Reply to the letter
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LETTER TO THE EDITOR
Reply to the letter Hirohisa Okabe1,3 · Yo‑ichi Yamashita1 · Hatem A. Elmezayen1,2 · Hiromitsu Hayashi1 · Katsunori Imai1 · Hideo Baba1 Received: 19 February 2020 / Accepted: 17 March 2020 © Springer Nature Singapore Pte Ltd. 2020
Keywords PD-L1 · Liver fibrosis · New Inuyama classification Grizzi et al. suggested the importance of a scientific method to quantitatively or semi-quantitatively evaluate liver fibrosis, which was missing in our latest report, ‘Clinical role of serum programmed death ligand 1 in patients with hepatocellular carcinoma: Where does it come from?’ [1] In this report, we investigated the role of serum programmed death ligand 1 (PD-L1) level by analyzing both the serum PD-L1 level and the tissue PD-L1 expression status in the tumor and the corresponding background liver by an immunological approach. Grizzi et al. indicated that the New Inuyama Classification [2] was based on the grade of fibrosis, which should be quantitatively discriminated. They recommend their original methodology, which would enable us to quantitatively or semi-quantitatively determine the extent of liver fibrosis [3]. The definition of liver fibrosis, which was defined by New Inuyama Classification in our report, is not based on numerical data, rather it is based on histological findings evaluated by a pathologist. As Grizze et al. carefully introduced in the ‘letter to the editor’, that there were 5 stages in the classification. We previously quantified the myofibroblasts which have a major role in the liver fibrosis by immunohistochemistry with an imaging analysis [4]. It might be possible to define the fibrosis status in a quantitative or semi-quantitative manner with some definitive marker in the future. For example, the investigation of the serum Mac-2 binding protein glycan isomer (M2BPGi) level is commonly accepted in the quantitative evaluation of liver fibrosis [5]. * Hideo Baba hdobaba@kumamoto‑u.ac.jp 1
Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1‑1‑1 Honjo, Kumamoto City 860‑8556, Japan
2
Department of Chemistry, Helwan University, Cairo, Egypt
3
Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
There is another issue with liver damage, which we have faced based on our previous investigations. The clinical importance is not based on the evaluation of liver fibrosis but on the liver function. The liver function is not always accurately correlated with the grade of liver fibrosis [6]. This variation in the liver function is substantially high, especially in patients with high-grade liver fibrosis. We already reported that in patients with liver damage, a discrepancy is sometimes observed between the clinical liver function and the pathological findings of the liver (e.g., a patient with a very good indocyanine green test and pathological liver cirrhosis) [7]. We hypothesize that this discrepancy can be attributed to the heterogeneous causes of liver damage, such as viral infection, alcohol consum
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