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Yang J, Yang Z, Zeng X, Yu S, Gao L, Jiang Y, Sun F. Benefits and harms of screening for hepatocellular carcinoma in high-risk populations: systematic review and meta-analysis. JOURNAL OF THE NATIONAL CANCER CENTER 2023; 3:175-185. [PMID: 39035193 PMCID: PMC11256723 DOI: 10.1016/j.jncc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/30/2022] [Accepted: 02/03/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE The incidence and mortality of hepatocellular carcinoma (HCC) have been increasing around the world. Current guidelines recommend HCC screening in high-risk population. However, the strength of evidence of benefits and harms of HCC screening to support the recommendation was unclear. The objective is to systematically synthesize current evidence on the benefits and harms of HCC screening. METHODS We searched PubMed and nine other databases until August 20, 2021. We included cohort studies and RCTs that compared the benefits and harms of screening and non-screening in high-risk population of HCC. Case series studies that reported harms of HCC screening were also included. Pooled risk ratio (RR), according to HCC screening status, was calculated for each benefit outcome (e.g., HCC mortality, survival rate, proportion of early HCC), using head-to-head meta-analysis. The harmful outcomes (e.g., proportion of physiological harms provided by non-comparative studies were pooled by prevalence of meta-analysis. Analysis on publication bias and quality of life, subgroup analysis, and sensitivity analysis were also conducted. RESULTS We included 70 studies, including four random clinical trials (RCTs), 63 cohort studies,three case series studies. The meta-analysis of RCTs showed HCC screening was significantly associated with reduced HCC mortality (RR [risk ratio], 0.73 [95% CI, 0.56-0.96]; I 2 = 75.1%), prolonged overall survival rates (1-year, RR, 1.72 [95% CI, 1.13-2.61]; I 2 = 72.5%; 3-year, RR, 2.86 [95% CI, 1.78-4.58]; I 2 = 10.1%; and 5-year, RR, 2.76 [95% CI, 1.37-5.54]; I 2 = 28.3%), increased proportion of early HCC detection (RR, 2.68 [95% CI, 1.77-4.06]; I 2 = 50.4%). Similarly, meta-analysis of cohort studies indicated HCC screening was more effective than non-screening. However, pooled proportion of physiological harms was 16.30% (95% CI: 8.92%-23.67%) and most harms were of a mild to moderate severity. CONCLUSION The existing evidence suggests HCC screening is more effective than non-screening in high-risk population. However, harms of screening should not be ignored.
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Affiliation(s)
- Jichun Yang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Zhirong Yang
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridgeshire, UK
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xueyang Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shuqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Le Gao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Yu Jiang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Zeng H, Cao M, Xia C, Wang D, Chen K, Zhu Z, Fu R, Zhang S, Zhou J, Wang H, Qi X, Dai S, Chen Y, Sun Z, Ding H, Li Q, Zhao H, Zhang X, Morze J, Ji JS, Sun F, Yu X, Qu C, Chen W. Performance and effectiveness of hepatocellular carcinoma screening in individuals with HBsAg seropositivity in China: a multicenter prospective study. NATURE CANCER 2023; 4:1382-1394. [PMID: 37667043 DOI: 10.1038/s43018-023-00618-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/19/2023] [Indexed: 09/06/2023]
Abstract
Current guidelines recommend hepatocellular carcinoma (HCC) surveillance for at-risk individuals, including individuals with hepatitis B virus infection. However, the performance and survival benefits of annual screening have not been evaluated through multicenter prospective studies in a Chinese population. Between 2017 and 2021, we included 14,426 participants with hepatitis B surface antigen seropositivity in an annual HCC screening study in China using a multicenter prospective design with ultrasonography and serum alpha-fetoprotein. After four rounds of screening and follow-up, the adjusted hazard ratios of death after correction for lead-time and length-time biases for screen-detected cancers at the prevalent and incident rounds were 0.74 (95% confidence interval = 0.60-0.91) and 0.52 (95% confidence interval = 0.40-0.68), respectively. A meta-analysis demonstrated that HCC screening was associated with improved survival after adjusting for lead-time bias. Our findings highlight the 'real-world' feasibility and effectiveness of annual HCC screening in community settings for the early detection of HCC and to improve survival.
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Affiliation(s)
- Hongmei Zeng
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Maomao Cao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Changfa Xia
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Dongmei Wang
- State Key Laboratory of Molecular Oncology and Department of Immunology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Kun Chen
- State Key Laboratory of Molecular Oncology and Department of Immunology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zheng Zhu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ruiying Fu
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shaokai Zhang
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, People's Republic of China
| | - Jinyi Zhou
- Department for Chronic Non-communicable Diseases Control, Jiangsu Provincial Center for Disease Control and Prevention (Public Health Research Institute of Jiangsu Province), Nanjing, People's Republic of China
| | - Huadong Wang
- Department of Chronic Non-communicable Diseases Prevention and Treatment, Anhui Provincial Center for Disease Control and Prevention, Hefei, People's Republic of China
| | - Xianyun Qi
- Department of Chronic Non-communicable Diseases Prevention and Treatment, Yingdong Center for Disease Control and Prevention, Fuyang, People's Republic of China
| | - Shuguang Dai
- Sheyang Center for Disease Control and Prevention, Yancheng, People's Republic of China
| | - Yong Chen
- Binhai Center for Disease Control and Prevention, Yancheng, People's Republic of China
| | - Zhong Sun
- Dancheng Center for Disease Control and Prevention, Zhoukou, People's Republic of China
| | - Hao Ding
- Mengcheng Center for Disease Control and Prevention, Bozhou, People's Republic of China
| | - Qingwen Li
- Shenqiu Center for Disease Control and Prevention, Zhoukou, People's Republic of China
| | - Hui Zhao
- Lingbi Center for Disease Control and Prevention, Suzhou, People's Republic of China
| | - Xuehong Zhang
- Department of Nutrition, Harvard University, Cambridge, MA, USA
| | - Jakub Morze
- Department of Cardiology and Internal Medicine, College of Medical Sciences, SGMK University, Olsztyn, Poland
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, People's Republic of China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, Peking University, Beijing, People's Republic of China
| | - Xueqin Yu
- The Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Chunfeng Qu
- State Key Laboratory of Molecular Oncology and Department of Immunology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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Tang MJ, Eslick GD, Lubel JS, Majeed A, Majumdar A, Kemp W, Roberts SK. Outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma: A systematic review and meta-analysis. World J Meta-Anal 2022; 10:220-237. [DOI: 10.13105/wjma.v10.i4.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/01/2022] [Accepted: 08/11/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies to date comparing outcomes of microwave ablation (MWA) with radiofrequency ablation (RFA) on patients with hepatocellular carcinoma have yielded conflicting results, with no clear superiority of one technique over the other. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of MWA with RFA.
AIM To perform a systematic review and meta-analysis comparing the efficacy and safety of MWA with RFA.
METHODS A systematic literature search was performed using Ovid Medline, Embase, PubMed, Reference Citation Analysis, Cochrane Central and Cochrane Systematic Review databases, and Web of Science. Abstracts and full manuscripts were screened for inclusion utilising predefined inclusion and exclusion criteria comparing outcomes of MWA and RFA. A random-effects model was used for each outcome. Meta-regression analysis was performed to adjust for the difference in follow-up period between the studies. Primary outcome measures included complete ablation (CA) rate, local recurrence rate (LRR), survival [local recurrence-free survival (LRFS), overall survival (OS)] and adverse events.
RESULTS A total of 42 published studies [34 cohort and 8 randomised controlled trials (RCT)] with 6719 patients fulfilled the selection criteria. There was no significant difference in tumour size between the treatment groups. CA rates between MWA and RFA groups were similar in prospective cohort studies [odds ratio (OR) 0.95, 95% confidence interval (CI) 0.28–3.23] and RCTs (OR 1.18, 95%CI 0.64–2.18). However, retrospective studies reported higher rates with MWA (OR 1.29, 95%CI 1.06–1.57). Retrospective cohort studies reported higher OS (OR 1.54, 95%CI 1.15–2.05 and lower LRR (OR 0.67, 95%CI 0.51–0.87). No difference in terms of LRFS or 30-d mortality was observed between both arms. MWA had an increased rate of adverse respiratory events when compared to RFA (OR 1.99, 95%CI 1.07–3.71, P = 0.03).
CONCLUSION MWA achieves similar CA rates and as good or better longer-term outcomes in relation to LRR and OS compared to RFA. Apart from an increased rate of respiratory events post procedure, MWA is as safe as RFA.
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Affiliation(s)
- Myo Jin Tang
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Monash Medical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Guy D Eslick
- Department of Statistics, Clued Pty Ltd, Sydney 2006, New South Wales, Australia
| | - John S Lubel
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Avik Majumdar
- Department of Gastroenterology, Austin Hospital, Heidelberg 3084, Victoria, Australia
- Department of Medicine, Austin Campus, University of Medicine, Melbourne 3084, Victoria, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Hospital, Melbourne 3004, Victoria, Australia
- Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
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Cao M, Li H, Sun D, He S, Xia C, Lei L, Peng J, Chen W. A Primary Screening Method for Liver Cancer in Chronic Hepatitis B Carriers: A Prospective Community-Based Cohort Study. Front Oncol 2022; 11:762662. [PMID: 35047391 PMCID: PMC8761897 DOI: 10.3389/fonc.2021.762662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/06/2021] [Indexed: 11/15/2022] Open
Abstract
Background Patients with hepatitis B virus (HBV) were invited to receive ultrasound and alpha-protein examination directly in China. However, not all HBV carriers need to be subjected to further tests. This study aimed to develop a feasible primary screening method to narrow down potential high-risk individuals of liver cancer among populations with HBV. Methods Based on a prospective community-based cohort, potential risk factors were selected as the predictors, including age, sex, smoking, alcohol consumption, diabetes, liver cancer family history, liver diseases in mothers, source of water, body mass index (BMI), and psychological trauma. Cox proportional regression model was applied to predict the 3-year absolute risk of liver cancer and derive risk scores. The area under receiver operating characteristic curve (AUROC) and calibration plot were used to assess the performance of the model. Bootstrap resampling was used for internal validation. Results Age, sex, BMI, alcohol consumption, liver diseases in mothers, and psychological trauma were independent risks of liver cancer. The 1- to 3-year AUROC of the prediction model was 71.15% (95% CI, 66.88–75.42), 71.16% (95% CI, 67.42–74.90), and 72.95% (95% CI, 64.20–81.70), respectively. The predicted risk was calibrated well with the observed liver cancer risk. Bootstrap resampling showed that C-index was 0.70 (0.67–0.74). A 32-point risk score was also developed and a score over 5 was identified for patients at extremely high risk. Conclusions A user-friendly primary screening method was created that could estimate the 3-year absolute risk of liver cancer and identify extremely high-risk individuals among the population with HBV.
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Affiliation(s)
- Maomao Cao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
| | - He Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
| | - Dianqin Sun
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
| | - Siyi He
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
| | - Changfa Xia
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
| | - Lin Lei
- Department of Cancer Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Ji Peng
- Department of Cancer Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
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Galle PR, Kudo M, Llovet JM, Finn RS, Karwal M, Pezet D, Kim TY, Yang TS, Lonardi S, Tomasek J, Phelip JM, Touchefeu Y, Koh SJ, Stirnimann G, Liang K, Ogburn KD, Wang C, Abada P, Widau RC, Zhu AX. Ramucirumab in patients with previously treated advanced hepatocellular carcinoma: Impact of liver disease aetiology. Liver Int 2021; 41:2759-2767. [PMID: 34173317 DOI: 10.1111/liv.14994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) is a common complication of chronic liver disease with diverse underlying aetiologies. REACH/REACH-2 were global phase III studies investigating ramucirumab in advanced HCC (aHCC) following sorafenib treatment. We performed an exploratory analysis of outcomes by liver disease aetiology and baseline serum viral load. METHODS Meta-analysis was conducted in patients with aHCC and alpha-fetoprotein (AFP) ≥400 ng/mL (N = 542) from REACH/REACH-2 trials. Individual patient-level data were pooled with results reported by aetiology subgroup (hepatitis B [HBV] or C [HCV] and Other). Pre-treatment serum HBV DNA and HCV RNA were quantified using Roche COBAS AmpliPrep/COBAS TaqMan. Overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan-Meier method and Cox proportional hazard model (stratified by study). RESULTS Baseline characteristics were generally balanced between arms in each subgroup (HBV: N = 225, HCV: N = 127, Other: N = 190). No significant difference in treatment effect by aetiology subgroup was detected (OS interaction P-value = .23). Median OS (ramucirumab vs placebo) in months was 7.7 versus 4.5 (HR 0.74, 95% CI 0.55-0.99) for HBV, 8.2 versus 5.5 (HR 0.82, 95% CI 0.55-1.23) for HCV and 8.5 versus 5.4 (HR 0.56, 95% CI 0.40-0.79) for Other. Ramucirumab showed similar overall safety profiles across subgroups. Worst outcomes were noted in patients with a detectable HBV load. Use of HBV antiviral therapy, irrespective of viral load, was beneficial for survival, liver function and liver-specific adverse events. CONCLUSIONS Ramucirumab improved survival across aetiology subgroups with a tolerable safety profile, supporting its use in patients with aHCC and elevated AFP.
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Affiliation(s)
- Peter R Galle
- Department of Internal Medicine, Mainz University Medical Center, Mainz, Germany
| | - Masatoshi Kudo
- Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Josep M Llovet
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Translational Research in Hepatic Oncology, Liver Unit, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Institució Catalana d'Estudis Avançats (ICREA), Barcelona, Spain
| | | | - Mark Karwal
- University of Iowa Hospitals and Clinics, University of Iowa Health Care, Iowa City, IA, USA
| | - Denis Pezet
- Estaing Hospital, Aubrac, Clermont-Ferrand, France
| | - Tae-You Kim
- Seoul National University Hospital, Seoul, Korea
| | | | - Sara Lonardi
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | | | | | - Su-Jin Koh
- Division of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Guido Stirnimann
- University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Kun Liang
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Paolo Abada
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Jiahui International Cancer Center, Jiahui Health, Shanghai, China
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Freeman E, Cheung W, Ferdousi S, Kavnoudias H, Majeed A, Kemp W, Roberts SK. Irreversible electroporation versus radiofrequency ablation for hepatocellular carcinoma: a single centre propensity-matched comparison. Scand J Gastroenterol 2021; 56:942-947. [PMID: 34057003 DOI: 10.1080/00365521.2021.1930145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Irreversible electroporation (IRE) is a relatively new non-thermal ablative method for unresectable hepatocellular carcinoma (HCC). We aimed to compare the longer-term efficacy of IRE to the standard thermal technique of radiofrequency ablation (RFA) in HCC. METHODS All patients who underwent IRE or RFA for HCC in our centre were identified and demographic and clinical data were analysed up until 1st March, 2020. Local recurrence-free survival (LRFS) was compared between groups after propensity score matching for age, gender, Child-Pugh grade, BCLC stage, lesion size and alpha-fetoprotein (AFP) level. RESULTS A total of 190 HCC ablations (31 IRE and 159 RFA) were identified. After propensity score matching, we compared 25 IRE procedures (76% males, median age 62.4 years, median tumour size 20 mm) to 96 RFA procedures (84.4% males, median age 64.3 years, median tumour size 18.5 mm). LRFS did not differ between groups, with a 1-, 2- and 5-year LRFS of 80.4% (95% CI 55.8-92.2), 69.1% (95% CI 43.3-84.9) and 44.9% (95% CI 18.9-68.1%), respectively for IRE and 84.8% (95% CI 75.2-90.9), 71.3% (95% CI 58.3-81.0) and 52.1% (95% CI 35.4-66.4%), respectively for RFA (p = .63). There were no major procedure-related complications or deaths in either group. CONCLUSIONS Whilst IRE remains a relatively novel therapy for HCC cases where standard thermal ablation is contraindicated, the LRFS in our centre is comparable to that of RFA. IRE should therefore be considered as a treatment option in such cases when available before stage-migration to non-curative therapies such as transarterial chemoembolization (TACE).
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Affiliation(s)
- Elliot Freeman
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia
| | - Wa Cheung
- Department of Radiology, Alfred Hospital, Melbourne, Australia
| | - Sapphire Ferdousi
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia
| | | | - Ammar Majeed
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
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Bae H, Lee SA, Choi JW, Hwang SH, Park S, Park MS. Effectiveness of Hepatocellular Carcinoma Surveillance and an Optimal Surveillance Interval: Nationwide Cohort of Korea. Yonsei Med J 2021; 62:758-766. [PMID: 34296554 PMCID: PMC8298874 DOI: 10.3349/ymj.2021.62.8.758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/28/2021] [Accepted: 05/29/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To assess associations between surveillance intervals in a national hepatocellular carcinoma (HCC) surveillance program and receiving curative treatment and mortality using nationwide cohort data for Korea. MATERIALS AND METHODS Using the National Health Insurance Service Database of Korea, we retrospectively identified 3201852 patients, the target population of the national HCC surveillance program, between 2008 and 2017. After exclusion, a total of 64674 HCC patients were divided based on surveillance intervals: never screened, ≤6 months (6M), 7-12 months (1Y), 13-24 months (2Y), and 25-36 months (3Y). Associations for surveillance interval with the chance to receive curative therapy and all-cause mortality were analyzed. RESULTS The 6M group (51.9%) received curative therapy more often than the other groups (1Y, 48.3%; 2Y, 43.8%; 3Y, 41.3%; never screened, 34.5%). Odds ratio for receiving curative therapy among the other surveillance interval groups (1Y, 0.87; 2Y, 0.76; 3Y, 0.77; never screened, 0.57; p<0.001) were significantly lower than that of the 6M group. The hazard ratios (HRs) of all-cause mortality were 1.07, 1.14, and 1.37 for 2Y, 3Y, and never screened groups. The HR for the 1Y group (0.96; p=0.092) was not significantly different, and it was lower (0.91; p<0.001) than that of the 6M group after adjustment for lead-time bias. Curative therapy was associated with survival benefits (HR, 0.26; p<0.001). CONCLUSION HCC surveillance, especially at a surveillance interval of 6 months, increases the chance to receive curative therapy.
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Affiliation(s)
- Heejin Bae
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Ah Lee
- Big Data Strategy Department, National Health Insurance Service, Wonju, Korea
| | - Jong Won Choi
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Shin Hye Hwang
- Department of Radiology, Yongin Severance Hospital, Yongin, Korea
| | - Sumi Park
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
| | - Mi Suk Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
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Rho YS, Pagano I, Wong LL, Kwee SA, Acoba JD. Factors and Survival Implications associated with biopsy of hepatocellular carcinoma. HPB (Oxford) 2021; 23:1054-1060. [PMID: 33229278 DOI: 10.1016/j.hpb.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/01/2020] [Accepted: 11/02/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the few cancers that can be diagnosed based on imaging findings alone. The factors associated with the decision to perform a biopsy and the clinical impact have not been previously studied. METHODS We collected data of patients diagnosed with HCC between 2004 and 2015 from the National Cancer Database. We assessed associations between biopsy and survival with demographic and clinical factors. RESULTS We included 160,507 patients. The median age was 62 (40-90), 74.1% were male and 74.9% were white. Over the 12-year period, 47.7% (76,524/160,517) underwent a biopsy. Factors associated with a biopsy were black race, older age, presence of metastatic disease, larger tumor size, and treatment at a community cancer center. Factors associated with increased mortality were older age, higher comorbidity index, larger tumor size, presence of metastatic disease, higher AFP and elevated bilirubin. There was a significant decreased use of biopsy over successive years (2007-2015). After adjusting for prognostic factors, biopsy had no significant impact on survival HR 1.01 (95%CI 1.00-1.03. p = 0.07). CONCLUSIONS A significant number of patients underwent a biopsy. Performing a biopsy did not have a significant impact on survival.
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Affiliation(s)
- Young S Rho
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | - Ian Pagano
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Linda L Wong
- Cancer Biology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Sandi A Kwee
- Cancer Biology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Jared D Acoba
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA; Translational and Clinical Research, University of Hawaii Cancer Center, Honolulu, HI, USA; Queen's Medical Center, Honolulu, HI, USA.
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Li ZL, Wu H, Wei YP, Zhong Q, Song JC, Yu JJ, Li C, Wang MD, Xu XF, Li JD, Han J, Xing H, Lau WY, Wu MC, Shen F, Yang T. Impact of Surveillance in Chronic Hepatitis B Patients on Long-Term Outcomes After Curative Liver Resection for Hepatocellular Carcinoma. J Gastrointest Surg 2020; 24:1987-1995. [PMID: 31388886 DOI: 10.1007/s11605-019-04295-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/03/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Clinical guidelines recommend surveillance in high-risk population to early detect hepatocellular carcinoma (HCC), when curative treatment such as liver resection can be applied. However, it is largely unknown whether surveillance would provide long-term survival benefits to these high-risk patients who have received curative liver resection for HCC. METHODS A prospectively maintained database on patients with chronic hepatitis B infection who underwent curative liver resection for HCC from 2003 to 2014 was reviewed. Patients' overall survival and recurrence were compared between the groups of patients whose HCCs were diagnosed by surveillance or non-surveillance, as well as between the groups of patients operated in the first (2003-2008) and second (2009-2014) 6-year periods. RESULTS Of 1075 chronic hepatitis B patients with HCC, 452 (42.0%) patients were diagnosed by preoperative surveillance. Compared with the non-surveillance group, the OS and RFS rates were significantly better in the surveillance group (both P < 0.001). Surveillance was associated with a 55% decrease in the overall survival risk and a 48% decrease in the recurrence risk (HR 0.45, 95% CI 0.38-0.53, and HR 0.52, 95% CI 0.44-0.61). Compared with the first period, a significant reduction of 12% and 19% in the overall death and recurrence risks, respectively, was observed in the second period (HR 0.88, 95% CI 0.78-0.97, and HR 0.81, 95% CI 0.70-0.95). CONCLUSION Surveillance for HCC was associated with favorable long-term overall and recurrence-free survival rates after curative liver resection of HCC in patients with chronic hepatitis B.
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Affiliation(s)
- Zhen-Li Li
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No 225, Changhai Road, Shanghai, 200438, China
| | - Han Wu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No 225, Changhai Road, Shanghai, 200438, China
| | - Yong-Peng Wei
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No 225, Changhai Road, Shanghai, 200438, China
| | - Qian Zhong
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jin-Chao Song
- Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jiong-Jie Yu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No 225, Changhai Road, Shanghai, 200438, China
| | - Chao Li
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No 225, Changhai Road, Shanghai, 200438, China
| | - Ming-Da Wang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No 225, Changhai Road, Shanghai, 200438, China
| | - Xin-Fei Xu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No 225, Changhai Road, Shanghai, 200438, China
| | - Ju-Dong Li
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No 225, Changhai Road, Shanghai, 200438, China
| | - Jun Han
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No 225, Changhai Road, Shanghai, 200438, China
| | - Hao Xing
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No 225, Changhai Road, Shanghai, 200438, China
| | - Wan Yee Lau
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No 225, Changhai Road, Shanghai, 200438, China
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - Meng-Chao Wu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No 225, Changhai Road, Shanghai, 200438, China
| | - Feng Shen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No 225, Changhai Road, Shanghai, 200438, China.
| | - Tian Yang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No 225, Changhai Road, Shanghai, 200438, China.
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10
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Hassan I, Gane E. Improving survival in patients with hepatocellular carcinoma related to chronic hepatitis C and B but not in those related to non-alcoholic steatohepatitis or alcoholic liver disease: a 20-year experience from a national programme. Intern Med J 2019; 49:1405-1411. [PMID: 30908822 DOI: 10.1111/imj.14304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/11/2019] [Accepted: 03/15/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the most rapidly increasing cause of cancer mortality in New Zealand due to endemic hepatitis B virus (HBV) infection and recent hepatitis C virus (HCV) and obesity epidemics. AIM To describe the changing landscape of HCC referred to a national HCC service over a 20-year period, including trends in underlying liver disease, screening uptake and access to curative treatments, and to determine the impact of screening on outcomes with a comparison between screened detected and non-screened detected cases. METHODS All newly diagnosed cases of HCC referred to New Zealand Liver Transplant Unit between 1998 and 2017 were included. Data on patient demographics, liver disease aetiology, screening status and treatment modalities were collected. RESULTS HCC diagnosis rates have increased from 24 cases in 1998 to 250 in 2017, an increase of 20% per annum. The total of 1985 HCC cases was divided into three cohorts (Era 1: 1998-2009; Era 2: 2009-2014; Era 3: 2014-2017), each comprising 661-662 patients. During the study period, overall survival improved (P = 0.005). The proportion with screen-detected HCC was similar across the three cohorts (44% in Era 1, 42% in Era 2 and 47% in Era 3). Five- and 10-year survival was higher in screen-detected cases (49 and 43%) than in non-screen detected cases (14 and 10%), P < 0.0001. Survival was higher in patients with HCV and HBV than in those with non-alcoholic steatohepatitis (NASH) or alcoholic liver disease (ALD) - 5 and 10-year survival was 40 and 34% in HCV-HCC, 30 and 26% in HBV-HCC, 15 and 14% in NASH-HCC, 13 and 10% in ALD-HCC, P < 0.0001. CONCLUSION Better outcomes in patients with HBV- or HCV-related HCC than in those with NASH-related or ALD-related HCV may reflect better screening uptake and better access to curative therapies.
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Affiliation(s)
- Ibrahim Hassan
- New Zealand Liver Transplant Unit (NZLTU), Auckland City Hospital, Auckland, New Zealand
| | - Edward Gane
- New Zealand Liver Transplant Unit (NZLTU), Auckland City Hospital, Auckland, New Zealand
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11
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Moon AM, Weiss NS, Beste LA, Su F, Ho SB, Jin GY, Lowy E, Berry K, Ioannou GN. No Association Between Screening for Hepatocellular Carcinoma and Reduced Cancer-Related Mortality in Patients With Cirrhosis. Gastroenterology 2018; 155:1128-1139.e6. [PMID: 29981779 PMCID: PMC6180323 DOI: 10.1053/j.gastro.2018.06.079] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/18/2018] [Accepted: 06/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Screening patients with cirrhosis for hepatocellular carcinoma (HCC) has been recommended. We conducted a matched case-control study within the US Veterans Affairs (VA) health care system to determine whether screening by abdominal ultrasonography (USS) and/or by measuring serum level of α-fetoprotein (AFP) was associated with decreased cancer-related mortality in patients with cirrhosis. METHODS We defined cases (n = 238) as patients with cirrhosis who died of HCC from January 1, 2013 through August 31, 2015 and had been in VA care with a diagnosis of cirrhosis for at least 4 years before the diagnosis of HCC. We matched each case to 1 control (n = 238), defined as a patient with cirrhosis who did not die of HCC and had been in VA care for at least 4 years before the date of the matched case's HCC diagnosis. Controls were matched to cases by year of cirrhosis diagnosis, race and ethnicity, age, sex, etiology of cirrhosis, Model for End-Stage Liver Disease score, and VA medical center. We identified all USS and serum AFP tests performed within 4 years before the date of HCC diagnosis in cases or the equivalent index date in controls and determined by chart extraction (blinded to case or control status) whether these tests were performed for screening. RESULTS There were no significant differences between cases and controls in the proportions of patients who underwent screening USS (52.9% vs 54.2%), screening measurement of serum AFP (74.8% vs 73.5%), screening USS or measurement of serum AFP (81.1% vs 79.4%), or screening USS and measurement of serum AFP (46.6% vs 48.3%) within 4 years before the index date, with or without adjusting for potential confounders. There also was no difference in receipt of these screening tests within 1, 2, or 3 years before the index date. CONCLUSIONS In a matched case-control study of the VA health care system, we found that screening patients with cirrhosis for HCC by USS, measurement of serum AFP, either test, or both tests was not associated with decreased HCC-related mortality. We encourage additional case-control studies to evaluate the efficacy of screening for HCC in other health care systems, in which available records are sufficiently detailed to enable identification of the indication for USS and AFP tests.
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Affiliation(s)
- Andrew M Moon
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Noel S Weiss
- Department of Epidemiology, University of Washington, Seattle, and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lauren A Beste
- Division of General Internal Medicine, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington
| | - Feng Su
- Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington
| | - Samuel B Ho
- Division of Gastroenterology, Veterans Affairs San Diego Healthcare System and University of California, San Diego, California
| | - Ga-Young Jin
- Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
| | - Elliott Lowy
- Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
| | - Kristin Berry
- Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
| | - George N Ioannou
- Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington; Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington.
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12
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Sheppard-Law S, Zablotska-Manos I, Kermeen M, Holdaway S, Lee A, George J, Zekry A, Maher L. Utilisation of hepatocellular carcinoma screening in Australians at risk of hepatitis B virus-related carcinoma and prescribed anti-viral therapy. J Clin Nurs 2018; 27:2673-2683. [PMID: 29603817 DOI: 10.1111/jocn.14367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2018] [Indexed: 12/17/2022]
Abstract
AIMS AND OBJECTIVES To investigate hepatocellular carcinoma screening utilisation and factors associated with utilisation among patients prescribed hepatitis B virus anti-viral therapy and at risk of hepatocellular carcinoma. BACKGROUND The incidence of hepatocellular carcinoma has increased in Australia over the past three decades with chronic hepatitis B virus infection a major contributor. hepatocellular carcinoma surveillance programs aim to detect cancers early enabling curative treatment options, longer survival and longer times to recurrence. DESIGN Multi-site cross-sectional survey. METHODS An online study questionnaire was administered to eligible participants attending three Sydney tertiary hospitals. Data were grouped into six mutually exclusive hepatocellular carcinoma risk factor categories as per American Association for the Study of Liver Diseases guidelines. All analyses were undertaken in STATA. Logistic regression was used to assess the associations between covariates and screening utilisation. Multivariate models described were assessed using the Hosmer-Lemeshow goodness of fit. RESULTS Of the 177 participants, 137 (77.4%) self-reported that US had been performed in the last six months. Awareness that screening should be performed and knowing the correct frequency of US screening were independently associated with screening utilisation. Participants who knew that screening should be undertaken were three times more likely to have had pretreatment education or were prescribed hepatitis B virus anti-viral treatment for >4 years. Participants reporting a family history of hepatocellular carcinoma were less likely to know that screening should be undertaken every 6 months. CONCLUSION While utilisation of hepatocellular carcinoma surveillance programs was higher in this study than in previous reports, strategies to further improve surveillance remain necessary. RELEVANCE TO CLINICAL PRACTICE Findings from this research form the basis for proposing strategies to improve utilisation of hepatocellular carcinoma screening, inform hepatitis B virus-related clinical practice and for the delivery of care and nursing education to people receiving hepatitis B virus anti-viral therapy and at risk of developing hepatocellular carcinoma.
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Affiliation(s)
- Suzanne Sheppard-Law
- Faculty of Health, University of Technology, Sydney, Ultimo, NSW, Australia.,Sydney Children's Hospital Network-Sydney Children's Hospital, Randwick, NSW, Australia.,The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | | | - Melissa Kermeen
- Department of Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Susan Holdaway
- Storr Liver Unit, Westmead Hospital, Westmead, NSW, Australia
| | - Alice Lee
- Department of Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Jacob George
- Storr Liver Unit, Westmead Hospital, Westmead, NSW, Australia.,Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | - Amany Zekry
- Department of Gastroenterology & Hepatology, St George Hospital, Kogarah, NSW, Australia.,St George Hospital Clinical Group School of Medicine, UNSW Australia, Sydney, NSW, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
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13
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Hallager S, Ladelund S, Kjaer M, Madsen LG, Belard E, Laursen AL, Gerstoft J, Røge BT, Grønbaek KE, Krarup HB, Christensen PB, Weis N. Hepatocellular carcinoma in patients with chronic hepatitis C and cirrhosis in Denmark: A nationwide cohort study. J Viral Hepat 2018; 25:47-55. [PMID: 28750141 DOI: 10.1111/jvh.12764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 06/23/2017] [Indexed: 12/17/2022]
Abstract
Cirrhosis in patients with chronic hepatitis C increases the risk of hepatocellular carcinoma (HCC), and surveillance with ultrasound (US) and alpha-fetoprotein (AFP) is recommended. This study aimed to estimate changes in the HCC incidence rate (IR) over time, HCC stage and prognosis, and AFP and US performed in patients with hepatitis C and cirrhosis. Eligible patients were identified in the Danish Database for Hepatitis B and C, and data from national health registries and patient charts were obtained. Tumour stage was based on Barcelona-Clinic Liver Cancer stage, TNM classification and size and number of lesions combined into stages 0-3. We included 1075 patients with hepatitis C and cirrhosis, free of HCC and liver transplant at baseline. During 4988 person years (PY), 115 HCC cases were diagnosed. The HCC incidence rate increased from 0.8/100 PY [CI95% 0.4-1.5] in 2002-2003 to 2.9/100 PY [2.4-3.4] in 2012-2013. One-year cumulative incidence of at least one AFP or US was 53% among all patients. The positive predictive value of an AFP ≥ 20 ng mL-1 was 17%. Twenty-three (21%) patients were diagnosed with early-stage HCC (stage 0/1) and 84 (79%) with late stage. Median survival after HCC for early-stage HCC disease was 30.1 months and 7.4 months for advanced HCC (stage 2/3). The incidence rate of HCC increased over time among patients with hepatitis C and cirrhosis in Denmark. Application of AFP and US was suboptimal, and most patients were diagnosed with advanced HCC with a poor prognosis.
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Affiliation(s)
- S Hallager
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - S Ladelund
- Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark
| | - M Kjaer
- Department of Hepatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L G Madsen
- Department of Gastroenterology, Zealand University Hospital, Køge, Denmark
| | - E Belard
- Department of Gastroenterology, Copenhagen University Hospital, Herlev, Denmark
| | - A L Laursen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - J Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - B T Røge
- Department of Internal Medicine, Kolding Hospital, Kolding, Denmark
| | - K E Grønbaek
- Department of Gastroenterology, Copenhagen University Hospital, Hvidovre, Denmark
| | - H B Krarup
- Section of Molecular Diagnostics, Clinical Biochemistry and Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - P B Christensen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - N Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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14
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de la Torre AN, Castaneda I, Ahmad M, Ekholy N, Tham N, Herrera IB, Beaty P, Malapero RJ, Ayoub F, Slim J, Johnson MB. Audio-computer-assisted survey interview and patient navigation to increase chronic viral hepatitis diagnosis and linkage to care in urban health clinics. J Viral Hepat 2017. [PMID: 28636784 DOI: 10.1111/jvh.12744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Intravenous drug use and sexual practices account for 60% of hepatitis C (HCV) and B (HBV) infection. Disclosing these activities can be embarrassing and reduce risk reporting, blood testing and diagnosis. In diagnosed patients, linkage to care remains a challenge. Audio-computer-assisted survey interview (Audio-CASI) was used to guide HCV and HBV infection testing in urban clinics. Risk reporting, blood testing and serology results were compared to historical controls. A patient navigator (PN) followed up blood test results and provided patients with positive serology linkage to care (LTC). Of 1932 patients surveyed, 574 (30%) were at risk for chronic viral hepatitis. A total of 254 (44.3%) patients were tested, 34 (13.5%) had serology warranting treatment evaluation, and 64% required HBV vaccination. Of 16 patients with infection, seven HCV and three HBV patients started treatment following patient LTC. Of 146 HBV-naïve patients, 70 completed vaccination. About 75% and 49% of HCV antibody and HBV surface antigen-positive patients were born between 1945 and 1965. Subsequently, automated HCV testing of patients born between 1945 and 1965 was built into our hospital electronic medical records. Average monthly HCV antibody testing increased from 245 (January-June) to 1187 (July-October). Patient navigator directed LTC for HCV antibody-positive patients was 61.6%. In conclusion, audio-CASI can identify patients at risk for HCV or HBV infection and those in need of HBV vaccination in urban medical clinics. Although blood testing once a patient is identified at risk for infection needs to increase, a PN is useful to provide LTC of newly diagnosed patients.
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Affiliation(s)
- A N de la Torre
- Liver Surgery, St Joseph's Medical Center, Paterson, NJ, USA.,Liver Surgery, New Jersey Medical School Rutgers University, Newark, NJ, USA
| | - I Castaneda
- Liver Surgery, St Joseph's Medical Center, Paterson, NJ, USA
| | - M Ahmad
- Hepatology, St Joseph's Medical Center, Paterson, NJ, USA
| | - N Ekholy
- Internal Medicine, St Joseph's Medical Center, Paterson, NJ, USA
| | - N Tham
- Segundo Ruiz Belvis Community Health Center - Gotham Health, Bronx, NY, USA
| | - I B Herrera
- Internal Medicine, New Jersey Medical School Rutgers University, Newark, NJ, USA
| | - P Beaty
- Metropolitan Family Health Network FQHC, Jersey City, NJ, USA
| | | | - F Ayoub
- Liver Surgery, St Joseph's Medical Center, Paterson, NJ, USA
| | - J Slim
- Division of Infectious Deceases, St. Michael's Medical Center, Newark, NJ, USA
| | - M B Johnson
- Family Medicine, Howard University, Washington, DC, USA
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15
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Mgaieth S, Kemp W, Gow P, Fink M, Lubel J, Nicoll A, Gazzola A, Hong T, Ryan M, Knight V, Dev AT, Sood S, Bell S, Paul E, Roberts SK. Impact of viral hepatitis aetiology on survival outcomes in hepatocellular carcinoma: A large multicentre cohort study. J Viral Hepat 2017; 24:982-989. [PMID: 28414893 DOI: 10.1111/jvh.12717] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/27/2017] [Indexed: 12/15/2022]
Abstract
While HBV and HCV are risk factors for HCC, uncertainty exists as to whether these viral infections have prognostic significance in HCC. Thus, we compared the overall survival of patients with HBV, HCV and nonviral HCC, and evaluated whether the presence of HBV and HCV predicts patient outcomes. We conducted a multicentre study of HCC cases diagnosed at six Melbourne tertiary hospitals between Jan 2000-Dec 2014. Patient demographics, liver disease and tumour characteristics and patient outcomes were obtained from hospital databases, computer records and the Victorian Death Registry. Survival outcomes were compared between HBV, HCV and nonviral hepatitis cases and predictors of survival determined using Cox proportional hazards regression. There were 1436 new HCC cases identified including 776 due to viral hepatitis (HBV 235, HCV 511, HBV-HCV 30) and 660 from nonviral causes. The median survival of HBV, HCV and nonviral HCC patients was 59.1, 28.4 and 20.9 months, respectively (P<.0001). On multivariate analysis, independent risk factors for survival included HCC aetiology, gender, BCLC stage, serum AFP, total number and size of lesions, and serum creatinine and albumin. After adjusting for these and method of detection, HBV remained an independent predictor of improved overall survival when compared to both nonviral (HR 0.60%, 95% CI 0.35-0.98; P=.03) and HCV-related HCC (HR 0.51%, 95% CI 0.30-0.85; P=.01). In this large multicentre study, HBV is independently associated with improved overall survival compared with HCV and nonviral-related HCC. Further studies are needed to determine the underlying factor(s) responsible.
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Affiliation(s)
- S Mgaieth
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
| | - W Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
| | - P Gow
- Department of Gastroenterology, Austin Hospital, Heidelberg, Vic., Australia
| | - M Fink
- Department of Surgery, Austin Hospital, Heidelberg, Vic., Australia
| | - J Lubel
- Department of Gastroenterology, Box Hill Hospital, Box Hill, Vic., Australia
| | - A Nicoll
- Department of Gastroenterology, Box Hill Hospital, Box Hill, Vic., Australia.,Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - A Gazzola
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
| | - T Hong
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Vic., Australia
| | - M Ryan
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Vic., Australia
| | - V Knight
- Department of Gastroenterology, Monash Medical Centre, Clayton, Vic., Australia
| | - A T Dev
- Department of Gastroenterology, Monash Medical Centre, Clayton, Vic., Australia
| | - S Sood
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - S Bell
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Vic., Australia
| | - E Paul
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - S K Roberts
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
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16
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Abstract
Hepatocellular carcinoma (HCC) is the predominant primary liver cancer in many countries and is the third most common cause of cancer-related death in the Asia-Pacific region. The incidence of HCC is higher in men and in those over 40 years old. In the Asia-Pacific region, chronic hepatitis B virus and hepatitis C virus infections are the main etiological agents; in particular, chronic hepatitis B infection (CHB) is still the major cause in all Asia-Pacific countries except for Japan. Over the past two decades, the incidence of HCC has remained stable in countries in the region except for Singapore and Hong Kong, where the incidence for both sexes is currently decreasing. Chronic hepatitis C infection (CHC) is an important cause of HCC in Japan, representing 70% of HCCs. Over the past several decades, the prevalence of CHC has been increasing in many Asia-Pacific countries, including Australia, New Zealand, and India. Despite advancements in treatment, HCC is still an important health problem because of the associated substantial mortality. An effective surveillance program could offer early diagnosis and hence better treatment options. Antiviral treatment for both CHB and CHC is effective in reducing the incidence of HCC.
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Affiliation(s)
- Ran Xu Zhu
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Wai-Kay Seto
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Ching-Lung Lai
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Man-Fung Yuen
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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17
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Targeting Notch3 in Hepatocellular Carcinoma: Molecular Mechanisms and Therapeutic Perspectives. Int J Mol Sci 2016; 18:ijms18010056. [PMID: 28036048 PMCID: PMC5297691 DOI: 10.3390/ijms18010056] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/12/2016] [Accepted: 12/16/2016] [Indexed: 12/15/2022] Open
Abstract
The Notch signaling pathway is a very conserved system that controls embryonic cell fate decisions and the maintenance of adult stem cells through cell to cell communication. Accumulating evidence support the relevance of Notch signaling in different human diseases and it is one of the most commonly activated signaling pathways in cancer. This review focuses mainly on the role of Notch3 signaling in hepatocellular carcinoma and its potential therapeutic applications against this malignancy. In this regard, the crosstalk between Notch and p53 may play an important role.
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18
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Appel-da-Silva MC, Miozzo SADS, Dossin IDA, Tovo CV, Branco F, Mattos AAD. Incidence of hepatocellular carcinoma in outpatients with cirrhosis in Brazil: A 10-year retrospective cohort study. World J Gastroenterol 2016; 22:10219-10225. [PMID: 28028370 PMCID: PMC5155181 DOI: 10.3748/wjg.v22.i46.10219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/04/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the incidence of hepatocellular carcinoma (HCC) and the impact of HCC surveillance on early diagnosis and survival of cirrhotic outpatients.
METHODS In this retrospective cohort study, cirrhotic outpatients undergoing HCC surveillance between March 2005 and March 2014 were analyzed. Exclusion criteria were HIV coinfection; previous organ transplantation; diagnosis of HCC at first consultation; missing data in the medical chart; and less than 1 year of follow-up. Surveillance was carried out every six months using ultrasound and serum alpha-fetoprotein determination. Ten-year cumulative incidence and survival were estimated through Kaplan-Meier analysis.
RESULTS Four hundred and fifty-three patients were enrolled, of which 57.6% were male. Mean age was 55 years. Hepatitis C virus and heavy use of alcohol were the main etiologic agents of cirrhosis. HCC was diagnosed in 75 patients (16.6%), with an estimated cumulative incidence of 2.6% in the 1st year, 15.4% in the 5th year, and 28.8% in the 10th year. Median survival was estimated at 17.6 mo in HCC patients compared to 234 mo in non-HCC patients (P < 0.001). Early-stage HCC was more often detected in patients who underwent surveillance every 6 mo or less (P = 0.05). However, survival was not different between patients with early stage vs non-early stage tumors [HR = 0.54 (0.15-1.89), P = 0.33].
CONCLUSION HCC is a frequent complication in patients with cirrhosis and adherence to surveillance programs favors early diagnosis.
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Mittal S, Kanwal F, Ying J, Chung R, Sada YH, Temple S, Davila JA, El-Serag HB. Effectiveness of surveillance for hepatocellular carcinoma in clinical practice: A United States cohort. J Hepatol 2016; 65:1148-1154. [PMID: 27476765 PMCID: PMC5322857 DOI: 10.1016/j.jhep.2016.07.025] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/28/2016] [Accepted: 07/19/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The effectiveness of surveillance for hepatocellular carcinoma (HCC) in reducing cancer related mortality among patients with cirrhosis is largely unknown. The objective of this study was to study the effectiveness of HCC surveillance in the national Veterans Administration (VA) clinical practice. METHODS We conducted a retrospective cohort study of patients with HCC during 2005-2010 by reviewing patients' medical records to determine receipt of HCC surveillance in the 2years prior to HCC diagnosis. We determined association of HCC surveillance with overall mortality adjusting for age, risk factors, model for end-stage liver disease (MELD) score, comorbidity index, alpha-fetoprotein levels, healthcare utilization, Barcelona Clinic Liver Cancer (BCLC) stage, and treatment. We accounted for lead and length time biases. RESULTS Of 887 patients with HCC, only 412 (46.5%) received any surveillance prior to HCC diagnosis. Patients who received surveillance were significantly more likely to have early stage disease HCC (BCLC stage 0/A 27.2% vs. 11.6%) and receive potentially curative (20.9% vs. 11.6%) or palliative (59.2% vs. 45.5%) treatments compared to those without HCC surveillance. Receipt of HCC surveillance was associated with 38% reduction in mortality risk (unadjusted hazard ratios (HR) 0.62, 95% confidence intervals (CI) 0.54-0.71) that declined to 20% (HR 0.80, 95% CI 0.69-0.94) after adjusting for HCC stage and treatment, compared to those without HCC surveillance. CONCLUSIONS Among patients with HCC, pre-diagnosis HCC surveillance is associated with a significant 38% reduction in overall mortality. The reduction in mortality risk with surveillance is mediated via stage migration and receipt of HCC specific treatment. LAY SUMMARY Surveillance for liver cancer leads to earlier detection of cancer and increases chances of getting curative treatment. This ultimately leads to increased longevity in patients with liver cancer.
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Affiliation(s)
- Sahil Mittal
- Section of Gastroenterology and Hepatology, USA; Effectiveness and Quality (iQuEST), Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
| | - Fasiha Kanwal
- Section of Gastroenterology and Hepatology, USA; Effectiveness and Quality (iQuEST), Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Jun Ying
- Effectiveness and Quality (iQuEST), Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Randy Chung
- Effectiveness and Quality (iQuEST), Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Yvonne H Sada
- Sections of Health Services Research, Center of Innovation, USA; Effectiveness and Quality (iQuEST), Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Sarah Temple
- Effectiveness and Quality (iQuEST), Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Jessica A Davila
- Sections of Health Services Research, Center of Innovation, USA; Effectiveness and Quality (iQuEST), Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, USA; Effectiveness and Quality (iQuEST), Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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Wang C, Chen V, Vu V, Le A, Nguyen L, Zhao C, Wong CR, Nguyen N, Li J, Zhang J, Trinh H, Nguyen MH. Poor adherence and low persistency rates for hepatocellular carcinoma surveillance in patients with chronic hepatitis B. Medicine (Baltimore) 2016; 95:e4744. [PMID: 27583921 PMCID: PMC5008605 DOI: 10.1097/md.0000000000004744] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Our goal was to examine rates and predictors for hepatocellular carcinoma (HCC) surveillance adherence and persistency, since studies of such adherence and persistency in patients with chronic hepatitis (CHB) are currently limited.Consecutive CHB patients (N = 1329) monitored for ≥1 year at 4 US clinics from January 1996 to July 2013 were retrospectively studied. Surveillance adherence was evaluated based on the American Association for the Study of Liver Diseases guidelines. Kaplan-Meier method was used to analyze surveillance persistency of 510 patients who had initially fair adherence (having at least annual surveillance imaging with further follow-up).Mean age was 48, with the majority being male (58%), Asian (92%), foreign-born (95%), and medically insured (97%). Patients with cirrhosis and those seen at university liver clinics were more likely to have optimal HCC surveillance than those without cirrhosis and those seen at community clinics (38.4% vs 21.6%, P <0.001 and 33.5% vs 14.4%, P < 0.001, respectively). HCC diagnosed in optimally adherent patients trended toward smaller tumor size (P < 0.08). On multivariate analysis also inclusive of age, sex, clinical visits, cirrhosis, clinic setting and antiviral therapy use, strong independent predictors for having at least annual imaging were a history of more frequent clinical visits (odds ratio [OR] = 2.5, P < 0.001) and university-based care (OR = 5.2, P < 0.001). Even for those with initially fair adherence, persistency dropped to 70% at 5 years.Adherence and persistency to HCC surveillance in CHB patients is generally poor. More frequent clinic visits and university-based settings were significant and strong predictors of at least annual HCC surveillance adherence.
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Affiliation(s)
- Christina Wang
- Public Policy Department, Stanford University, Stanford, CA
| | - Vincent Chen
- Department of Medicine, Stanford University Medical Center, Palo Alto, CA
| | - Vinh Vu
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA
| | - An Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA
| | - Linda Nguyen
- Department of Biology, Stanford University, Stanford, CA
| | - Changqing Zhao
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA
- Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai University of T.C.M., Shanghai, P.R. China
| | - Carrie R. Wong
- Department of Medicine, Yale University Medical Center, New Haven, CT
| | - Nghia Nguyen
- Department of Medicine, University of California, San Diego Medical Center, San Diego, CA
| | - Jiayi Li
- Department of Gastroenterology, Palo Alto Medical Foundation, Palo Alto, CA
| | - Jian Zhang
- Department of Outpatient Clinics, Chinese Hospital, San Francisco, CA
| | - Huy Trinh
- San Jose Gastroenterology, San Jose, CA
| | - Mindie H. Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA
- Correspondence: Mindie H. Nguyen, Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA 94304 (e-mail: )
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Wu CY, Hsu YC, Ho HJ, Chen YJ, Lee TY, Lin JT. Association between ultrasonography screening and mortality in patients with hepatocellular carcinoma: a nationwide cohort study. Gut 2016; 65:693-701. [PMID: 25670811 DOI: 10.1136/gutjnl-2014-308786] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/19/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Current guidelines recommend screening for hepatocellular carcinoma (HCC) in high-risk populations. However, the effectiveness of screening in reducing mortality has been challenged. In addition, it is unclear which subgroups benefit most from HCC screening. DESIGN This nationwide cohort study identified a total of 52,823 newly diagnosed HCC patients between 1 January 2002 and 31 December 2007. These HCC patients were classified into the following cohorts according to the time intervals in which they received ultrasonography screening: 0-6 months (6M), 7-12 months (12M), 13-24 months (24M), 25-36 months (36M) and not screened within 3 years (never screened). The chance to receive curative therapy and 5-year cumulative mortalities were calculated after adjusting for lead-time bias. RESULTS Chances to receive curative therapy among the 6M, 12M, 24M, 36M and never screened cohorts were 24.3% (95% CI 23.7% to -24.9%), 26.9% (95% CI 25.7% to 28.2%), 22.9% (95% CI 21.8% to 24.1%), 21.3% (95% CI 19.9% to 22.8%) and 18.3% (95% CI 17.8% to 18.8%), respectively. Compared with the 6M cohort, adjusted HRs of mortality for the 12M, 24M, 36M and never screened cohorts were 1.11 (95% CI 1.07 to 1.15), 1.23 (95% CI 1.19 to 1.28), 1.31 (95% CI 1.26 to 1.37) and 1.47 (95% CI 1.43 to 1.51) (all p<0.001), respectively. On multivariable subgroup analyses, the associations between shorter screening intervals and better survival were observed in nearly all subgroups, especially in younger patients, patients without diabetes and patients with hepatitis B infection. CONCLUSIONS Shorter ultrasonography screening intervals are associated with reduced overall mortality in HCC patients in a dose-dependent manner.
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Affiliation(s)
- Chun-Ying Wu
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan Faculty of Medicine and Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan Department of Public Health and Graduate Institute of Clinical Medical Sciences, China Medical University, Taichung, Taiwan National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan Department of Life Sciences and Rong Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Yao-Chun Hsu
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Hsiu J Ho
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ju Chen
- Faculty of Medicine and Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Teng-Yu Lee
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jaw-Town Lin
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan School of Medicine, Fu Jen Catholic University, Taipei, Taiwan Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
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22
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Clark PJ, Stuart KA, Leggett BA, Crawford DH, Boyd P, Fawcett J, Whiteman DC, Baade PD. Remoteness, race and social disadvantage: disparities in hepatocellular carcinoma incidence and survival in Queensland, Australia. Liver Int 2015; 35:2584-94. [PMID: 25900432 DOI: 10.1111/liv.12853] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/17/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Incidence and mortality of hepatocellular carcinoma (HCC) is increasing globally, but varies between countries and regions. To target scarce resources to most need, clinical services must be informed by regional epidemiology. Using population-based data, we sought to document the incidence and mortality of HCC in Queensland, Australia, a state occupying a vast land area with diverse at-risk subpopulations. METHODS Using population-based data from 1996 to 2011, the age-standardised incidence rate (ASR), annual percentage change (APC) and survival of HCC in Queensland were assessed with negative binomial regression, Kaplan-Meier and Cox survival analysis. Spatial patterns of HCC incidence and survival and relevant predictors were mapped. RESULTS Thousand six hundred and twenty HCCs were diagnosed during this study period, with an overall ASR of 2.00-cases/1000 population. ASR increased by 3.5% per year, (95% CI: 2.1 to 5.0), P < 0.001) among males to 5.6/100,000 in 2011 and a non-significant increase of 2.6% per year, (95% CI = -0.7 to 6.0), P = 0.111) among females to 1.6/100,000 in 2011. Higher incidence was associated with male gender, older age, major city residence and proportionally higher area Indigenous population. Thousand and two hundred and eighty-seven patients died. Median survival was approximately 10 months. Five-year survival improved from 18% in 1996-2000 to 24% in 2006-2011 (P < 0.001). Poorer survival was associated with older age, less recent period of diagnosis, lower hepatitis B prevalence in country of origin and greater area-level social disadvantage. CONCLUSIONS Over this study period, HCC incidence increased significantly. HCC survival improved but remains poor. Social determinants are critical to HCC epidemiology.
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Affiliation(s)
- Paul J Clark
- Cancer Control Unit, QIMR-Berghofer Medical Research Institute, Brisbane, Qld, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Qld, Australia.,School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Katherine A Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Barbara A Leggett
- School of Medicine, University of Queensland, Brisbane, Qld, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | | | - Peter Boyd
- Cairns Base Hospital, Cairns, Qld, Australia
| | - Jonathan Fawcett
- School of Medicine, University of Queensland, Brisbane, Qld, Australia.,Hepato-Pancreato-Biliary Surgery Unit, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - David C Whiteman
- Cancer Control Unit, QIMR-Berghofer Medical Research Institute, Brisbane, Qld, Australia.,School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Peter D Baade
- School of Medicine, University of Queensland, Brisbane, Qld, Australia.,Epidemiology, Cancer Council Queensland, Brisbane, Qld, Australia
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Gory I, Fink M, Bell S, Gow P, Nicoll A, Knight V, Dev A, Rode A, Bailey M, Cheung W, Kemp W, Roberts SK. Radiofrequency ablation versus resection for the treatment of early stage hepatocellular carcinoma: a multicenter Australian study. Scand J Gastroenterol 2015; 50:567-76. [PMID: 25615260 DOI: 10.3109/00365521.2014.953572] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES It remains unclear whether radiofrequency ablation (RFA) provides comparable outcomes to surgical resection (SR). We, therefore, compared survival outcomes of RFA to SR in patients with early stage and very early stage hepatocellular carcinoma (HCC). METHODS A multicenter retrospective analysis was performed in patients from five academic hospitals with Barcelona Cancer of the Liver Clinic (BCLC) stages 0-A HCC having RFA or SR as primary therapy. RESULTS From 2000-2010, 146 patients who received treatment with RFA (n = 96) or SR (n = 52) were identified. In BCLC A patients with ≤5 cm HCC, there was a trend of lower overall survival after RFA compared with SR (3- and 5-year survival: 62% and 37% vs. 66% and 62% respectively; p = 0.11). By multivariate analysis, RFA was an independent predictor of poor survival (hazard ratio = 2.26; 95% confidence interval: 1.02-5.03; p = 0.04). In ≤3 cm HCC (n = 109), the 3- and 5-year survivals in RFA and SR groups were 66% and 39%, and 69% and 59%, respectively, with no difference in the median survival (p = 0.41). Local recurrence was significantly higher after RFA compared to SR in HCC ≤5 cm (p = 0.006) with a trend of lower recurrence-free survival (p = 0.06) after RFA in HCC ≤3 cm. There were fewer major complications after RFA (2% vs. 8%). CONCLUSION While SR is superior to RFA for the management of early stage BCLC A disease with ≤5 cm HCC, both appear effective as first-line treatment options for Western patients with small ≤3 cm tumors. Although safer than SR, RFA is associated with higher rates of tumor recurrence and local disease progression. Further prospective randomized controlled trials are warranted to compare these two modalities.
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Affiliation(s)
- Ilana Gory
- The Alfred Hospital , Melbourne , Australia
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24
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Wong RJ, Devaki P, Nguyen L, Cheung R, Cho-Phan C, Nguyen MH. Increased long-term survival among patients with hepatocellular carcinoma after implementation of Model for End-stage Liver Disease score. Clin Gastroenterol Hepatol 2014; 12:1534-40.e1. [PMID: 24361414 DOI: 10.1016/j.cgh.2013.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 11/14/2013] [Accepted: 12/06/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Assignment of Model for End-stage Liver Disease (MELD) exception points to patients with hepatocellular carcinoma (HCC) who fall within Milan criteria, which began in 2003, increases their priority on liver transplantation waitlists. However, little is known about how this change affected survival of all patients with HCC (transplant eligible and ineligible). We compared long-term survival of HCC patients before and after this change. METHODS We performed a large population-based cohort study by using the Surveillance, Epidemiology, and End Results cancer registry to investigate survival times of patients with HCC before those who met the Milan criteria were given MELD exception points (1998-2003) and afterward (2004-2010) by using Kaplan-Meier methods. Multivariate Cox proportional hazards models evaluated independent predictors of survival. RESULTS During 2004-2010, a significantly higher percentage of patients with HCC survived for 5 years compared with 1998-2003 (21.9% vs 13.0%, P < .001). This difference remained significant among all treatment groups (no therapy: 15.2% vs 10.2%, P < .001; local tumor destruction: 37.6% vs 22.1%, P < .001; resection: 55.5% vs 39.2%, P < .001; transplantation: 77.2% vs 73.1%, P = .12). Multivariate Cox proportional hazards models, inclusive of sex, age, ethnicity, Milan criteria, number and stage of tumor, and time period, showed increased survival of patients during 2004-2010 (hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.83-0.91; P < .001). Compared with non-Hispanic whites, Asians (HR, 0.81; 95% CI, 0.77-0.86; P < .001) and Hispanics (HR, 0.89; 95% CI, 0.84-0.95; P < .001) had longer survival times, whereas blacks had a trend toward shorter survival times (HR, 1.05; 95% CI, 0.98-1.13; P = .16). CONCLUSIONS Patients with HCC who met Milan criteria had significantly longer survival times after implementation of the MELD exception points, regardless of sex or ethnicity. Blacks continued to have the lowest rates of 5-year survival.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Pardha Devaki
- Department of Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, Michigan
| | - Long Nguyen
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Cheryl Cho-Phan
- Division of Medical Oncology, Stanford University Medical Center, Stanford, California
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California.
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Fatima S, Luk JM, Poon RTP, Lee NP. Dysregulated expression of dickkopfs for potential detection of hepatocellular carcinoma. Expert Rev Mol Diagn 2014; 14:535-48. [PMID: 24809435 DOI: 10.1586/14737159.2014.915747] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The prognosis for hepatocellular carcinoma (HCC) remains dismal due to the lack of diagnostic markers for early detection. This review will discuss the clinical potential of the dickkopf (DKK) family members as diagnostic and/or prognostic markers for HCC. In comparison to serum α-fetoprotein (AFP) level, which remains the gold standard for HCC diagnosis, high serum DKK1 levels have higher diagnostic value for HCC, especially for AFP-negative HCC, and can distinguish HCC from non-malignant chronic liver diseases. Additionally, the combination of serum DKK1 and AFP levels enhances diagnostic accuracy for HCC compared to serum DKK1 or AFP levels alone. Although DKK1 offers potential for its use in HCC diagnosis this review will discuss the challenges facing DKK1 and also shed some light on recent developments on the remaining DKK family members: DKK2, DKK3 and DKK4.
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Affiliation(s)
- Sarwat Fatima
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
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26
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Wong N, Haydon A, Kemp W, Wijeratne P, Roberts S. Improved survival trend of patients with hepatocellular carcinoma at an Australian tertiary hospital between 1995-2009. Intern Med J 2013; 43:197-203. [PMID: 22372378 DOI: 10.1111/j.1445-5994.2012.02755.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 02/08/2012] [Indexed: 01/02/2023]
Abstract
AIM To evaluate trends in survival of patients with hepatocellular carcinoma (HCC) at The Alfred over a 15-year period from 1995-2009 METHODS A retrospective cohort study of patients with HCC comparing epidemiology, clinical presentation, treatment parameters and overall survival of those diagnosed between 1995-2001 and 2002-2009. Overall survival of patients with primary liver cancer. RESULTS The study population consisted of 215 patients; 110 diagnosed between 1995-2001 (Cohort A) and 105 between 2002-2009 (Cohort B). Overall survival increased significantly between 1995-2010 (P = 0.016); median survival was 365 days in Cohort A compared with 665 in Cohort B. The improvement in survival was associated with an increase in the proportion of cases detected at an asymptomatic stage (P = 0.012), a decline in the severity of liver disease at diagnosis (P = 0.002) and increased utilisation of loco-regional therapy (P = 0.001) over the same period. Survival of patients detected through screening was significantly higher than those detected through non-screening methods (1309 vs 233 days, P < 0.001). CONCLUSIONS The survival of patients with HCC managed at a tertiary referral centre has improved over the period 1995-2009. This improvement may relate to the increased detection of the disease at an asymptomatic stage (e.g. through screening) as well as increased utilisation of effective loco-regional therapies for HCC.
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Affiliation(s)
- N Wong
- Department of Medical Oncology, The Alfred, Melbourne, Victoria, Australia
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Fenoglio L, Serraino C, Castagna E, Cardellicchio A, Pomero F, Grosso M, Senore C. Epidemiology, clinical-treatment patterns and outcome in 256 hepatocellular carcinoma cases. World J Gastroenterol 2013; 19:3207-3216. [PMID: 23745022 PMCID: PMC3671072 DOI: 10.3748/wjg.v19.i21.3207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/30/2013] [Accepted: 03/15/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the epidemiology, clinical characteristics, treatment patterns and outcome in hepatocellular carcinoma (HCC) patients.
METHODS: We analyzed clinical, pathological and therapeutic data from 256 consecutive patients, examined at S. Croce Hospital in Cuneo-Piedmont, with a diagnosis of HCC between 30th June 2000 and 1st July 2010. We analyzed the hospital imaging database and examined all medical records, including the diagnosis code for HCC (155.0 according to the ICD-9M classification system), both for inpatients and outpatients, and discovered 576 relevant clinical records. After the exclusion of reports relating to multiple admissions for the same patient, we identified 282 HCC patients. Moreover, from this HCC series, we excluded 26 patients: 1 patient because of an alternative final diagnosis, 8 patients because of a lack of complete clinical data in the medical record and 17 patients because they were admitted to different health care facilities, leaving 256 HCC patients. To highlight possible changes in HCC patterns over the ten-year period, we split the population into two five-year groups, according to the diagnosis period: 30th June 2000-30th June 2005 and 1st July 2005-1st July 2010. Patients underwent a 6-mo follow up.
RESULTS: Two hundred and fifty-six HCC patients were included (male/female 182/74; mean age 70 years), 133 in the first period and 123 in the second. Hepatitis C virus (HCV) infection was the most common HCC risk factor (54.1% in the first period, 50.4% in the second; P = 0.63); in the first period, 21.8% of patients were alcoholics and 15.5% were alcoholics in the second period (P > 0.05); the non-viral/non-alcoholic etiology rate was 3.7% in the first period and 20.3% in the second period (P < 0.001). Child class A patients increased significantly in the second period (P < 0.001). Adjusting for age, gender and etiology, there was a significant increase in HCC surveillance during the second period (P = 0.01). Differences between the two periods were seen in tumor parameters: there was an increase in the number of unifocal HCC patients, from 53 to 69 (P = 0.01), as well as an increase in the number of cases where the HCC was < 3 cm [from 22 to 37 (P = 0.01)]. The combined incidence of stage Barcelona Clinic Liver Cancer 0 (very-early) and A (early) HCC was 46 (34.6%) between 2000-2005, increasing to 62 (50.4%) between 2005-2010 (P = 0.01). Of the patients, 62.4% underwent specific treatment in the first group, which increased to 90.2% in the second group (P < 0.001). Diagnosis period (P < 0.01), Barcelona-Clinic Liver Cancer stage (P < 0.01) and treatment per se (P < 0.05) were predictors of better prognosis; surveillance was not related to survival (P = 0.20).
CONCLUSION: This study showed that, between 2000-2005 and 2005-2010, the number of HCV-related HCC decreased, non-viral/non alcoholic etiologies increased and of surveillance programs were more frequently applied.
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Fatima S, Lee NP, Tsang FH, Kolligs FT, Ng IOL, Poon RTP, Fan ST, Luk JM. Dickkopf 4 (DKK4) acts on Wnt/β-catenin pathway by influencing β-catenin in hepatocellular carcinoma. Oncogene 2012; 31:4233-44. [PMID: 22249261 DOI: 10.1038/onc.2011.580] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/17/2011] [Accepted: 11/09/2011] [Indexed: 12/18/2022]
Abstract
Deregulation of Wnt/β-catenin pathway is a hallmark of major gastrointestinal cancers including hepatocellular carcinoma (HCC). The oncogenic role of β-catenin is well defined but reasons for its accumulation in HCC remain unclear. Dickkopf 4 (DKK4) acts as a negative regulator of Wnt/β-catenin pathway but its functional role in liver carcinogenesis has not been studied. We investigated the role of DKK4 in β-catenin regulation in HCC. Reduced expression of DKK4 was found in 47% (38/81) of HCC, as measured by quantitative real time PCR. Ectopic expression of DKK4 in two HCC cell lines, PLC/PRF/5 (PLC) and MHCC97L (97L), attenuated β-catenin responsive luciferase activity, and decreased both β-catenin and cyclin D1 protein levels. To study the effect of DKK4 on cell growth and tumourigenicity, two stable HCC cell lines were established from PLC and 97L cells. Functional assays demonstrated that overexpression of DKK4 hampered cell proliferation, reduced colony formation and retarded cell migration. When DKK4-expressing 97L stable cells were used to induce tumour xenografts in nude mice (n=8), reduction in tumour sizes was observed (P=0.027). Furthermore, immunohistochemical studies showed that decreased expression of DKK4 was associated with β-catenin accumulation in HCC tissues. Additionally, inhibition of the proteasome using specific inhibitor in DKK4-expressing 97L stable cells masked the effect of β-catenin. Our findings suggest a potential tumour suppressive role of DKK4 as well as that of an important regulator of HCC.
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Affiliation(s)
- S Fatima
- Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong
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30
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Muszbek N, Kreif N, Valderrama A, Benedict A, Ishak J, Ross P. Modelling survival in hepatocellular carcinoma. Curr Med Res Opin 2012; 28:1141-53. [PMID: 22563794 DOI: 10.1185/03007995.2012.691422] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To identify the pattern of the risk of death over long-term in unresectable hepatocellular carcinoma by determining the appropriate distribution to extrapolate overall survival and to assess the role of the Weibull distribution as the standard survival model in oncology. RESEARCH DESIGN AND METHODS To select the appropriate distribution, three types of data sources have been analysed. Patient level data from two randomized controlled trials and published Kaplan-Meier curves from a systematic literature review provided short term follow-up data. They were supplemented with patient level data, with long-term follow-up from the Cancer Institute New South Wales, Australia. Published Kaplan-Meier curves were read in and a time-to-event dataset was created. Distributions were fitted to the data from the different sources separately. Their fit was assessed visually and compared using statistical criteria based on log-likelihood, the Akaike information criterion (AIC), and the Bayesian information criterion (BIC). RESULTS Based on both published and patient-level, and both short- and long-term follow-up data, the Weibull distribution, used very often in cost-effectiveness models in oncology, does not seem to offer a good fit in hepatocellular carcinoma among the different survival models. The best fitting distribution appears to be the lognormal, with loglogistic as the second-best fitting function. Results were consistent between the different sources of data. CONCLUSIONS In unresectable hepatocellular carcinoma, the Weibull model, which is often treated at the gold standard, does not appear to be appropriate based on different sources of data (two clinical trials, a retrospective database and published Kaplan-Meier curves). Lognormal distribution seems to be the most appropriate distribution for extrapolating overall survival.
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Walter SR, Thein HH, Gidding HF, Amin J, Law MG, George J, Dore GJ. Risk factors for hepatocellular carcinoma in a cohort infected with hepatitis B or C. J Gastroenterol Hepatol 2011; 26:1757-64. [PMID: 21615789 DOI: 10.1111/j.1440-1746.2011.06785.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM The incidence of hepatocellular carcinoma (HCC) has increased in Australia in recent decades, a large and growing proportion of which occurs among a population chronically infected with hepatitis B virus (HBV) or hepatitis C virus (HCV). However, risk factors for HCC among these high-risk groups require further characterization. METHODS We conducted a population-based cohort study using HBV and HCV cases notified to the New South Wales Health Department between 2000 and 2007. These were linked to cause of death data, HIV/AIDS notifications, and hospital records. Proportional hazards regression was used to identify significant risk factors for developing HCC. RESULTS A total of 242 and 339 HCC cases were linked to HBV (n = 43 892) and HCV (n = 83 817) notifications, respectively. For both HBV and HCV groups, being male and increasing age were significantly associated with risk of HCC. Increasing comorbidity score indicated high risk, while living outside urban areas was associated with lower risk. Hazard ratios for males were two to three times those of females. For both HBV and HCV groups, cirrhosis, alcoholic liver disease, and the interaction between the two were associated with significantly and considerably elevated risk. CONCLUSION This large population-based study confirms known risk factors for HCC. The association with older age highlights the potential impact of HBV and HCV screening of at-risk groups and early clinical assessment. Additional research is required to evaluate the impact of improving antiviral therapy on HCC risk.
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Affiliation(s)
- Scott R Walter
- The Kirby Institute, The University of New South Wales, Australia
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Yang L, Marx H, Yen Y. Early finding of chest wall metastasis of hepatocellular carcinoma in a woman by fluorodeoxyglucose-positron emission tomography scan: a case report. J Med Case Rep 2011; 5:147. [PMID: 21489297 PMCID: PMC3089792 DOI: 10.1186/1752-1947-5-147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 04/13/2011] [Indexed: 01/18/2023] Open
Abstract
Introduction The use of fluorodeoxyglucose-positron emission tomography to evaluate well-differentiated hepatocellular carcinomas is facing critical problems. It is reported that the activity of fluorodeoxyglucose-6-phosphatase, which converts fluorodeoxyglucose-6-phosphatase to fluorodeoxyglucose, is high in normal liver cells. However, the enzyme-converting activity of glucose-6-phosphatase of well-differentiated hepatocellular carcinomas is similar to normal liver tissue. Thus, using fluorodeoxyglucose in diagnosing primary hepatocellular carcinomas is difficult. However, using fluorodeoxyglucose to detect extrahepatic metastasis of hepatocellular carcinomas is still possible. Case presentation We describe the case of a 45-year-old Chinese woman who developed a recurrent lesion in the chest wall from a previous surgically resected hepatocellular carcinoma. This recurrent lesion was detected first on the basis of a positron emission tomography scan, then on the basis of a computed tomography scan and other clinical tests. Conclusion This finding indicates that the positron emission tomography scan is a potentially reliable tool to screen for systemic metastatic disease in patients with hepatocellular carcinomas when other cross-sectional imaging tests such as computed tomography or magnetic resonance imaging are negative.
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Affiliation(s)
- Lixin Yang
- Department of Medical Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
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Mohran ZY, Ali-Eldin FA, Abdel Aal HA. Serum interleukin-18: does it have a role in the diagnosis of hepatitis C virus related hepatocellular carcinoma? Arab J Gastroenterol 2011; 12:29-33. [PMID: 21429452 DOI: 10.1016/j.ajg.2010.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 09/02/2010] [Accepted: 11/18/2010] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND STUDY AIMS Early diagnosis of hepatocellular carcinoma (HCC) is the only hope for cure. Although the role of alpha foetoprotein (AFP) in the diagnosis of advanced HCC is well recognised, at least one-third of cases will be missed unless another diagnostic tool is used. Increased levels of circulating interleukin-18 (IL-18) have been observed in patients with several cancer types and were described in patients with chronic hepatitis. The aim of this study is to assess the role of serum IL-18 level in the diagnosis of hepatitis C virus (HCV)-related HCC. PATIENTS AND METHODS A total of 75 subjects categorised into four groups, including 25 patients with HCV-related HCC and AFP above 200ng/ml, 25 patients with HCV-related HCC and AFP below 200ng/ml, 15 patients with HCV-related chronic liver disease and 10 healthy controls, were enrolled. HCC was diagnosed according to guidelines of the American Association for the Study of Liver Diseases. AFP and IL-18 were assessed in all subjects. RESULTS AFP and IL-18 levels are significantly higher in patients with HCC than in disease control and healthy control subjects. IL-18 level is not correlating with the size or the number of hepatic focal lesions neither with the presence of lymphovascular invasion or abdominal lymphadenopathy. The best cut-off value of IL-18 for the diagnosis of HCC is 500pg/ml with 84% sensitivity and 86.7% specificity and the area under receiver operating characteristic curve is 0.675. CONCLUSION Serum IL-18 level is a suitable marker for the diagnosis of HCV-related HCC complementary to AFP, especially in cases with AFP level less than the diagnostic value.
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Affiliation(s)
- Zakaria Y Mohran
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Abbasseya Square, Cairo, Egypt
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Nguyen TT, McPhee SJ, Stewart S, Gildengorin G, Zhang L, Wong C, Maxwell AE, Bastani R, Taylor VM, Chen MS. Factors associated with hepatitis B testing among Vietnamese Americans. J Gen Intern Med 2010; 25:694-700. [PMID: 20306150 PMCID: PMC2881980 DOI: 10.1007/s11606-010-1285-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 01/22/2010] [Accepted: 01/30/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic hepatitis B and hepatitis B-associated liver cancer is a major health disparity among Vietnamese Americans, who have a chronic hepatitis B prevalence rate of 7-14% and an incidence rate for liver cancer six times that of non-Latino whites. OBJECTIVE Describe factors associated with hepatitis B testing among Vietnamese Americans. DESIGN A population-based telephone survey conducted in 2007-2008. PARTICIPANTS Vietnamese Americans age 18-64 and living in the Northern California and Washington, DC areas (N = 1,704). MAIN MEASURES Variables included self-reports of sociodemographics, health care factors, and hepatitis B-related behaviors, knowledge, beliefs, and communication with others. The main outcome variable was self-reported receipt of hepatitis B testing. KEY RESULTS The cooperation rate was 63.1% and the response rate was 27.4%. Only 62% of respondents reported having received a hepatitis B test and 26%, hepatitis B vaccination. Only 54% knew that hepatitis B could be transmitted by sexual intercourse. In multivariable analyses, factors negatively associated with testing included: age 30-49 years, US residence for >10 years, less Vietnamese fluency, lower income, and believing that hepatitis B can be deadly. Factors positively associated with testing included: Northern California residence, having had hepatitis B vaccination, having discussed hepatitis B with family/friends, and employer requested testing. Physician recommendation of hepatitis B testing (OR 4.46, 95% CI 3.36, 5.93) and respondent's request for hepatitis B testing (OR 8.37, 95% CI 5.95, 11.78) were strongly associated with test receipt. CONCLUSION Self-reports of hepatitis B testing among Vietnamese Americans remain unacceptably low. Physician recommendation and patient request were the factors most strongly associated with test receipt. A comprehensive effort is needed to promote hepatitis B testing in this population, including culturally-targeted community outreach, increased access to testing, and physician education.
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Affiliation(s)
- Tung T Nguyen
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.
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Kuo YH, Lu SN, Chen CL, Cheng YF, Lin CY, Hung CH, Chen CH, Changchien CS, Hsu HC, Hu TH, Lee CM, Wang JH. Hepatocellular carcinoma surveillance and appropriate treatment options improve survival for patients with liver cirrhosis. Eur J Cancer 2010; 46:744-51. [PMID: 20060710 DOI: 10.1016/j.ejca.2009.12.018] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 12/10/2009] [Accepted: 12/14/2009] [Indexed: 01/12/2023]
Abstract
OBJECTIVE/AIM Hepatocellular carcinoma (HCC) surveillance is a common practice for patients with liver cirrhosis. The aims of the study were to assess impacts of surveillance and therapeutic options on survival of patients with HCC. METHODS A total of 1436 cirrhotic patients with newly diagnosed HCC were enrolled between January 2002 and December 2004. Patients with HCC detected within periodic surveillance were the surveillance group (n=318, 22.1%). The other patients with HCC incidentally detected were the non-surveillance group (n=1118, 77.95%). Initial treatment options were recorded and overall survival was analysed. RESULTS Compared with patients in the non-surveillance group, larger proportions of patients in the surveillance group possessed small tumours, at an early stage without vascular invasion or metastases, and afforded more curative treatment options including surgical resection, radiofrequency ablation and percutaneous ethanol injection. The overall survival was better for patients in surveillance (3-year survival rate: 59.1% versus 29.3%, p<0.001), early stages by Barcelona Clinic Liver Cancer (BCLC) staging or curative treatment options. Multivariate analysis demonstrated surveillance, hepatitis aetiology, alpha-fetoprotein, tumour gross type, tumour stage and treatment options were associated factors for patients' survival. Moreover, surveillance patients in curative BCLC stage following the treatment guideline for HCC proposed by the American association for the study of liver disease (AASLD) had a significantly better 3-year survival rate (77.1% versus 55.2%, p<0.001). CONCLUSIONS HCC surveillance for cirrhotic patients could detect HCC at early and curative stages. However, appropriate treatment options following AASLD guideline further improve the survival for patients in early stage.
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Affiliation(s)
- Yuan-Hung Kuo
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123 Ta-Pei Rd., Niao-Sung, Kaohsiung County 819, Taiwan
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Fassio E, Díaz S, Santa C, Reig ME, Martínez Artola Y, Alves de Mattos A, Míguez C, Galizzi J, Zapata R, Ridruejo E, de Souza FC, Hernández N, Pinchuk L. Etiology of hepatocellular carcinoma in Latin America: a prospective, multicenter, international study. Ann Hepatol 2010; 9:63-69. [PMID: 20332549 DOI: 10.1016/s1665-2681(19)31681-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND/AIMS No prospective study has been published investigating etiology of HCC in Latin America. The primary aim of this prospective study was to analyze the etiology of liver disease in patients with HCC from our area. Secondary aims were to evaluate staging using Okuda and BCLC classifications; and percentage of patients receiving treatment. METHODS The Governing Board of the Latin American Association for the Study of the Liver designed the protocol. During a 18 month period, all members were invited to load their incident HCC cases on line. RESULTS 240 cases from 9 countries were uploaded, 174 were male (72.5%), median age was 64 years, interquartile range 57-72. In 85.4% of cases, patients had underlying cirrhosis. Main etiological factors were: HCV in 74 patients (30.8%), alcohol in 49 (20.4%), cryptogenic cirrhosis in 35 (14.6%), HBV in 26 (10.8%), HCV plus alcohol in 14 (5.8%). Considering the combinations, hepatitis C was shown in 91 patients (38%); chronic alcoholism in 68 patients (28%); and hepatitis B in 33 patients (14%). There were no significant differences between the groups in the age at diagnosis. Percentage of male gender was higher in groups of alcohol (94%), HCV plus alcohol (93%) and HBV (85%) than in cryptogenic cirrhosis (60%) and HCV (59%) (p<0.001). CONCLUSIONS Our prospective study showed that hepatitis C is the more frequent etiology of HCC in Latin America, followed by alcoholic cirrhosis. Demographical results showed a male predominance (male:female ratio 2.6) with an important proportion of patients being diagnosed at their sixties.
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Affiliation(s)
- Eduardo Fassio
- Hospital Nacional Prof. A. Posadas, Buenos Aires, Argentina.
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Andreana L, Isgrò G, Pleguezuelo M, Germani G, Burroughs AK. Surveillance and diagnosis of hepatocellular carcinoma in patients with cirrhosis. World J Hepatol 2009; 1:48-61. [PMID: 21160965 PMCID: PMC2998953 DOI: 10.4254/wjh.v1.i1.48] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 09/11/2009] [Accepted: 09/18/2009] [Indexed: 02/06/2023] Open
Abstract
Early identification of hepatocellular carcinoma (HCC) is more frequent because of surveillance programs for HCC worldwide. The optimal strategy of surveillance in cirrhosis is a current topical issue. In terms of diagnosis, recent advances in non-invasive imaging technology, including various techniques of harmonic ultrasound, new ultrasound contrast agents, multi-slice helical computed tomography and rapid high quality magnetic resonance, have all improved the accuracy of diagnosis. Consequently the role of liver biopsy in diagnosis of HCC has declined. The imaging diagnosis relies on the hallmark of arterial hypervascularity with portal venous washout. However, with recent advances in genomics and proteomics a great number of potential serum and tissue markers have been identified and are being developed as new candidate markers for both diagnosis and prognosis of hepatocellular carcinoma, and may increase the need for liver biopsy.
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Affiliation(s)
- Lorenzo Andreana
- Lorenzo Andreana, Graziella Isgrò, Maria Pleguezuelo, Giacomo Germani, Andrew K Burroughs, The Royal Free Sheila Sherlock Liver Center, Departement of Surgery, Royal Free Hospital, London, NW3 2QG, United Kingdom
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Nguyen VTT, Amin J, Law MG, Dore GJ. Predictors and survival in hepatitis B-related hepatocellular carcinoma in New South Wales, Australia. J Gastroenterol Hepatol 2009; 24:436-42. [PMID: 19175834 DOI: 10.1111/j.1440-1746.2008.05577.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Incidence and mortality of hepatocellular carcinoma (HCC) has increased markedly over the last three decades in Australia. An increasing proportion of HCC cases is related to chronic viral hepatitis including hepatitis B virus (HBV) infection. However, there is very limited data on HBV-related HCC survival. METHODS Data on HBV-related HCC cases was obtained from a community-based linkage study. HCC cases notified to the New South Wales (NSW) Central Cancer Registry (CCR) during the period 1994-2002 were linked to HBV notifications from the NSW Health Department. Age, sex, country of birth, year of diagnosis, tumor stage were extracted from the CCR database. Survival analysis was conducted to determine median survival and identify predictors of survival. RESULTS Over the 9-year study period, 278 HCC cases were linked to chronic HBV infection. The majority of cases were male (83.5%) and overseas-born (93.6%); Asian-born cases accounted for 72.1%. Median survival following HCC diagnosis was 15.0 months. HCC survival was poorer among older age groups (P < 0.0001), and among cases with regional spread (hazard ratio, 3.23; 95% confidence interval, 1.83-5.69; P < 0.0001) and distant metastases (hazard ratio, 3.85; 95% confidence interval, 2.44-6.08; P < 0.0001). Sex, region of birth and study period (1994-1997 vs 1998-2002) were not associated with HCC survival. CONCLUSION The vast majority of HBV-related HCC were overseas-born, however, region of birth was unrelated to HCC survival. The continued extremely poor HCC survival, including lack of improvement in HCC survival in more recent years, suggests low uptake of HCC screening programs. Public health strategies including early diagnosis and appropriate referral for antiviral therapy assessment and increased HCC screening among high-risk populations are required to reduce HCC incidence and improve HCC survival.
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Affiliation(s)
- Van T T Nguyen
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
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Muszbek N, Shah S, Carroll S, McDonald H, Dale P, Maroun J, Knox J. Economic evaluation of sorafenib in the treatment of hepatocellular carcinoma in Canada. Curr Med Res Opin 2008; 24:3559-69. [PMID: 19032137 DOI: 10.1185/03007990802563706] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND A randomized phase III trial of sorafenib vs. placebo in hepatocellular carcinoma (HCC) demonstrated that sorafenib significantly prolonged overall survival (OS) compared to placebo. RESEARCH DESIGN AND METHODS A Markov model was developed to evaluate the cost-effectiveness of sorafenib vs. best supportive care (BSC) in HCC from the perspective of the Canadian provincial Ministry of Health. The model followed survival and time to progression (TTP) in monthly cycles based on the extrapolation of patient level trial data. Health effects were expressed as life-years gained (LYG). Resource use included drugs, physician visits, laboratory tests, scans, and hospitalizations. Unit costs were gathered from public sources and were expressed in 2007 Canadian Dollars. Costs and effects were evaluated over a lifetime and discounted at 5%. Results were presented as mean +/- standard deviation. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS LYG was longer for sorafenib (1.52 +/- 0.16 vs. 1.03 +/- 0.09 LYG/patient for sorafenib and BSC, respectively). The lifetime total costs were $47,511 +/- 3 656 for sorafenib and $10,376 +/- 1 649 for BSC, resulting in an incremental cost-effectiveness ratio (ICER) of $75,821/LYG, and deterministic ICER of $75,759/LYG. The results were most sensitive to OS, TTP and BSC costs after progression. Sensitivity analyses results showed that the model was robust. CONCLUSIONS The economic evaluation indicates that sorafenib is cost-effective as compared to BSC in HCC. Limitations include multiple data sources, use of expert opinion for resource use, and the lack of utility data.
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Racial and ethnic variations in hepatocellular carcinoma incidence within the United States. Am J Med 2008; 121:525-31. [PMID: 18501235 DOI: 10.1016/j.amjmed.2008.03.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 02/22/2008] [Accepted: 03/04/2008] [Indexed: 12/29/2022]
Abstract
BACKGROUND The increasing incidence of hepatocellular carcinoma coupled with this cancer's high mortality is a public health problem. Delineating high-risk populations and cancer patterns can provide valuable information. This is necessary to broaden screening and surveillance guidelines related to early detection and prevention. METHODS By using data collected by the Surveillance, Epidemiology, and End Results program, a population-based cancer registry in the United States, our retrospective cohort study evaluated sex-specific, race/ethnicity-specific, and age-specific variations in hepatocellular carcinoma incidence from 1992 to 2004. RESULTS With men and women combined, the incidence of hepatocellular carcinoma among Asians was the highest, nearly double that of white Hispanics (11.0 vs 6.8 per 100,000/y), and more than 4 times higher than that of Caucasians (11.0 vs 2.6 per 100,000/y). Although male subjects demonstrated a doubling of cancer rates every 10 years from 30 to 50 years of age, female subjects reached male-comparable rates of cancer 10 to 15 years later and peaked at significantly lower values for all race and ethnic groups. CONCLUSION Marked differences in the incidence rates of hepatocellular carcinoma by sex, ethnicity, and age of diagnosis likely represent variations in risk factor distributions (eg, viral hepatitis) and possibly in host genetics or other environmental factors. An individualized approach tailored to specific risk profiles may more effectively identify treatable tumors than more general guidelines.
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Nguyen VTT, Razali K, Amin J, Law MG, Dore GJ. Estimates and projections of hepatitis B-related hepatocellular carcinoma in Australia among people born in Asia-Pacific countries. J Gastroenterol Hepatol 2008; 23:922-9. [PMID: 17608637 DOI: 10.1111/j.1440-1746.2007.05065.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM Australia has increasing immigration from hepatitis B virus (HBV) endemic countries of the Asia-Pacific region (APR). This study estimates immigration-related chronic HBV cases, chronic HBV prevalence, and HBV-related hepatocellular carcinoma (HCC) from 1960 to 2005 and projects HBV-related HCC to 2025 in Australia among people born in the APR. METHODS The populations of APR origin for the period 1960-2005 were derived from Australian census data. HBV prevalence from population-based sero surveys in the APR countries was used to estimate new chronic HBV cases (immigrant arrivals per year with chronic HBV). Age-specific incidence rates of HCC derived from a Taiwanese population-based study were used to estimate and project HBV-related HCC. RESULTS Chronic HBV cases among APR-born population increased rapidly from the late 1970s reaching a peak of 4182 in 1990. Chronic HBV prevalence increased to >53 000 in 2005. Estimates of HBV-related HCC increased linearly from one in 1960 to 140 in 2005, with a projected increase to 250 in 2025. Universal HBV vaccination programs in countries of origin had limited impact on projected HBV-related HCC to 2025. CONCLUSION The burden of chronic HBV including HBV-related HCC among APR-born Australians has increased over the past three decades and is projected to increase further during the next two decades.
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Affiliation(s)
- Van Thi Thuy Nguyen
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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Chemoembolization of hepatocellular carcinoma: patient status at presentation and outcome over 15 years at a single center. AJR Am J Roentgenol 2008; 190:608-15. [PMID: 18287429 DOI: 10.2214/ajr.07.2879] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We report the outcome of the care of 209 patients with hepatocellular carcinoma with a focus on relevant scoring systems for predicting overall survival and time to progression and on changes in presentation status and outcome from 1991 to 2006. MATERIALS AND METHODS Hepatic arterial chemoembolization was performed on 209 patients in 375 sessions. Disease status was evaluated with the Child-Pugh, Okuda, Cancer of the Liver Italian Program, and American Joint Committee on Cancer (AJCC) systems. Changes in status at presentation from 1991 to 2006 and change in overall survival period and time to progression were analyzed. RESULTS Median and mean overall survival periods for the entire group were 376 and 574 +/- 61 days. Median and mean times to progression were 267 and 409 +/- 54 days. Forty-nine patients underwent liver transplantation a median of 143 days after chemoembolization. The median and mean overall survival times among patients not undergoing transplantations were 466 and 574 +/- 61 days. Okuda score (p < 0.0001) and AJCC stage (p = 0.014) were the best predictors of overall survival and time to progression, respectively. Patients with disease with an Okuda I score and in AJCC stage I or II had median and mean overall survival periods of 667 and 992 +/- 176 days and times to progression of 378 and 589 +/- 110 days. Clinical status at presentation, overall survival period (p = 0.64), and time to progression (p = 0.44) were unchanged from 1991 to 2006. The 30-day mortality was 3.2%. CONCLUSION Patients treated with hepatic arterial chemoembolization for HCC in Okuda score I and AJCC stage I or II have more durable survival than previously reported in a U.S. population.
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Changing Paradigm in the Management of Hepatocellular Carcinoma Improves the Survival Benefit of Early Detection by Screening. Ann Surg 2008; 247:666-73. [DOI: 10.1097/sla.0b013e31816a747a] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Amin J, O'Connell D, Bartlett M, Tracey E, Kaldor J, Law M, Dore G. Liver cancer and hepatitis B and C in New South Wales, 1990-2002: a linkage study. Aust N Z J Public Health 2008; 31:475-82. [PMID: 17931297 DOI: 10.1111/j.1753-6405.2007.00121.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/AIMS Hepatocellular carcinoma (HCC) incidence has increased in Australia in the past 20-30 years. We conducted a community-based linkage study to examine the characteristics of hepatocellular carcinoma with particular reference to hepatitis B and C infections. METHODS Hepatocellular carcinoma cases (n=2,072) notified to the New South Wales (NSW) Central Cancer Registry from 1990 to 2002 were probabilistically linked to HBV and HCV diagnoses notified to NSW Health. Sex, age, year of diagnosis, region of birth, method of diagnosis and spread at diagnosis and survival were compared by linkage group. RESULTS Hepatocellular carcinoma incidence increased from 1.4/100,000 in 1990 to 2.8/100,000 in 2002. Incidence varied by region of birth (p<0.001), with people born in Vietnam having the highest relative rate compared with those born in Australia (RR=11.7, 95% CI 9.8-13.8). Of the hepatocellular carcinoma records, 15.6%, 12.9% and 0.8% were linked to hepatitis B, hepatitis C and hepatitis B/C co-infection respectively and 70.7% were unlinked. Median age at diagnosis of HCV-related hepatocellular carcinoma varied markedly at 51, 68 and 71 years for Australian, European, and Asian-born groups, respectively (p<0.0001). CONCLUSION Contrasting age distribution of HCV-related HCC by country/region of birth is consistent with divergent patterns of HCV transmission. IMPLICATIONS These data highlight the increase in HCC in NSW and the divergent populations whose needs in terms of treatment, care and prevention will need to be met.
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Affiliation(s)
- Janaki Amin
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales.
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Bartlett ASJR, McCall JL, Koea JB, Holden A, Yeong ML, Gurusinghe N, Gane E. Liver resection for hepatocellular carcinoma in a hepatitis B endemic area. World J Surg 2007; 31:1775-1781. [PMID: 17610112 DOI: 10.1007/s00268-007-9069-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 02/13/2007] [Accepted: 03/04/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver. Treatment options include liver resection, tumor ablation, and liver transplantation. METHODS We report the results of all patients undergoing partial hepatectomy for HCC with curative intent from a center where all major treatment modalities were available. RESULTS A series of 53 patients were identified, of whom 72% had underlying liver disease, mostly chronic hepatitis B infection. Altogether, 57% of patients underwent major resections, of whom 43% had histologically proven cirrhosis. Postoperative morbidity and mortality occurred in 41.5% and 7.5%, respectively. After a median follow-up of 34 months, the survival probabilities at 1, 3, and 5 years were 74.1%, 54.1%, and 42.6%, respectively. A total of 47% developed recurrent disease over the study period with a median disease-free survival of 13.8 months. The probabilities of recurrence at 1, 3, and 5 years were 35.2%, 49.4%, and 55.9%, respectively. Among those who developed recurrence, 76% died, with a median time to death from the time the recurrence was diagnosed of 7.8 months. There was a good association between the CLIP score and survival following liver resection. Multivariate analysis showed that only tumor recurrence and the presence of cirrhosis was a significant determinant of the risk of tumor-related death. CONCLUSION These findings confirm that with careful patient selection liver resection for HCC can achieve good long-term patient survival and acceptable risks.
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Affiliation(s)
- Adam St J R Bartlett
- Department of Hepatobiliary and Transplant Surgery, New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand
| | - John L McCall
- Department of Hepatobiliary and Transplant Surgery, New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand.
| | - Jonathan B Koea
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Andrew Holden
- Department of Hepatobiliary and Transplant Surgery, New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand
| | - Mee-Ling Yeong
- Department of Hepatobiliary and Transplant Surgery, New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand
| | | | - Ed Gane
- Department of Hepatobiliary and Transplant Surgery, New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand
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Gellert L, Jalaludin B, Levy M. Hepatocellular carcinoma in Sydney South West: late symptomatic presentation and poor outcome for most. Intern Med J 2007; 37:516-22. [PMID: 17543001 DOI: 10.1111/j.1445-5994.2007.01392.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Hepatocellular cancer (HCC) is a serious complication of cirrhosis and chronic hepatitis B infection. The aim of the study was to determine the characteristics of patients with HCC presenting within the South West Sydney area, including an analysis of the rates and benefits of hepatocellular surveillance. METHODS Data from patients with HCC presenting to Liverpool and Bankstown Hospitals from July 1993 to June 2003 were analysed retrospectively, predominantly from hospital records. RESULTS Of the 151 HCC patients, 41% were Asian born. Most of the patients required an interpreter. Chronic viral hepatitis infection was present in 91 patients, of whom only 7% had previously received antiviral therapy. Alcohol alone was considered responsible in 31 patients. Cirrhosis could be documented in 58% of patients. Most of the patients (75%) presented symptomatically. The median survival was 5.1 months. When HCC was detected by surveillance, the tumours were slightly but not significantly more likely to be operable and the patients tended to be offered some form of active treatment more frequently. Multivariate analysis identified detection by surveillance, lower Child-Pugh score, smaller tumour size and eligibility for some form of treatment to be associated with a more favourable outcome. CONCLUSION We observed low rates of surveillance for HCC, low recognition of cirrhosis before development of HCC and low rates of prior treatment of viral hepatitis. The poor outcome of HCC in the small group who had some sort of community surveillance is also a concern requiring further investigation.
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Affiliation(s)
- L Gellert
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Liverpool, New South Wales, Australia.
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Roberts SK, Kemp W. Hepatocellular carcinoma in an Australian tertiary referral hospital 1975-2002: change in epidemiology and clinical presentation. J Gastroenterol Hepatol 2007; 22:191-6. [PMID: 17295870 DOI: 10.1111/j.1440-1746.2006.04459.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM We compared the epidemiology and clinical features of hepatocellular carcinoma (HCC) cases diagnosed between 1975 and 2002. METHODS Retrospective and prospective analysis was performed of HCC cases diagnosed at The Alfred during the time periods 1975-1983 and 1995-2002. Demographic, epidemiological, clinical and laboratory data were recorded and compared between the two periods. RESULTS Comparing the 1995-2002 cohort to the 1975-1983 cohort, patients were older (64 years vs 60 years; P = 0.02), and were more likely to be non-Caucasian (25%vs 9%; P = 0.003) and born overseas (57%vs 40%; P = 0.03) particularly from Asia. In addition, hepatitis C virus (HCV) (35%), hepatitis B virus (HBV) (22%), and alcoholic liver disease (29%) were the major etiological factors for HCC with alcohol less likely the cause of underlying liver disease (33%vs 55%; P < 0.01). Among the 1995-2002 cohort, overseas-born patients were more likely to be infected with HBV (P < 0.001) and HCV (P = 0.01), while alcohol was more likely to be the etiological factor in Australian-born cases (P = 0.02), particularly among males. Detection of HCC by screening was the initial presentation in 38% of patients, and diagnosis of HCC was often by non-invasive means. CONCLUSIONS The epidemiology of HCC has changed in Australia over the past 20 years with hepatitis C and hepatitis B now major etiological factors, and an increase in cases born overseas particularly from areas where HCV and HBV are endemic. This suggests the recent increase in incidence and death rates due to HCC in Australia relate to HCV and HBV infection.
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Affiliation(s)
- Stuart K Roberts
- Department of Gastroenterology The Alfred, Melbourne, Victoria, Australia.
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Nguyen TT, Taylor V, Chen MS, Bastani R, Maxwell AE, McPhee SJ. Hepatitis B awareness, knowledge, and screening among Asian Americans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2007; 22:266-272. [PMID: 18067441 DOI: 10.1007/bf03174128] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Due to the high prevalence of hepatitis B, Asian Americans have high rates of liver cancer. Screening for hepatitis B leads to monitoring and treatment and prevent further infection through vaccination of contacts. METHODS We reviewed the published literature up to 2006 on hepatitis B awareness, knowledge, and screening among Asian Americans. RESULTS Many Asian Americans lack knowledge about hepatitis B and have not been screened. Sociodemographics, knowledge, beliefs, and health care variables are associated with screening. CONCLUSIONS Further research and health policy changes are needed to address the problem of hepatitis B and liver cancer among Asian Americans.
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Affiliation(s)
- Tung T Nguyen
- Vietnamese Community Health Promotion Project and UCSF Comprehensive Cancer Center, University of California, San Francisco, CA 94143, USA.
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Braillon A. Screening for hepatocellular carcinoma: still in search for evidence based medicine? J Gastroenterol Hepatol 2006; 21:1355-6; author reply 1356. [PMID: 16872327 DOI: 10.1111/j.1440-1746.2006.04175.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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