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BackgroundHepatocellular cancer is notorious for recurrence even after curative therapy. High recurrence determines the long term prognosis of the patients. Vitamin K2 has been tested in trials for its effect on prevention of recurrence and improving survival. The results are inconclusive from individual trials and in our knowledge no systematic review which entirely focuses on Vitamin K2 as a chemo preventive agent is available to date. This review is an attempt to pool all the existing trials together and update the existing knowledge on the topic.MethodsMedline, Embase and Cochrane Register of Controlled trials were searched for randomized controlled trials where vitamin K2 or its analogues, in any dosage were compared to placebo or No vitamin K2, for participants of any age or sex. Reference lists and abstracts of conference proceedings were searched by hand. Additional papers were identified by a manual search of the references from the key articles. Attempt was made to contact the authors of primary studies for missing data and with the experts in the field.Trials were assessed for inclusion by two independent reviewers. Primary outcomes were recurrence rates and survival rates. There were no secondary outcomes. Data was synthesized using a random effects model and results presented as relative risk with 95% Confidence Intervals.ResultFor recurrence of hepatocellular cancer after hepatic resection or local ablative therapy, compared with controls, participants receiving Vitamin K2, pooled relative risks for hepatocellular cancer were 0.60; 95% CI: 0.28–1.28, p = 0.64) at 1 yr 0.66; 95% CI: 0.47–0.91), p = 0.01) at 2 yr; 0.71; 95% CI: 0.58–0.85, p = 0.004) at 3 yr respectively. The results were combined using the random analysis model.ConclusionFive RCTs evaluated the preventive efficacy of menatetrenone on HCC recurrence after hepatic resection or local ablative therapy. The meta-analysis of all five studies, failed to confirm significantly better tumor recurrence- free survival at 1 year. Improved tumor recurrence at 2nd and 3rd year may be just due to insufficient data. There was no beneficial effect on the overall survival. However, to confirm the beneficial effect or lack of it, large, higher quality randomized controlled trials are still required.

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Maintaining quality of life (QOL) is one of the important aims of cancer treatment. Quality of life of a cancer patient is affected by various factors, which may be disease related, patient related, or treatment related. To study changes in health-related quality of life (HRQOL) brought about by treatment of rectal cancer and factors affecting the changes using Malayalam translation of FACT-C (Functional Assessment of Cancer Therapy-Colorectal) Questionnaire. Also to detect the minimally important clinical changes (MICC) in health-related quality of life of patients with carcinoma rectum, who have undergone surgery. Forty-five patients diagnosed with carcinoma rectum, who have undergone curative surgery, were studied. HRQOL was assessed at baseline 2 weeks after surgery and 3 months after surgery. The changes in scores were correlated with various demographic factors like age, sex, marital status, number of children, number of married children, and education and occupation of the patient and spouse. Also the treatment-related factors like presence of stoma, presence of morbidity, previous treatment, stage of disease, and administration of chemotherapy before and after surgery were correlated. All the subscales of FACT-C tool, except emotional well-being, were significantly reduced 2 weeks after surgery and increased slightly above pre-treatment level 3 months after surgery. The Chronbach α values were 0.88, 0.89 and 0.86 on three occasions, respectively, establishing internal validity of the test. Baseline HRQOL scores were better in males compared to females. Among the various subscales, the drops in SWB, FWB, FACT-G, total Score and TOI were significant (P < .05).There were no significant differences in scores between patients who have undergone open surgery and minimally invasive surgery or patients who had permanent colostomy versus no colostomy. The HRQOL scores after surgery reduced 2 weeks after surgery and improved above pre-surgical levels 3 months after surgery. The approach of surgery (minimally invasive versus open) or presence or absence of permanent colostomy didn't make any significant change in HRQOL. But since the sample size of the study was small, we need further larger studies to arrive at definite conclusions.

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