・発行元:Alimentary Pharmacology and Therapeutics  

    Background: Intrahepatic non-hypervascular hypointense nodules (NHHNs) detected during the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) have the potential to transition into typical hypervascular hepatocellular carcinoma (HCC). However, the incidence and risk factors for the emergence of these nodules in patients with chronic hepatitis C virus (HCV) infection are unknown. Aim: To investigate the incidence and risk factors for NHHNs in patients with chronic HCV infection in a longitudinal follow-up study. Methods: EOB-MRI was performed in 608 patients with chronic HCV infection and no history of HCC. The characteristics of patients with and without NHHNs were compared. In patients without NHHNs at baseline, the incidence of NHHN emergence and associated risk factors were analysed. Results: NHHNs were detected at baseline in 93 of 608 patients (15.3%). Among 515 patients without NHHNs at baseline, the 1-year, 3-year and 5-year incidence of NHHN emergence was 1.8%, 9.8% and 16.4%, respectively. Only FIB-4 index was independently associated with the emergence of NHHNs in multivariate analyses. Whereas NHHNs emerged in 24.1% of patients with FIB-4 index ≥ 3.25 at 5 years, none emerged in patients with FIB-4 index < 1.45. Conclusion: In patients with chronic HCV infection, advanced liver fibrosis is an important risk factor for the presence or emergence of NHHNs.

    DOI: 10.1111/apt.15490

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  15. IMPACT OF PRETREATMENT COMPENSATED CIRRHOSIS OR A HISTORY OF CURATIVELY TREATED HCC ON THE MORTALITY OF PATIENTS WITH HCV AFTER SVR BY DAA REGIMENS

    Toyoda, H; Yasuda, S; Mizuno, K; Kumada, T

    HEPATOLOGY   70 巻   頁: 984A - 984A   2019年10月

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  16. The course of elderly patients with persistent hepatitis C virus infection without hepatocellular carcinoma

    Mizuno, K; Toyoda, H; Yasuda, S; Tada, T; Kumada, T; Sone, Y; Tanaka, J

    JOURNAL OF GASTROENTEROLOGY   54 巻 ( 9 ) 頁: 829 - 836   2019年9月

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    記述言語:英語   出版者・発行元:Journal of Gastroenterology  

    Background: Little is known about the course of elderly patients with persistent hepatitis C virus (HCV) infection. We investigated the course of HCV infection in this patient population. Methods: Among 9,126 HCV antibody-positive patients who visited our hospital between 1995 and 2015, there were 453 patients with continuous follow-up who survived to age 80. They were included in the study following the inclusion criteria: confirmed persistent detection of HCV RNA, no HCV eradication if anti-HCV therapy occurred before enrollment, and no development of hepatocellular carcinoma (HCC) before enrollment. For all study patients, baseline was defined as the date when they turned 80. Mortality rates after the age of 80 years and cause of death were analyzed. Results: During the study period, 155 patients (34.2%) died. Median survival time (MST) after age 80 was 8.8 years, which was comparable to that of the general population (10.1 years). Among 155 deceased patients, the majority (115 patients, 74.2%) died due to non-liver-related disease, followed by HCC (28 patients, 18.1%) and liver-related disease other than HCC (12 patients, 7.7%). Patients with advanced liver fibrosis (FIB-4 index > 3.25, n = 245) had shorter MST than patients with mild liver fibrosis (FIB-4 index ≤ 3.25, n = 208) (7.1 vs. 10.2 years; p = 0.020) due to a higher mortality rate from liver-related complications, including HCC. Conclusion: Most elderly HCV patients die from non-liver-related disease, especially those with less advanced liver fibrosis.

    DOI: 10.1007/s00535-019-01595-5

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  17. Influence of renal dysfunction on dose reduction and virologic efficacy of regimens combining ribavirin and all-oral direct acting antivirals in patients with chronic hepatitis C virus infection

    Nakashima, M; Toyoda, H; Tada, T; Mizuno, K; Iio, E; Tanaka, Y; Sugiyama, T; Yoshimura, T; Kumada, T

    HEPATOLOGY RESEARCH   49 巻 ( 5 ) 頁: 512 - 520   2019年5月

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    記述言語:英語   出版者・発行元:Hepatology Research  

    Aim: Several interferon (IFN)-free, all-oral regimens with direct acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection also include ribavirin (RBV). We investigated the influence of renal dysfunction on virologic efficacy and adverse effects in 189 patients with HCV genotype 2 infection who received combination RBV–DAA regimens. Methods: The incidence of RBV-induced anemia, RBV dose reduction, and virologic efficacy were compared according to baseline renal function as defined by the estimated glomerular filtration rate (eGFR). Results: Patients with renal dysfunction (eGFR = 30–59 mL/min/1.73 m2) had higher rate of RBV dose reduction and more marked decreases in hemoglobin levels. These findings were more pronounced in patients with the ITPA CC genotype, who are more sensitive to RBV-induced anemia. Although there were no statistically significant differences in sustained virologic response (SVR) rates according to renal function overall (P = 0.1650), the SVR rate was significantly lower in patients who required RBV dose reduction than in those who did not (P < 0.0001). Conclusions: Baseline renal dysfunction could unfavorably affect the outcomes of RBV–DAA in patients with chronic HCV infection due to the increased risk of RBV dose reduction, even in the era of IFN-free DAA regimens.

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  18. The impact of HCV eradication by direct-acting antivirals on the transition of precancerous hepatic nodules to HCC: A prospective observational study

    Toyoda, H; Kumada, T; Tada, T; Mizuno, K; Sone, Y; Akita, T; Tanaka, J; Johnson, PJ

    LIVER INTERNATIONAL   39 巻 ( 3 ) 頁: 448 - 454   2019年3月

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    記述言語:英語   出版者・発行元:Liver International  

    Background & Aims: It remains controversial whether the eradication of hepatitis C virus (HCV) by interferon (IFN)-free anti-HCV therapy using direct-acting antivirals (DAAs) suppresses or promotes hepatocellular carcinoma (HCC) development. We investigated the influence of HCV eradication by DAA therapy on HCC development, by observing changes of non-hypervascular hypointense nodules (NHHNs) by gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI). Methods: A total of 401 patients treated with DAA therapy who did not have a history of HCC were enrolled in this prospective cohort study. All patients underwent EOB-MRI prior to the start of DAA therapy and were followed up periodically after therapy. The progression of NHHNs detected at baseline to typical HCC, as indicated by hypervascularization and the incidence of newly emergent NHHNs, was analyzed. Results: In comparison of patients who achieved sustained virologic response (SVR) with propensity score-matched patients with persistent HCV infection, there was no difference in the incidence of hypervascularization of NHHNs to typical HCC among patients who had NHHNs at baseline. Among patients who did not have NHHNs at baseline, the incidence of the new emergence of NHHNs did not differ between study patients and propensity score–matched patients with persistent HCV infection. Conclusions: During a 2-year observation period after SVR, the eradication of HCV by IFN-free DAA therapy did not suppress or enhance HCC development. (UMIN000017020).

    DOI: 10.1111/liv.13987

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  19. Impact of hepatocellular carcinoma aetiology and liver function on the benefit of surveillance: A novel approach for the adjustment of lead-time bias

    Toyoda, H; Kumada, T; Tada, T; Mizuno, K; Hiraoka, A; Tsuji, K; Ishikawa, T; Akita, T; Tanaka, J

    LIVER INTERNATIONAL   38 巻 ( 12 ) 頁: 2260 - 2268   2018年12月

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    記述言語:英語   出版者・発行元:Liver International  

    Background & Aims: Surveillance reportedly has benefit on survival in patients with hepatocellular carcinoma (HCC), even after adjustment for lead-time bias. However, previous adjustment for lead-time bias using tumour volume doubling time (TVDT) had inherent problem in accuracy. We evaluated survival benefit of HCC surveillance with newly developed approach for adjusting lead-time bias. In addition, survival benefit was evaluated according to HCC aetiology and liver function. Methods: A total of 3899 patients were studied. TVDT was calculated in 255 study patients with ≥2 tumour size measurements before the diagnosis of HCC. Adjusted survival time was calculated based on TVDT, as the time from when HCC was assumed to be 5 mm to death or last follow-up. Survival rates based on this adjusted survival time were compared between the surveillance and nonsurveillance groups and categorized by HCC aetiology and liver function. Results: Calculated TVDT varied widely by study patients (median 141.9, IQR, 73.1-261.7 days). Survival rates based on adjusted survival time were higher in the surveillance group overall and by patients HCC aetiology. Whereas adjusted survival rates were higher in the surveillance group in Child-Pugh class A patients, the survival benefit was smaller in Child-Pugh class B patients and not statistically significant in Child-Pugh class C patients. Conclusions: The survival benefit of surveillance for patients with HCC was demonstrated after adjustment for lead-time bias with novel, more accurate methodology. However, the benefits differed based on liver function and may vary largely by patients because of wide variation in TVDT.

    DOI: 10.1111/liv.13927

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  20. Impact of previously cured hepatocellular carcinoma (HCC) on new development of HCC after eradication of hepatitis C infection with non-interferon-based treatments

    Toyoda, H; Kumada, T; Tada, T; Mizuno, K; Sone, Y; Kaneoka, Y; Maeda, A; Akita, T; Tanaka, J

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS   48 巻 ( 6 ) 頁: 664 - 670   2018年9月

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    記述言語:英語   出版者・発行元:Alimentary Pharmacology and Therapeutics  

    Background: The incidence of hepatocellular carcinoma (HCC) in patients with a history of curatively-treated HCC is higher than in patients with no history of HCC even after sustained virologic response (SVR). Aim: To investigate differences in the patterns of HCC development after SVR in patients with a history of curatively-treated HCC and those with no history of HCC, based on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) findings. Methods: EOB-MRI was performed in 164 patients with HCV cirrhosis who achieved SVR by interferon-free direct-acting antiviral (DAA) therapy just before the start of therapy. Changes in EOB-MRI findings after SVR were compared prospectively between patients with (n = 62) and without (n = 102) a history of HCC. Results: The incidence of HCC after SVR was higher in patients with a history of HCC (P < 0.0001). The prevalence of nonhypervascular hypointense nodules (NHHNs) by EOB-MRI was significantly higher in patients with a history of HCC at baseline (P = 0.05). Although there was no difference in the incidence of the hypervascularisation of baseline NHHNs to typical hypervascular HCC between patients with and without a history of HCC, the incidence of direct emergence of hypervascular HCC despite the absence of NHHNs at baseline was significantly higher in patients with a history of HCC (P < 0.0001). Conclusion: Direct emergence of hypervascular HCC and a higher prevalence of NHHNs before DD therapy contributed to the higher incidence of HCC after SVR. (UMIN000017020).

    DOI: 10.1111/apt.14914

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  21. Significance of day-1 viral response of hepatitis C virus in patients with chronic hepatitis C receiving direct-acting antiviral therapy

    Toyoda, H; Kumada, T; Tada, T; Yama, T; Mizuno, K

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   33 巻 ( 6 ) 頁: 1264 - 1270   2018年6月

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    記述言語:英語   出版者・発行元:Journal of Gastroenterology and Hepatology (Australia)  

    Background and Aim: On-treatment response of serum hepatitis C virus (HCV) is reportedly less useful to predict the outcome of anti-HCV therapy with interferon (IFN)-free regimen with direct-acting antivirals than with IFN-based regimens in clinical trials. We evaluated the significance of very early viral response after the start of therapy, which indicates direct HCV response to the drugs, on therapeutic outcome. Methods: Reductions in serum HCV-RNA levels were measured at 1 day after the start of therapy in 544 patients who underwent IFN-free direct-acting antiviral regimens. The association between these reductions and the achievement or failure of sustained virologic response (SVR) was evaluated. Results: Patient characteristics did not influence 1-day reduction in serum HCV-RNA except for liver fibrosis. There was no difference in 1-day HCV reduction between SVR and non-SVR patients treated with a 24-week regimen. In contrast, in patients treated with a 12-week regimen, 1-day reduction was significantly greater in SVR than in non-SVR patients (P = 0.0013) and was predictive of SVR versus non-SVR (area under the receiver-operating characteristics curve: 0.80). Conclusions: Whereas the reduction in serum HCV-RNA levels at 1 day after the start of therapy was not associated with treatment outcomes in patients who underwent a 24-week regimen of IFN-free therapy, there was an association in patients receiving a 12-week regimen, and this reduction was predictive of SVR, thus potentially serving as a factor to identify patients at risk of treatment failure.

    DOI: 10.1111/jgh.14053

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  22. The impact of HCV eradication by IFN-free regimens on the transition of precancerous hepatic nodules to HCC: a prospective observational study

    Toyoda, H; Kumada, T; Tada, T; Yama, T; Mizuno, K; Akita, T; Tanaka, J

    JOURNAL OF HEPATOLOGY   68 巻   頁: S529 - S529   2018年4月

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  23. Impact of curative HCC history on the development of HCC after the eradication of HCV by DAA therapy in patients with HCV infection

    Toyoda, H; Kumada, T; Tada, T; Mizuno, K

    JOURNAL OF HEPATOLOGY   68 巻   頁: S529 - S530   2018年4月

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  24. Imaging basis of AFP and WFA<SUP>+</SUP>M2BP as indicators of the risk of HCC after SVR

    Toyoda, H; Kumada, T; Tada, T; Mizuno, K

    JOURNAL OF HEPATOLOGY   68 巻 ( 3 ) 頁: 606 - 607   2018年3月

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    記述言語:英語   出版者・発行元:Journal of Hepatology  

    DOI: 10.1016/j.jhep.2017.08.040

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  25. Improvement of liver stiffness in patients with hepatitis C virus infection who received direct-acting antiviral therapy and achieved sustained virological response

    Tada, T; Kumada, T; Toyoda, H; Mizuno, K; Sone, Y; Kataoka, S; Hashinokuchi, S

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   32 巻 ( 12 ) 頁: 1982 - 1988   2017年12月

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    記述言語:英語   出版者・発行元:Journal of Gastroenterology and Hepatology (Australia)  

    Background and Aim: There is insufficient research on whether direct-acting antiviral (DAA) therapy can improve liver fibrosis in patients with chronic hepatitis C virus (HCV). We evaluated sequential changes in liver stiffness using shear wave elastography in patients with HCV who received DAA therapy. Methods: A total of 210 patients with HCV who received daclatasvir and asunaprevir therapy and achieved sustained virological response (SVR) were analyzed. Liver stiffness, as evaluated by shear wave elastography, and laboratory data were assessed before treatment (baseline), at end of treatment (EOT), and at 24 weeks after EOT (SVR24). Results: Alanine aminotransferase levels (ALT) decreased over time, and there were significant differences between baseline and EOT and between EOT and SVR24. Although platelet counts did not significantly differ between baseline and EOT, they increased significantly from EOT to SVR24. The median (interquartile range) liver stiffness values at baseline, EOT, and SVR24 were 10.2 (7.7–14.7), 8.8 (7.1–12.1), and 7.6 (6.3–10.3) kPa, respectively (P < 0.001, baseline vs EOT; P < 0.001, EOT vs SVR24). Additionally, in patients with ALT ≤ 30 (indicating low necroinflammatory activity in the liver) and Fibrosis-4 index > 2.0 (n = 75), the liver stiffness values at baseline, EOT, and SVR24 were 9.6 (7.7–15.2), 9.2 (7.3–12.1), and 7.7 (6.3–10.1) kPa, respectively (P < 0.001, baseline vs EOT; P < 0.001, EOT vs SVR24). Conclusion: These results suggest that early improvement of liver stiffness starts during the administration of DAAs in patients who achieve SVR, and this effect is particularly pronounced in patients with progressive liver fibrosis.

    DOI: 10.1111/jgh.13788

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  26. Differences in the impact of prognostic factors for hepatocellular carcinoma over time

    Toyoda, H; Kumada, T; Tada, T; Yama, T; Mizuno, K; Sone, Y; Maeda, A; Kaneoka, Y; Akita, T; Tanaka, J

    CANCER SCIENCE   108 巻 ( 12 ) 頁: 2438 - 2444   2017年12月

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    記述言語:英語   出版者・発行元:Cancer Science  

    The aim of the present study was to evaluate the prognostic significance of serum markers that reflect tumor progression, liver function, or liver fibrosis in patients with hepatocellular carcinoma (HCC), focusing on how their impact changes over time after diagnosis. Alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP), albumin-bilirubin (ALBI) score, aspartate aminotransferase to platelet ratio index (APRI), and FIB-4 index were measured at the time of initial non-recurrent HCC diagnosis in 1669 patients between 1997 and 2016. Survival rates after diagnosis were compared after stratifying patients by these markers. Time-dependent receiver-operating characteristics (ROC) analysis was carried out to assess how these markers predict patient survival or death. Serum AFP and DCP levels, ALBI score, and APRI and FIB-4 index were strongly correlated with HCC progression, liver function, and degree of liver fibrosis, respectively. Survival rates after diagnosis were significantly different when patients were stratified by these markers. In the time-dependent ROC analysis, AFP and DCP had a high prognostic impact within 3 years of diagnosis but the impact decreased thereafter. In contrast, APRI and FIB-4 index had higher prognostic impact 10 years after diagnosis. ALBI score had a high prognostic impact throughout the study period. Time-dependent ROC analysis clearly showed changes in the prognostic importance of serum markers based on the duration after diagnosis. Whereas the prognostic impact of tumor progression markers was strong in the short term, liver fibrosis markers had higher prognostic impact long after diagnosis. Liver function had constant prognostic impact on patient survival after diagnosis.

    DOI: 10.1111/cas.13406

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  27. Progression of Liver Fibrosis Is Associated With Non-Liver-Related Mortality in Patients With Nonalcoholic Fatty Liver Disease

    Tada, T; Kumada, T; Toyoda, H; Mizuno, K; Sone, Y; Akita, T; Tanaka, J

    HEPATOLOGY COMMUNICATIONS   1 巻 ( 9 ) 頁: 899 - 910   2017年11月

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    記述言語:英語   出版者・発行元:Hepatology Communications  

    In patients with nonalcoholic fatty liver disease (NAFLD), prognosis and outcome, especially non-liver-related mortality, remain incompletely elucidated. We clarified the mortality from all causes in patients with NAFLD. A total of 4,073 patients with NAFLD diagnosed by ultrasonography were enrolled. We investigated the causes of death and analyzed the mortality from non-liver-related diseases according to the degrees of steatosis and fibrosis using the competing risk method. We used the NAFLD fibrosis score (NFS) to assess fibrosis severity and the ultrasonography fatty liver score to evaluate steatosis severity. The numbers of patients with NFS indicating low, intermediate, and high probabilities of advanced fibrosis were 2,451 (60.2%), 1,462 (35.9%), and 160 (3.9%), respectively. Of the 4,073 patients, 179 died during follow-up, but only nine deaths were due to liver-related diseases. Of the remaining 170 patients who died due to non-liver-related diseases, 83 (48.8%), 42 (24.7%), and 45 (26.5%) patients died due to malignancies, cerebrovascular and cardiovascular diseases, and benign diseases (excluding cerebrovascular and cardiovascular diseases), respectively. Multivariate analysis showed that the intermediate and high NFS groups were independently associated with each disease category: hazard ratio (HR) 2.163 (95% confidence interval [CI], 1.354-3.457) and HR 4.814 (95% CI, 2.323-9.977) for malignancies; HR 2.265 (95% CI, 1.141-4.497) and HR 8.482 (95% CI, 3.558-20.220) for cerebrovascular and cardiovascular diseases; and HR 3.216 (95% CI, 1.641-6.303) and HR 5.558 (95% CI, 1.923-16.070) for benign diseases, respectively. Conversely, the status of steatosis was not associated with risk of mortality in multivariate analysis. Conclusion: Progression of liver fibrosis severity was associated with mortality from various non-liver-related causes in patients with NAFLD. (Hepatology Communications 2017;1:928–945).

    DOI: 10.1002/hep4.1105

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  28. Discrepant imaging findings of portal vein thrombosis with dynamic computed tomography and computed tomography during arterial portography in hepatocellular carcinoma: possible cause leading to inappropriate treatment selection

    Toyoda H., Kumada T., Tada T., Mizuno K., Kobayashi N., Inukai Y., Takeda A., Sone Y.

    Clinical Journal of Gastroenterology   10 巻 ( 2 ) 頁: 163 - 167   2017年4月

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    記述言語:英語   出版者・発行元:Clinical Journal of Gastroenterology  

    We encountered a patient with hepatocellular carcinoma who had discrepant imaging findings on portal vein thrombosis with portal phase dynamic computed tomography (CT) and CT during arterial portography (CTAP). CTAP, via the superior mesenteric artery and via the splenic artery, both showed a portal perfusion defect in the right hepatic lobe, indicating portal vein thrombosis in the main trunk of the right portal vein. Portal phase dynamic CT clearly depicted portal perfusion of the same hepatic area. Transarterial chemoembolization was successfully performed, but it was associated with severe liver injury. Clinicians should be cautious about this possible discrepancy based on imaging technique. The inaccurate evaluation of portal vein thrombosis may result in inappropriate treatment selection, which can worsen patient prognosis.

    DOI: 10.1007/s12328-017-0717-4

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  29. B型肝炎関連肝細胞癌の予後予測におけるALBI gradeの有用性

    水野 和幸, 豊田 秀徳, 多田 俊史, 竹田 尭, 東堀 諒, 小林 奈津子, 山 剛基, 谷川 誠, 桐山 勢生, 熊田 卓

    肝臓   58 巻 ( 7 ) 頁: 379 - 385   2017年

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    記述言語:日本語   出版者・発行元:一般社団法人 日本肝臓学会  

    <p>B型肝炎を背景とする肝細胞癌症例の肝機能評価におけるALBI gradeの予後予測能を,Child-Pugh分類と比較した.HBs抗原陽性の初発肝細胞癌の生存率はALBI grade・Child-Pugh分類いずれでも有意差をもって分別されたが,5年・10年生存率はALBI grade 1で77.8%・64.8%,Child-Pugh Aで60.8%・48.5%と前者で有意に高かった(p=0.004).Child-Pugh Aに限って検討すると,5年・10年生存率はALBI grade 1で78.8%・65.7%,grade 2で27.9%・17.0%であり肝機能の面からみた予後を分別した(p<0.001).ALBI gradeはB型肝炎由来の肝細胞癌においても予後予測に有用であり,Child-Pugh分類と比べさらに肝機能の良い症例の選択が可能な評価法と考えられた.</p>

    DOI: 10.2957/kanzo.58.379

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科研費 1

  1. 網羅的遺伝子解析によるirAE肝障害発症メカニズムの探索および治療アルゴリズムの開発

    研究課題/研究課題番号:23K07434  2023年4月 - 2026年3月

    科学研究費助成事業  基盤研究(C)

    水野 和幸

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    担当区分:研究代表者 

    配分額:4680000円 ( 直接経費:3600000円 、 間接経費:1080000円 )

    がん治療において免疫チェックポイント阻害薬 (immune checkpoint inhibitor: ICI)の使用が増加している。ICIは従来の抗がん剤とは異なる副作用である免疫関連有害事象 (immune-related adverse event:irAE)を起こしうる。irAEによる肝障害に対しICI治療の中断と免疫抑制治療が必要となるが、無治療で改善する症例も存在し、ICIの再投与が施行可能なこともある。本研究はirAE肝障害の肝生検組織のRNAを調べ、irAE肝障害のメカニズムの探索、新規治療法の開発ならびにirAE肝障害の治療法や再投与の可否を予測するバイオマーカーを検索する。