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      Cancer and liver cirrhosis: implications on prognosis and management

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          Abstract

          Liver cirrhosis, the end-stage of every chronic liver disease, is not only the major risk factor for the development of hepatocellular carcinoma but also a limiting factor for anticancer therapy of liver and non-hepatic malignancies. Liver cirrhosis may limit surgical and interventional approaches to cancer treatment, influence pharmacokinetics of anticancer drugs, increase side effects of chemotherapy, render patients susceptible for hepatotoxicity, and ultimately result in a competitive risk for morbidity and mortality. In this review, we provide a concise overview about the impact of liver cirrhosis on the management and prognosis of patients with primary liver cancer or non-hepatic malignancies.

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          Transection of the oesophagus for bleeding oesophageal varices.

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            Hyponatremia and mortality among patients on the liver-transplant waiting list.

            Under the current liver-transplantation policy, donor organs are offered to patients with the highest risk of death. Using data derived from all adult candidates for primary liver transplantation who were registered with the Organ Procurement and Transplantation Network in 2005 and 2006, we developed and validated a multivariable survival model to predict mortality at 90 days after registration. The predictor variable was the Model for End-Stage Liver Disease (MELD) score with and without the addition of the serum sodium concentration. The MELD score (on a scale of 6 to 40, with higher values indicating more severe disease) is calculated on the basis of the serum bilirubin and creatinine concentrations and the international normalized ratio for the prothrombin time. In 2005, there were 6769 registrants, including 1781 who underwent liver transplantation and 422 who died within 90 days after registration on the waiting list. Both the MELD score and the serum sodium concentration were significantly associated with mortality (hazard ratio for death, 1.21 per MELD point and 1.05 per 1-unit decrease in the serum sodium concentration for values between 125 and 140 mmol per liter; P<0.001 for both variables). Furthermore, a significant interaction was found between the MELD score and the serum sodium concentration, indicating that the effect of the serum sodium concentration was greater in patients with a low MELD score. When applied to the data from 2006, when 477 patients died within 3 months after registration on the waiting list, the combination of the MELD score and the serum sodium concentration was considerably higher than the MELD score alone in 32 patients who died (7%). Thus, assignment of priority according to the MELD score combined with the serum sodium concentration might have resulted in transplantation and prevented death. This population-wide study shows that the MELD score and the serum sodium concentration are important predictors of survival among candidates for liver transplantation. 2008 Massachusetts Medical Society
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              EASL Recommendations on Treatment of Hepatitis C 2015.

              (2015)
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                Author and article information

                Journal
                ESMO Open
                ESMO Open
                esmoopen
                esmoopen
                ESMO Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2059-7029
                2016
                17 March 2016
                : 1
                : 2
                : e000042
                Affiliations
                [1 ]Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna , Vienna, Austria
                [2 ]Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Harvard Medical School & Massachusetts General Hospital , Boston, USA
                [3 ]Department of Gastroenterology & Hepatology, Endocrinology and Nephrology, Klinikum Klagenfurt am Wörthersee , Klagenfurt, Austria
                [4 ]Austrian Society of Gastroenterology & Hepatology, Working Group GI-Oncology
                Author notes
                [Correspondence to ] Dr Wolfgang Sieghart; wolfgang.sieghart@ 123456meduniwien.ac.at

                MP, MP-R, and WS Liver Cancer (HCC)-Study Group Vienna.

                Article
                esmoopen-2016-000042
                10.1136/esmoopen-2016-000042
                5070280
                fccc0fef-4649-4358-b810-a91d06286b1c
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 4 February 2016
                : 6 February 2016
                Funding
                Funded by: National Institutes of Health, http://dx.doi.org/10.13039/100000002;
                Award ID: R01 DK103879
                Funded by: National Cancer Institute, http://dx.doi.org/10.13039/100000054;
                Award ID: P01 CA080124
                Funded by: Austrian Science Fund, http://dx.doi.org/10.13039/501100002428;
                Award ID: J 3747-B28
                Categories
                Review
                1506

                hepatocellular carcinoma,intrahepatic cholangiocarcinoma,non-hepatic cancer,liver cirrhosis,viral reactivation

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