Nonalcoholic Fatty Liver Disease
The largest natural history study of patients with nonalcoholic fatty liver disease suggests that this disease has a more benign natural history than previously reported, except in cirrhotic disease stages.
Among 420 patients diagnosed with nonalcoholic fatty liver disease in Olmsted County, Minn., from 1980 to 2000, only 7 (1.7%) died of liver-related causes over a mean follow-up of 7.6 years, reported Leon A. Adams, M.D., and his colleagues at the Mayo Clinic, Rochester, Minn. (Gastroenterology 2005;129:113–21).
The rates of cirrhosis (5%) and cirrhosis-related complications (3.1%) also were low. Of the 21 patients with cirrhosis, 7 died of liver-related causes during a median follow-up of 6.8 years.
Nonalcoholic fatty liver disease patients in the community were 34% more likely to die than the general population of similar age and sex in Minnesota.
Mutation Carriers in Colorectal Cancer
Use of wide clinical criteria to select relatives with hereditary nonpolyposis colorectal cancer, followed by immunohistochemical analysis of a tumor from an affected family member, can predict mismatch repair mutations with high sensitivity and specificity, according to the results of a prospective study.
Astrid T. Stormorken of the Norwegian Radium Hospital, Oslo, and colleagues performed a mutational analysis of specimens from 48 index patients who had an abnormal immunohistochemical (IHC) analysis and/or a family history strongly indicating an increased probability of harboring a mutation in the mismatch repair (MMR) genes MLH1, MSH2, and MSH6. Nineteen patients had deleterious mutations and lacked protein expression, 16 had normal mutational and IHC analyses, and 11 did not have an MMR mutation but also lacked protein expression; tumor specimens were not available for 2 patients (J. Clin. Oncol. 2005;23:4705–12).
Compared with Amsterdam I or II or Bethesda criteria, IHC combined with clinical criteria had a better combination of sensitivity and specificity for predicting germ-line mutations in MMR genes in families with a relatively high probability of mutation.
Capecitabine for Stage III Colon Ca
Oral capecitabine was associated with equivalent disease-free survival but greater safety than intravenous bolus fluorouracil plus leucovorin as an adjuvant treatment for stage III colon cancer, reported Chris Twelves, M.D., of the University of Bradford (England), and his associates.
After 3 years in a randomized, double-blind trial, 1,004 patients who received capecitabine (Xeloda) had similar disease-free survival to that of 983 patients who received fluorouracil plus leucovorin (64.2% vs. 60.6%). Overall survival was similar between the capecitabine patients (81.3%) and fluorouracil plus leucovorin patients (77.6%) as well (N. Engl. J. Med. 2005;352:2696–704).
Capecitabine patients had significantly lower rates of neutropenia, stomatitis, nausea, vomiting, alopecia, and diarrhea than fluorouracil plus leucovorin patients, but severe hand-foot syndrome occurred significantly more often in capecitabine patients. Many of the investigators reported consulting and/or lecture fees from the manufacturer of capecitabine, Hoffmann-La Roche Inc., which funded the trial.
Radiofrequency Ablation of Liver Ca
Radiofrequency thermal ablation of three or fewer hepatocellular carcinoma nodules less than 3 cm in size produces significantly longer survival than either ethanol or acetic acid injections, according to the results of two separate randomized trials.
In a trial of 232 patients conducted by Shuichiro Shiina, M.D., and associates at the University of Tokyo, patients who received radiofrequency thermal ablation had a higher survival rate after 4 years than those who received percutaneous ethanol injection (74% vs. 57%). Radiofrequency ablation also reduced the overall risk of recurrence by 43% and decreased the risk of local tumor progression by 88%, compared with ethanol injection. The investigators did not find any difference in serious adverse events between the two groups (Gastroenterology 2005;129:122–30).
In a comparison with percutaneous acetic acid injections and ethanol injections, after 3 years radiofrequency ablation produced higher rates of overall survival (53% for acetic acid, 51% for ethanol, and 74% for ablation) and higher rates of cancer-free survival (23%, 21%, and 43%). It also resulted in a lower local recurrence rate (31% for acetic acid, 34% for ethanol, and 14% for ablation) in a trial of 187 patients, reported Shi-Ming Lin, M.D., and colleagues at Chang Gung University, Taipei, Taiwan. Radiofrequency ablation patients had a higher rate of major complications than the acetic acid and ethanol groups combined (4.8% vs. 0%), the group said (Gut 2005;54:1151–6).
Jeff Evans