title: Clinical significance of the Scheuer histological staging system for primary biliary cholangitis in Japanese patients.
abstract: BACKGROUND
  Inadequate response to ursodeoxycholic acid (UDCA) is associated with unfavorable outcomes in patients with primary biliary cholangitis (PBC). We aimed to identify surrogate markers for predicting long-term prognosis and biochemical response to UDCA in patients with PBC.
  
  
  METHODS
  In this single-center, retrospective study, 99 patients with PBC were classified into responders (n=53) and nonresponders (n=46) based on reductions in the γ-glutamyl transpeptidase levels at 1 year after initiating UDCA therapy (Nara criteria). We assessed whether the criteria for patentability by different countries are useful in predicting the prognosis of PBC. The accuracy of Scheuer and Nakanuma staging systems in predicting prognosis and treatment response was compared.
  
  
  RESULTS
  Nara definition had comparable utility to the Paris-II definition for selecting patients in whom UDCA monotherapy can be safely continued. Patients at Scheuer stage 1 had a significantly better prognosis than those at Scheuer stages 3 or 4 (P<0.05 and 0.0001, respectively). Patients at Nakanuma stage 4 had decreased survival compared with those at stage 1 (P<0.05). The proportion of responders to nonresponders was significantly higher in stages 1-3 PBC than in stage 4 PBC, according to both staging systems (P<0.05 for both). All patients with Scheuer stage 4 PBC were nonresponders, whereas only 28.6% (2/7) of those with Nakanuma stage 4 PBC were responders.
  
  
  CONCLUSIONS
  The Scheuer staging system had greater utility in predicting long-term prognosis and UDCA response than the Nakanuma staging system.
authors.affiliation: aThird Department of Internal Medicine, Nara Medical University bDepartment of Endoscopy and Ultrasound, Nara Medical University Hospital, Kashihara, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Namisaki
authors.forename: Kei
authors.initials: K
authors.lastname: Moriya
authors.forename: Mitsuteru
authors.initials: M
authors.lastname: Kitade
authors.forename: Hideto
authors.initials: H
authors.lastname: Kawaratani
authors.forename: Kosuke
authors.initials: K
authors.lastname: Takeda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takaya
authors.forename: Norihisa
authors.initials: N
authors.lastname: Nishimura
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Seki
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kaji
authors.forename: Shinya
authors.initials: S
authors.lastname: Sato
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sawada
authors.forename: Junichi
authors.initials: J
authors.lastname: Yamao
authors.forename: Akira
authors.initials: A
authors.lastname: Mitoro
authors.forename: Masakazu
authors.initials: M
authors.lastname: Uejima
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Mashitani
authors.forename: Naotaka
authors.initials: N
authors.lastname: Shimozato
authors.forename: Keisuke
authors.initials: K
authors.lastname: Nakanishi
authors.forename: Masanori
authors.initials: M
authors.lastname: Furukawa
authors.forename: Soichiro
authors.initials: S
authors.lastname: Saikawa
authors.forename: Takuya
authors.initials: T
authors.lastname: Kubo
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yoshiji
mesh_terms: D000368:Aged; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D004796:Clinical Enzyme Tests; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000187:drug effects / Q000473:pathology*; D008105:Liver Cirrhosis, Biliary / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D015415:Biomarkers; D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid; D005723:gamma-Glutamyltransferase; C554782:gamma-glutamyltransferase, human