Efficacy of tolvaptan for the patients with advanced hepatocellular carcinoma

Figure 1 Comparison of decreased body weight (%) between patients with and without hepatocellular carcinoma. The diuretic effect of tolvaptan was significantly higher in patients without hepatocellular carcinoma. HCC: Hepatocellular carcinoma.

Figure 2 In patients with hepatocellular carcinoma, serum sodium concentration before treatment with tolvaptan was positively correlated with decreased body weight (%), while no significant correlation was seen in those without hepatocellular carcinoma. HCC: Hepatocellular carcinoma.

Figure 3 Influence of concomitant furosemide on decreased body weight (%). Although the difference between each dose category was not significant, high dose of furosemide attenuated the decreased body weight (%) in patients with hepatocellular carcinoma (HCC), while the tendency was opposite in those without HCC.

Figure 4 Individual doses of furosemide and spironolactone were plotted. The area of the black-to-white gradation shows the population density. When the total amount of natriuretic diuretics, it was mainly controlled by the dose of furosemide.

Figure 5 If a sufficient dose of furosemide was administered to patients whose ascites mainly developed mainly because of portal hypertension, such as in aggressive hepatocellular carcinoma, it decreased serum sodium concentration and subsequently attenuated antidiuretic hormone secretion. In that condition, the effect of tolvaptan might be limited (A). In contrast, in patients with ascites that developed mainly because of attenuated liver function, hormonal diuretic systems were activated. A sufficient dose of furosemide reduced the role of the RAA system, and increased that of ADH (B). ADH: Antidiuretic hormone; RAA: Renin-angiotensin-aldosterone.