Bile acids and the risk for hepatocellular carcinoma in primary biliary cholangitis
Notice bibliographique
Résumé
Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the third most common cause of cancer death, and accounts for 5.6% of all cancers. Nearly 82% of the approximately 550,000 liver cancer deaths each year occur in Asia. In some regions, cancer-related death from HCC is second only to lung cancer.1 The most frequent risk factors include chronic viral hepatitis (types B and C), alcohol intake and aflatoxin exposure. However, it has been reported that HCC occurs in 1-6% of patients with primary biliary cholangitis (PBC) per year. In addition HCC surveillance with abdominal imaging and α-fetoprotein is recommended every 6-12 months for patients. Furthermore, some studies suggested that risk factors for the development of HCC in patients with PBC include older age, male sex, presence of portal hypertension, advanced histological stage, and poor response to ursodeoxycholic acid (UDCA).2,3 We read with a great interest the article by Trivedi, et al.4 on the stratification of HCC risk in PBC. The risk for HCC in patients with PBC has been reported in previous publications and it has also been demonstrated by Liang, et al.5 in a systematic review and meta-analysis, suggesting that PBC is significantly associated with an increased risk for HCC. Two major risk factors have been suggested to predispose patients with PBC to develop HCC. The first one is gender and the second the biochemical non-response to UDCA. In the present study the univariate analysis showed that male sex (unadjusted HR 2.91, p < 0.0001) is one the factors at PBC diagnosis associated with future HCC development.4 The reason for increased hepatocarcinogenesis in men compared to women remains yet to be defined, but a role of estrogen-related differences in inflammatory cytokine production has been suggested.6 Here we would like to suggest a hypothesis to explain in part the increased risk in men with PBC for HCC. Both risk factors gender and non-response to treatment may be related to each other and increase HCC susceptibility. PBC is more frequent in women than men. However, men are more prone to the development of HCC. Currently the gold standard for treatment of PBC is UDCA.7 This bile acid constitutes < 5% of the bile acid pool under physiological conditions. After oral administration of UDCA an enrichment of bile with this hydrophilic bile acid occurs, which represents the requirement for treatment response in patients with chronic cholangiopathies. The mechanism of action of UDCA is multifactorial8 and involves replacement of endogenous cytotoxic bile acids [chenodeoxycholic (CDCA) and deoxycholic (DCA) acid] by the non-cytotoxic bile acid UDCA; one of the mechanisms is likely to be competition for active ileal transport. Interestingly, it has been suggested that gender has a major effect on fasting plasma concentrations of individual bile acids in healthy individuals. In fact, Xiang, et al.9 reported that fasting plasma concentrations of individual bile acids are 111% higher in men than in women. Consequently, the mean concentration of total bile acids is about 50% higher in men than in women. These differences were also observed in the 70’s by Bennion, et al.10 in healthy male subjects whose chenodeoxycholic acid pool sizes were larger than in women. In addition, Diger, et al.11 reported that PBC patients differ from healthy individuals The Official Journal of the Mexican Association of Hepatology, the Latin-American Association for Study of the Liver and the Canadian Association for the Study of the Liver
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».