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Adverse outcomes of pregnancy in women with non-alcoholic fatty liver disease.

https://arctichealth.org/en/permalink/ahliterature277352
Source
Liver Int. 2016 Feb;36(2):268-74
Publication Type
Article
Date
Feb-2016
Author
Hannes Hagström
Jonas Höijer
Jonas F Ludvigsson
Matteo Bottai
Anders Ekbom
Rolf Hultcrantz
Olof Stephansson
Knut Stokkeland
Source
Liver Int. 2016 Feb;36(2):268-74
Date
Feb-2016
Language
English
Publication Type
Article
Keywords
Adult
Cesarean Section - statistics & numerical data
Cohort Studies
Diabetes, Gestational - epidemiology - etiology
Female
Humans
Infant, Low Birth Weight
Infant, Newborn
Non-alcoholic Fatty Liver Disease - complications - epidemiology
Pre-Eclampsia - epidemiology - etiology
Pregnancy
Pregnancy Complications - epidemiology
Pregnancy Outcome - epidemiology
Premature Birth - epidemiology - etiology
Sweden - epidemiology
Abstract
Non-alcoholic fatty liver disease (NAFLD) is considered the most common liver disease in the world, but little is known about its potential association with pregnancy outcomes. We aimed to investigate pregnancy outcomes in NAFLD.
The Swedish Medical Birth Register (MBR) was used to identify births between 1992 and 2011 (N = 1 960 416). By linkage with the National Patient Register, we identified women with a diagnosis of NAFLD. The MBR was then used to identify outcomes: gestational diabetes, pre-eclampsia, Caesarean section, Apgar score
PubMed ID
26114995 View in PubMed
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Alcohol consumption in late adolescence is associated with an increased risk of severe liver disease later in life.

https://arctichealth.org/en/permalink/ahliterature301635
Source
J Hepatol. 2018 03; 68(3):505-510
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
03-2018
Author
Hannes Hagström
Tomas Hemmingsson
Andrea Discacciati
Anna Andreasson
Author Affiliation
Centre for Digestive Diseases, Division of Hepatology, Karolinska University Hospital, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. Electronic address: hannes.hagstrom@ki.se.
Source
J Hepatol. 2018 03; 68(3):505-510
Date
03-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Alcohol drinking - epidemiology
Follow-Up Studies
Humans
Liver Diseases - diagnosis - epidemiology
Long Term Adverse Effects - diagnosis - epidemiology
Male
Middle Aged
Risk assessment
Risk factors
Severity of Illness Index
Sweden - epidemiology
Abstract
High alcohol consumption is associated with an increased risk of severe liver disease. Current recommendations suggest it is safe for men to consume 30 grams of alcohol per day. We investigated the association between alcohol consumption early in life and later development of severe liver disease.
We used data on alcohol consumption at conscription to military service from 43,296 men (18-20?years) in Sweden between 1969 and 1970. Outcomes were defined as incident diagnoses of severe liver disease from systematic national registration of clinical events until the end of 2009. A Cox regression model adjusted for body mass index, smoking, use of narcotics, cognitive ability and cardiovascular capacity was applied.
During a mean follow-up of 37.8?years, 383 men developed severe liver disease. Alcohol consumption was associated with an increased risk of development of severe liver disease in a dose-response pattern (adjusted hazard ratio for every one gram/day increase 1.02; 95% CI 1.01-1.02). No evidence of a threshold effect was found. Importantly, a clear trend pointed towards an increased risk of severe liver disease in men who consumed less than 30 grams of alcohol per day.
Alcohol consumption in young men is associated with an increased risk of severe liver disease, up to 39?years later in life. The risk was dose-dependent, with no sign of a threshold effect. Current guidelines for safe alcohol intake in men might have to be revised.
We investigated more than 43,000 Swedish men in their late teens enlisted for conscription in 1969-1970. After almost 40?years of follow-up, we found that alcohol consumption was a significant risk factor for developing severe liver disease, independent of confounders. This risk was dose-dependent, and was most pronounced in men consuming two drinks per day or more.
Notes
CommentIn: J Hepatol. 2018 Mar;68(3):389-390 PMID 29395456
CommentIn: J Hepatol. 2018 Jul;69(1):252-253 PMID 29636187
CommentIn: J Hepatol. 2018 Jul;69(1):251-252 PMID 29650335
CommentIn: Ann Hepatol. 2018 Apr 9;17(3):343-344 PMID 29735793
PubMed ID
29395457 View in PubMed
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Alcohol consumption in patients with primary sclerosing cholangitis.

https://arctichealth.org/en/permalink/ahliterature122648
Source
World J Gastroenterol. 2012 Jun 28;18(24):3105-11
Publication Type
Article
Date
Jun-28-2012
Author
Hannes Hagström
Per Stål
Knut Stokkeland
Annika Bergquist
Author Affiliation
Department of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institutet, 14186 Stockholm, Sweden. hannes.hagstrom@ki.se
Source
World J Gastroenterol. 2012 Jun 28;18(24):3105-11
Date
Jun-28-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alcohol drinking - epidemiology
Analysis of Variance
Binge Drinking - epidemiology
Chi-Square Distribution
Cholangitis, Sclerosing - diagnosis - epidemiology
Disease Progression
Elasticity Imaging Techniques
Female
Humans
Liver Cirrhosis, Alcoholic - diagnosis - epidemiology
Male
Middle Aged
Predictive value of tests
Questionnaires
Registries
Retrospective Studies
Risk assessment
Risk factors
Sweden - epidemiology
Time Factors
Young Adult
Abstract
To assess the alcohol drinking patterns in a cohort of primary sclerosing cholangitis (PSC) patients and the possible influence on the development of fibrosis.
Ninety-six patients with PSC were evaluated with a validated questionnaire about a patient's lifetime drinking habits: the lifetime drinking history (LDH) questionnaire. In addition, clinical status, transient elastography and biochemistry values were analysed and registered. Patients were defined as having either significant or non-significant fibrosis. Significant fibrosis was defined as either an elastography value of = 17.3 kPa or the presence of clinical signs of cirrhosis. Patients were divided into two groups depending on their alcohol consumption patterns; no/low alcohol consumption (one drink or unit/d) and moderate/high alcohol consumption (= 1 drink or unit/d). LDH data were calculated to estimate lifetime alcohol intake (LAI), current alcohol intake, drinks per year before and after diagnosis of PSC. We also calculated the number of episodes of binge-drinking (defined as consuming = 5 drinks per occasion) in total, before and after the diagnosis of PSC.
The mean LAI was 3882 units of alcohol, giving a mean intake after onset of alcohol consumption of 2.6 units per week. Only 9% of patients consumed alcohol equal to or more than one unit per day. Current alcohol intake in patients with significant fibrosis (n = 26) was less than in patients without significant fibrosis (n = 70), as shown by lower values of phosphatidylethanol (B-PEth) (0.1 ?mol/L vs 0.33 ?mol/L, respectively, P = 0.002) and carbohydrate-deficient transferrin (CDT) (0.88% vs 1.06%, respectively, P = 0.02). Self-reported LAI was similar between the two groups. Patients with significant fibrosis reduced their alcohol intake after diagnosis from 103 to 88 units per year whereas patients without fibrosis increased their alcohol intake after PSC diagnosis from 111 to 151 units/year. There were no correlations between elastography values and intake of alcohol (units/year) (r = -0.036).
PSC patients have low alcohol consumption. The lack of correlation between fibrosis and alcohol intake indicates that a low alcohol intake is safe in these patients.
Notes
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PubMed ID
22791946 View in PubMed
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Elevated serum ferritin is associated with increased mortality in non-alcoholic fatty liver disease after 16 years of follow-up.

https://arctichealth.org/en/permalink/ahliterature286590
Source
Liver Int. 2016 Nov;36(11):1688-1695
Publication Type
Article
Date
Nov-2016
Author
Hannes Hagström
Patrik Nasr
Matteo Bottai
Mattias Ekstedt
Stergios Kechagias
Rolf Hultcrantz
Per Stål
Source
Liver Int. 2016 Nov;36(11):1688-1695
Date
Nov-2016
Language
English
Publication Type
Article
Keywords
Adult
Female
Ferritins - blood
Follow-Up Studies
Humans
Iron Overload - blood
Liver - pathology
Longitudinal Studies
Male
Middle Aged
Non-alcoholic Fatty Liver Disease - mortality - physiopathology
Risk factors
Survival Analysis
Sweden
Abstract
High levels of ferritin in patients with non-alcoholic fatty liver disease (NAFLD) are associated with significant fibrosis and higher NAFLD activity score (NAS). It is unclear if this association has an impact on mortality. We investigated if high levels of ferritin, with or without iron overload, were associated with an increased mortality in NAFLD.
We included 222 patients between 1979 and 2009 with biopsy-proven NAFLD and available serum ferritin concentrations. The cohort was divided into 'high' (n = 89) and 'normal' (n = 133) ferritin values, using a cut-point of 350 µg/L in males, and 150 µg/L in females, and stratified upon iron overload status. Data on mortality were obtained from a national, population-based register. Poisson regression was used to estimate hazard ratios for mortality. The estimates were adjusted for age at biopsy, sex, smoking, BMI, diabetes, hypertension, cardiovascular disease and fibrosis stage at the time of biopsy.
The median follow-up time was 15.6 years (range: 0.5-34.2). Patients with high ferritin had more advanced fibrosis and higher NAS than patients with normal ferritin (P
PubMed ID
27064133 View in PubMed
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High BMI in late adolescence predicts future severe liver disease and hepatocellular carcinoma: a national, population-based cohort study in 1.2 million men.

https://arctichealth.org/en/permalink/ahliterature293525
Source
Gut. 2018 08; 67(8):1536-1542
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
08-2018
Author
Hannes Hagström
Per Tynelius
Finn Rasmussen
Author Affiliation
Centre for Digestive Diseases, Division of Hepatology, Karolinska University Hospital, Stockholm, Sweden.
Source
Gut. 2018 08; 67(8):1536-1542
Date
08-2018
Language
English
Geographic Location
Sweden
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Aged
Body mass index
Carcinoma, Hepatocellular - epidemiology
Cohort Studies
Diabetes Mellitus, Type 2 - epidemiology
Humans
Incidence
Liver Neoplasms - epidemiology
Male
Risk factors
Sweden - epidemiology
Young Adult
Abstract
A high body mass index (BMI) is associated with an increased risk for severe liver disease. It is unclear if this risk differs across BMI categories, and if the association is partially attributed to development of type 2 diabetes mellitus (T2DM).
We used register data from more than 1.2 million Swedish men enlisted for conscription between 1969 and 1996. Data regarding new events of severe liver disease and T2DM during follow-up were obtained by record-linkage of population-based registers. We used Cox regression to estimate adjusted HRs for future inpatient care and mortality in severe liver disease and incidence of hepatocellular carcinoma (HCC) across BMI categories, using BMI of 18.5-22.5 kg/m2 as reference.
During a follow-up of more than 34 million person-years, 5281 cases of severe liver disease including 251 cases of HCC were identified. An association with severe liver disease was found for overweight (HR 1.49, 95% CI 1.35 to 1.64) and for obese men (HR 2.17, 95% CI 1.82 to 2.59). Development of T2DM further increased the risk for severe liver disease across all BMI categories, for instance, men with obesity and T2DM had a higher risk of severe liver disease (HR 3.28, 95% CI 2.27 to 4.74) than men with obesity free of T2DM (HR 1.72, 95% CI 1.72 to 2.54).
A high BMI in late adolescent men was associated with an increased risk of future severe liver disease, including HCC. Development of T2DM during follow-up was associated with a further increased risk of severe liver disease, independent of baseline BMI.
Notes
CommentIn: Nat Rev Gastroenterol Hepatol. 2017 May;14 (5):260 PMID 28400624
CommentIn: Gut. 2018 Aug;67(8):1555 PMID 28592439
PubMed ID
28320770 View in PubMed
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Histologic Scores for Fat and Fibrosis Associate With Development of Type 2 Diabetes in Patients With Nonalcoholic Fatty Liver Disease.

https://arctichealth.org/en/permalink/ahliterature291627
Source
Clin Gastroenterol Hepatol. 2017 Sep; 15(9):1461-1468
Publication Type
Journal Article
Date
Sep-2017
Author
Karl Björkström
Per Stål
Rolf Hultcrantz
Hannes Hagström
Author Affiliation
Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden. Electronic address: karl.bjorkstrom@ki.se.
Source
Clin Gastroenterol Hepatol. 2017 Sep; 15(9):1461-1468
Date
Sep-2017
Language
English
Publication Type
Journal Article
Keywords
Adipose Tissue - pathology
Adult
Aged
Diabetes Mellitus, Type 2 - epidemiology
Female
Histocytochemistry
Humans
Incidence
Liver Cirrhosis - complications - pathology
Male
Middle Aged
Non-alcoholic Fatty Liver Disease - complications - pathology
Retrospective Studies
Risk assessment
Severity of Illness Index
Sweden - epidemiology
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a strong risk factor for development of type 2 diabetes, but little is known about how long-term NAFLD or its histologic features affect risk. We aimed to investigate the cumulative incidence of type 2 diabetes in patients with NAFLD and to identify histologic factors that affect risk of diabetes.
We performed a retrospective study of 396 patients in Sweden diagnosed with NAFLD by biopsy analysis from 1971 through 2009 who did not have type 2 diabetes at baseline. Data on development of type 2 diabetes were collected from patient charts and national registers. Patients were categorized into groups with fibrosis stages 0-2 (n = 357) or stages 3-4 (n = 39). Hazard ratios of histologic parameters for type 2 diabetes development were calculated separately in a multivariate Cox regression model adjusted for sex, age, body mass index, and serum levels of triglycerides greater than 150 mg/dL.
During a mean follow-up period of 18.4 years (range, 0-41 years), 132 individuals (33%) developed type 2 diabetes. A significantly higher proportion of patients with fibrosis stages 3-4 (51.2%) developed type 2 diabetes than patients with fibrosis stages 0-2 (31.3%) (P = .02). For patients with fibrosis stages 0-2, fat score associated independently with development of type 2 diabetes (adjusted hazard ratio, 1.34; 95% confidence interval, 1.03-1.74; P = .03). No histologic factors associated with development of diabetes in patients with fibrosis stages 3-4. Presence of nonalcoholic steatohepatitis was not associated with development of type 2 diabetes.
In a retrospective study we found a higher proportion of patients with fibrosis stages 3-4 to develop type 2 diabetes than patients with fibrosis stages 0-2. In patients with fibrosis stages 0-2, fat score associates with risk of type 2 diabetes.
PubMed ID
28479500 View in PubMed
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Low to moderate lifetime alcohol consumption is associated with less advanced stages of fibrosis in non-alcoholic fatty liver disease.

https://arctichealth.org/en/permalink/ahliterature285739
Source
Scand J Gastroenterol. 2017 Feb;52(2):159-165
Publication Type
Article
Date
Feb-2017
Author
Hannes Hagström
Patrik Nasr
Mattias Ekstedt
Stergios Kechagias
Kristina Önnerhag
Emma Nilsson
Fredrik Rorsman
Reza Sheikhi
Hanns-Ulrich Marschall
Rolf Hultcrantz
Per Stål
Source
Scand J Gastroenterol. 2017 Feb;52(2):159-165
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alcohol Drinking
Biomarkers - blood
Fatty Acids - blood
Female
Fibrosis
Glycerophospholipids - blood
Humans
Liver - pathology
Liver Cirrhosis - etiology - pathology
Logistic Models
Male
Middle Aged
Multivariate Analysis
Non-alcoholic Fatty Liver Disease - complications - pathology
Prospective Studies
Risk factors
Severity of Illness Index
Surveys and Questionnaires
Sweden
Young Adult
Abstract
Moderate alcohol consumption has been associated with a lower risk of disease severity in non-alcoholic fatty liver disease (NAFLD). It is unclear if this reflects current or lifetime drinking, or can be attributed to confounders such as diet and exercise. We evaluated the impact of lifetime alcohol consumption on fibrosis severity in NAFLD.
We prospectively enrolled 120 subjects with biopsy-proven NAFLD and through detailed questionnaires examined lifetime alcohol consumption, diet and physical activity. Main outcome measures were odds ratios (OR) for fibrosis stage, calculated through ordinal regression after adjustment for body mass index, diabetes mellitus type 2, smoking and age at biopsy. A biomarker for recent alcohol consumption, phosphatidyl ethanol (PEth) was sampled.
An increase in median weekly alcohol consumption to a maximum of 13 drinks per week was associated with lower fibrosis stage (adjusted OR for each incremental unit, 0.86; 95% CI, 0.76-0.97; p?=?.017). The lowest risk for fibrosis was found with the lowes`t odds seen in the top quartile of alcohol consumption (aOR 0.23; 95% CI 0.08-0.66; p?=?.006). Adding soft drink and coffee consumptions, and physical activity to the model did not change the estimates. Subjects with PEth =0.3?µmol/L had higher ORs for a higher fibrosis stage (aOR 2.77; 95% CI 1.01-7.59; p?=?.047).
Lifetime alcohol consumption with up to 13 units per week is associated with lower fibrosis stage in NAFLD. Elevated PEth is associated with higher stages of fibrosis.
PubMed ID
27650916 View in PubMed
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Source
Lakartidningen. 2017 Feb 17;114
Publication Type
Article
Date
Feb-17-2017
Author
Hannes Hagström
Johan Hoffstedt
Signy Reynisdottir
Source
Lakartidningen. 2017 Feb 17;114
Date
Feb-17-2017
Language
Swedish
Publication Type
Article
Keywords
Early Diagnosis
Humans
Liver Cirrhosis - diagnosis - etiology
Non-alcoholic Fatty Liver Disease - complications - diagnosis
Practice Guidelines as Topic
Risk Assessment - methods
Sweden
Abstract
New guidelines for NAFLD - a Swedish perspective Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease globally, with an estimated prevalence of 25%. It is clinically challenging to identify which persons with known or suspected NAFLD that have the highest risk for development of severe liver disease. New guidelines from several European organizations were recently presented. The suggested changes to healthcare practice include screening of high-risk groups in order to identify cases with cirrhosis. These guidelines and suggestions for adjustments to Swedish healthcare are discussed.
PubMed ID
28221405 View in PubMed
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Overweight in late adolescence predicts development of severe liver disease later in life: A 39years follow-up study.

https://arctichealth.org/en/permalink/ahliterature291225
Source
J Hepatol. 2016 Aug; 65(2):363-8
Publication Type
Journal Article
Date
Aug-2016
Author
Hannes Hagström
Per Stål
Rolf Hultcrantz
Tomas Hemmingsson
Anna Andreasson
Author Affiliation
Centre for Digestive Diseases, Division of Hepatology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden. Electronic address: hannes.hagstrom@ki.se.
Source
J Hepatol. 2016 Aug; 65(2):363-8
Date
Aug-2016
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Body mass index
Follow-Up Studies
Humans
Liver Diseases
Male
Overweight
Risk factors
Sweden
Young Adult
Abstract
The increased prevalence of overweight has been suggested to contribute to the worldwide increase in liver diseases. We investigated if body mass index (BMI) in late adolescence predicts development of severe liver disease later in life.
We performed a cohort study using data from 44,248 men (18-20years) conscribed to military service in Sweden between 1969 and 1970. Outcome data were collected from national registers to identify any diagnosis of severe liver disease (i.e., diagnosis of decompensated liver disease, cirrhosis or death in liver disease) until the end of 2009. A Cox regression model was applied using BMI as independent variable. The model was adjusted for use of alcohol, use of narcotics, smoking, high blood pressure and cognitive ability at time of conscription.
During a follow-up period of a mean of 37.8years, 393 men were diagnosed with severe liver disease (mean time to diagnosis 24.7years). BMI (Hazard ratio [HR]=1.05 for each unit increase in BMI, 95% confidence interval [CI]: 1.01-1.09, p=0.008) and overweight (HR=1.64 for BMI 25-30 compared to BMI 18.5-22.5, 95% CI: 1.16-2.32, p=0.006) were associated with an increased risk of development of severe liver disease.
Being overweight in late adolescence is a significant predictor of severe liver disease later in life in men.
We investigated close to 45,000 Swedish men in their late teens enlisted for conscription in 1969-1970. After almost 40years of follow-up, we found that being overweight was a risk factor for developing severe liver disease, independent of established risk factors such as alcohol consumption.
Notes
CommentIn: Nat Rev Gastroenterol Hepatol. 2016 Sep;13(9):506-7 PMID 27485787
PubMed ID
27321729 View in PubMed
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Quality of life as a prognostic factor for survival in hepatocellular carcinoma.

https://arctichealth.org/en/permalink/ahliterature297539
Source
Liver Int. 2018 05; 38(5):885-894
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
05-2018
Author
Malin Sternby Eilard
Hannes Hagström
Kim Erlend Mortensen
Tom Wilsgaard
Ola Magne Vagnildhaug
Olav Dajani
Per Stål
Magnus Rizell
Author Affiliation
Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Source
Liver Int. 2018 05; 38(5):885-894
Date
05-2018
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Aged
Carcinoma, Hepatocellular - mortality - physiopathology
Fatigue
Female
Humans
Liver Neoplasms - mortality - physiopathology
Male
Middle Aged
Multivariate Analysis
Norway
Nutritional Status
Prognosis
Proportional Hazards Models
Prospective Studies
Quality of Life
Severity of Illness Index
Surveys and Questionnaires
Sweden
Abstract
Prognostication in hepatocellular carcinoma (HCC) is demanding. Not only tumour extent and performance status are to be considered, but also liver function, which is often limiting for both survival itself and for treatment possibilities. This study was conducted to assess whether patient-reported questionnaires containing general and liver-specific questions could improve prognostication of survival.
185 patients with hepatocellular carcinoma in Norway and Sweden were prospectively included. Patients completed the quality-of-life questionnaires EORTC QLQ C30 and HCC18, and clinical, radiological and laboratory parameters were registered. Multivariate Cox regression and Harrell's C-statistics were used to identify the model that best predicted mortality.
Quality-of-life data were prognostic for overall survival. Fatigue and nutrition scales were prognostic in the multivariable analyses alone and in combination with clinical parameters. The prognostic value of established scoring systems was increased by the addition of QoL data. The best prognostic power was achieved by combining HCC18 nutrition scale with selected background parameters.
Quality-of-life questionnaires can prognosticate mortality in HCC patients. When combined with established scoring systems, both the general cancer questionnaire EORTC QLQ C30, and the additional liver cancer-specific HCC18 increased the prognostic accuracy slightly.
PubMed ID
28941130 View in PubMed
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11 records – page 1 of 2.