Miyazaki M, Yada M, Tanaka K, Senjyu T, Goya T, Motomura K, Kohjima M, Kato M, Masumoto A, Kotoh K. Efficacy of tolvaptan for the patients with advanced hepatocellular carcinoma. World J Gastroenterol 2017; 23(29): 5379-5385 [PMID: 28839438 DOI: 10.3748/wjg.v23.i29.5379]
Corresponding Author of This Article
Masayuki Miyazaki, MD, Department of Hepatology, Iizuka Hospital, 3-83 Yoshio, Iizuka 820-8505, Japan. mmasayuk@med.kyushu-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is 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/
Masayuki Miyazaki, Masayoshi Yada, Kosuke Tanaka, Takeshi Senjyu, Kenta Motomura, Akihide Masumoto, Department of Hepatology, Iizuka Hospital, Iizuka 820-8505, Japan
Takeshi Goya, Motoyuki Kohjima, Masaki Kato, Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, Fukuoka 810-0065, Japan
Kazuhiro Kotoh, Department of Hepatology, Harasanshin Hospital, Fukuoka 812-0033, Japan
Author contributions: Miyazaki M, Motomura K and Kotoh K wrote the paper; Yada M, Tanaka K, Senjyu T and Kotoh K analyzed the data; Kohjima M, Kato M and Masumoto A supervised writing of the paper; all authors contributed to this manuscript.
Institutional review board statement: This study protocol was approved by the Ethics Committees at Iizuka Hospital (approval No. 15174).
Informed consent statement: For this type of retrospective study formal consent in not required. Only patient administered tolvaptan at 15 mg/day received a sufficient explanation of the aim and contents of this study.
Conflict-of-interest statement: The authors declare no conflict of interest in this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is 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/
Correspondence to: Masayuki Miyazaki, MD, Department of Hepatology, Iizuka Hospital, 3-83 Yoshio, Iizuka 820-8505, Japan. mmasayuk@med.kyushu-u.ac.jp
Telephone: +81-948-223800 Fax: +81-948-29574
Received: January 19, 2017 Peer-review started: January 19, 2017 First decision: February 23, 2017 Revised: March 10, 2017 Accepted: April 21, 2017 Article in press: April 21, 2017 Published online: August 7, 2017 Processing time: 199 Days and 23.6 Hours
Abstract
AIM
To investigate the factors influenced the efficacy of tolvaptan (TLV) in liver cirrhosis.
METHODS
We retrospectively enrolled 61 consecutive patients with refractory hepatic ascites. All of them had been treated with furosemide and spironolactone before admission, and treated with TLV for 7 d in our hospital. The effect of TLV was defined by the rate of body weight loss, and the factors that influenced TLV efficacy were analyzed using multiple regression.
RESULTS
Coexistent hepatocellular carcinoma (HCC) was the only significant predictive variable that attenuated the efficacy of TLV. In stratified analysis, high doses of furosemide decreased the efficacy of TLV in patients with HCC, and increased efficacy in those without HCC. In the latter, a high Child-Pugh-Turcotte score had a positive influence and a high concentration of lactate dehydrogenase had a negative influence on the effectiveness of TLV.
CONCLUSION
Development of ascites may differ between patients with liver failure and those with HCC progression. A sufficient preceding dose of furosemide decreases diuretic effect of TLV.
Core tip: Efficacy of tolvaptan (TLV) for hepatic ascites has been confirmed but some patients are resistant to the drug. We investigate influencing factors of the efficacy of TLV. As a result, coexistent hepatocellular carcinoma (HCC) was the only significant predictive variable that attenuated the efficacy of TLV. In stratified analysis, high doses of furosemide decreased the efficacy of TLV in patients with HCC, and increased efficacy in those without HCC. This study suggests that development of ascites may differ between patients with liver failure and those with HCC progression. A sufficient preceding dose of furosemide decreases diuretic effect of TLV.
