1,422 research outputs found

    Trends of etiology and treatment in hepatocellular carcinoma over the years

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    Background: HCC has been the fastest-growing cause of cancer-related deaths. The aim of this study was to investigate the change trends in the etiology, treatment and mortality of HCC over the last 12 years.Methods: The study included 523 patients who were admitted to our clinic with the diagnosis of primary malignancy of the liver between 2006-2018. Demographic data, HCC etiologies, alpha feto-protein (AFP) values and imaging characteristics were recorded. The patients were divided into two groups as diagnosed before 2013 and 2013 and later. Because the number of patients with alcohol and HBV was high, it was evaluated as a separate etiology group. HCC was accepted related to NASH in the patients with obesity and diabetes mellitus (DM) after exclusion of HBV, HCV, and autoimmune hepatitis. The patients without obesity and DM were accepted as cryptogenic HCC and added to other etiologies group.Results: When the patients were evaluated, there was a significant increase in the rate of patients who were in compensated cirrhosis stage and in UCSF criteria in and 2013 and later (p = 0.0001, p = 0.037, respectively). A significant increase was observed in the ratio of NASH-related HCC 2013 and later (p = 0.032). Transplantation, resection and RFA / PEI rates were 14.9% before 2013 and 22.2% 2013 and later (p = 0.047).Conclusions: The rates of NAFLD related HCC due to diabetes and obesity are increasing. Knowing the change of HCC causes over the years is necessary for the effective treatment for these reasons in the future

    Rebleeding prophylaxis improves outcomes in patients with hepatocellular carcinoma. A multicenter case-control study

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    Outcome of variceal bleeding (VB) in patients with hepatocellular carcinoma (HCC) is unknown. We compared outcomes after VB in patients with and without HCC. All patients with HCC and esophageal VB admitted between 2007 and 2010 were included. Follow-up was prolonged until death, transplantation, or June 2011. For each patient with HCC, a patient without HCC matched by age and Child-Pugh class was selected. A total of 292 patients were included, 146 with HCC (Barcelona Classification of Liver Cancer class 0-3 patients, A [in 25], B [in 29], C [in 45], and D [in 41]) and 146 without HCC. No differences were observed regarding previous use of prophylaxis, clinical presentation, endoscopic findings, and initial endoscopic treatment. Five-day failure was similar (25% in HCC versus 18% in non-HCC; P = 0.257). HCC patients had greater 6-week rebleeding rate (16 versus 7%, respectively; P = 0.025) and 6-week mortality (30% versus 15%; P = 0.003). Fewer patients with HCC received secondary prophylaxis after bleeding (77% versus 89%; P = 0.009), and standard combination therapy was used less frequently (58% versus 70%; P = 0.079). Secondary prophylaxis failure was more frequent (50% versus 31%; P = 0.001) and survival significantly shorter in patients with HCC (median survival: 5 months versus greater than 38 months in patients without HCC; P < 0.001). Lack of prophylaxis increased rebleeding and mortality. On multivariate analysis Child-Pugh score, presence of HCC, portal vein thrombosis, and lack of secondary prophylaxis were predictors of death. Conclusions: Patients with HCC and VB have worse prognosis than patients with VB without HCC. Secondary prophylaxis offers survival benefit in HCC patient

    Serum Squamous Cell Carcinoma Antigen-Immunoglobulin M complex levels predict survival in patients with cirrhosis

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    Complications of chronic liver diseases - particularly hepatocellular carcinoma (HCC) - are a major cause of mortality worldwide. Several studies have shown that high or increasing levels of serum Squamous Cell Carcinoma Antigen-Immunoglobulin M complex (SCCA-IgM) are associated with development of HCC in patients with advanced liver disease and worse survival in patients with liver cancer. The aim of the present study was to assess, in patients with advanced liver disease, differences in long-term clinical outcomes in relation to baseline levels of serum SCCA-IgM. Ninety one consecutive outpatients with liver cirrhosis of different etiologies, without hepatocellular carcinoma at presentation, were enrolled from April 2007 to October 2012 in a prospective study. For a median time of 127 months, patients were bi-annually re-evaluated. SCCA-IgM complex levels were determined with a validated enzyme-linked immunosorbent assay. The results provided evidence that serum SCCA-IgM is a predictor of overall survival. The best cut-off to discriminate both HCC-free and overall survival rates was 120\u2009AU/mL. Patients with baseline values higher than this threshold showed a substantial increase in both HCC incidence rate and all-cause mortality rate. In conclusion, a single measurement of serum SCCA-IgM helps to identify those patients with liver cirrhosis with increased risks of HCC development and mortality

    Clinical Presentation, Risk Factors, and Treatment Modalities of Hepatocellular Carcinoma: A Single Tertiary Care Center Experience

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    Objective. To investigate the risk factors, clinical characteristics, treatment modalities, and outcomes in Saudi patients with HCC and propose points for early detection of the disease. Methods. Patients were stratified according to underlying risk factors for the development of HCC. Barcelona Clinic Liver Cancer (BCLC) was used for cancer staging. Treatment was classified into surgical resection/liver transplantation; locoregional ablation therapy; transarterial embolization; systemic chemotherapy; and best supportive care. Results. A total of 235 patients were included. Males had higher tumor size and incidence of portal vein thrombosis. Viral hepatitis was a risk factor in 75.7%. The most common BCLC stages were B (34.5%) and A (33.6%), and the most common radiological presentation was a single nodule of less than 5 cm. Metastases were present in 13.2%. Overall, 77 patients (32.8%) underwent a potentially curative treatment as the initial therapy. The most commonly utilized treatment modality was chemoembolization with 113 sessions in 71 patients. The overall median survival was 15.97±27.18 months. Conclusion. HCC in Saudi Arabia is associated with high prevalence of HCV. Potentially curative therapies were underutilized in our patients. Cancer stage BCLC-B was the most frequent (34.5%) followed by BCLC-A (33.6%). The overall median survival was shorter than other studies

    Measurement of Hepatocellular Carcinoma Screening and the Impact of Patient and Provider Factors on Screening Receipt, Early Tumor Detection and Overall Survival

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    Hepatocellular carcinoma (HCC) is the 2nd leading cause of cancer-related death worldwide and the leading cause of death among patients with cirrhosis. HCC screening is highly recommended by professional societies to improve early tumor detection and survival, but is underused in clinical practice. This dissertation addresses gaps in the current literature concentrated on HCC screening and specifically focuses on three areas: (1) two improved approaches to measure HCC screening using administrative data, (2) the impact of patient and provider factors on HCC screening, and (3) the impact of HCC screening on early tumor detection and overall survival. The first study in this dissertation explores two improved approaches to measure HCC screening using a linkage of two large population-based sources of data and subsequently characterizes HCC screening rates over time using these measures. Receipt of HCC screening was characterized using: (a) mutually exclusive categories (consistent vs. inconsistent vs. no screening), and (b) proportion of time up-to-date (PUTD) with screening. Most (51.1%) patients did not receive any screening in the 3 years prior to HCC diagnosis, and 13.4% of patients underwent timely, consistent screening annually (PUTD). The second study in this dissertation identifies patient and provider factors that influence HCC screening receipt using the PUTD measure. Patient and provider predictors for HCC screening were assessed using a multivariate two-part regression. Receipt of any HCC screening was associated with younger patient age, female gender, Asian race, longer length of time with known cirrhosis, presence of more than one liver correlated condition, presence of hepatic encephalopathy, higher comorbidity score and having visited a gastroenterologist (p<0.001). The third and final study in this dissertation evaluates the association between HCC screening receipt and clinical outcomes, including: (a) early tumor detection and (b) overall survival using multivariate logistic regression and Cox proportional hazards model, respectively. Receipt of consistent screening was associated with early tumor detection (OR 2.10; 95% CI 1.79-2.47) and improved survival (HR 0.72, 95%CI 0.66 – 0.78). The findings of this dissertation highlight potential areas for intervention including improved awareness and education regarding HCC screening for patients and providers

    Changes in the ultrasound presentation of hepatocellular carcinoma: a center's three decades of experience

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    Purpose: Ultrasound (US) surveillance is a cornerstone for early diagnosis of HCC, anyway US presentation has undergone significant changes. With the aim of evaluating the effects of US surveillance program in the real-world clinical practice, we wanted to evaluate US presentation of HCCs over the last 30 years and the differences of HCCs presentation according to etiology. Methods: 174 patients diagnosed between 1993 and 98 (G1), 96 between 2003 and 08 (G2), 102 between 2013 and 18 (G3), were compared. US patterns were: single, multiple or diffuse nodules. The echo-patterns: iso-, hypo-, hyper-echoic, or mixed. In G1, the HCC diagnosis was mainly histologic; in G2 by EASL 2001 and AASLD 2005, in G3 AASLD 2011, EASL 2012, and AISF 2013 guidelines. Results: HCV was the most frequent etiology, dropping between G1 (81%) and G3 (66%) (P &lt; 0.01), metabolic increased between G1 (5%) and G3 (14%) (P &lt; 0.01). Single HCC was more prevalent in G3 vs G1 (65.6% vs 40%) (P &lt; 0.0001), multiple nodules in G1 (50%) vs G3 (33.3%) (P &lt; 0.02) and diffuse in G1 (16%) vs G2 (2%) and vs G3 (1%) (P &lt; 0.001). The most frequent echo-pattern was hypo-echoic G1 (50%) vs G2 (79%) and G1 vs G3 (65%) (P &lt; 0.01). Iso-echoic pattern was the least frequent (7-12%). Mixed pattern decreased from G1 (28%) to G3 (12%) (P &lt; 0.002). In G3 there were more multiple or diffuse HCCs in metabolic (P &lt; 0.03). Conclusion: US presentation became less severe due to surveillance programs. HCV remains the most frequent cause, an increase in metabolic etiology has been shown throughout the decades

    Trends in Characteristics, Mortality, and Other Outcomes of Patients With Newly Diagnosed Cirrhosis

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    Importance: Changes in the characteristics of patients with cirrhosis are likely to affect future outcomes and are important to understand in planning for the care of this population. Objective: To identify changes in demographic and clinical characteristics and outcomes in patients with newly diagnosed cirrhosis. Design, Setting, and Participants: A retrospective cohort study of patients with a new diagnosis of cirrhosis was conducted using the Indiana Network for Patient Care, a large statewide regional health information exchange, between 2004 and 2014. Patients with at least 1 year of continuous follow-up before the cirrhosis diagnosis were followed up through August 1, 2015. The analysis was conducted from December 2018 to January 2019. Exposures: Age, cause of cirrhosis, and year of diagnosis. Main Outcomes and Measures: Overall rates for mortality, liver transplant, hepatocellular carcinoma, and hepatic decompensation (composite of ascites, hepatic encephalopathy, or variceal bleeding). Results: A total of 9261 patients with newly diagnosed cirrhosis were identified (mean [SD] age, 57.9 [12.6] years; 5109 [55.2%] male). A 69% increase in new diagnoses occurred over the course of the study period (620 in 2004 vs 1045 in 2014). The proportion of those younger than 40 years increased by 0.20% per year (95% CI, 0.04% to 0.36%; P for trend = .02), and the proportion of those aged 65 years and older increased by 0.81% per year (95% CI, 0.51% to 1.11%; P for trend < .001). The proportion of patients with alcoholic cirrhosis increased by 0.80% per year (95% CI, 0.49% to 1.12%), and the proportion with nonalcoholic steatohepatitis increased by 0.59% per year (95% CI, 0.30% to 0.87%), whereas the proportion with viral hepatitis decreased by 1.36% per year (95% CI, -1.68% to -1.03%) (P < .001 for all). In patients younger than 40 years, 40 to 64 years, and 65 years and older, mortality rates were 6.4 (95% CI, 5.4 to 7.6), 9.9 (95% CI, 9.5 to 10.4), and 16.2 (95% CI, 15.2 to 17.2) per 100 person-years, respectively (P < .001). Mortality rates decreased during the study period (11.9 [95% CI, 10.7-13.1] per 100 person-years in 2004 vs 10.0 [95% CI, 8.1-12.2] per 100 person-years in 2014; annual adjusted hazard ratio, 0.87 [95% CI, 0.86 to 0.88]) and were lower in those with alcoholic cirrhosis compared with patients with viral hepatitis (adjusted hazard ratio, 0.89 [95% CI, 0.80 to 0.98]). Rates of hepatocellular carcinoma were low in patients younger than 40 years (0.5 [95% CI, 0.2 to 0.9] per 100 person-years). Liver transplant rates were low throughout the study period (0.3 [95% CI, 0.3-0.4] per 100 person-years). In patients with compensated cirrhosis, rates of hepatic decompensation were lower in patients younger than 40 years (adjusted subhazard ratio 0.78; 95% CI, 0.62 to 0.99) and in patients with nonalcoholic steatohepatitis (adjusted subhazard ratio, 0.51; 95% CI, 0.43 to 0.60). Conclusions and Relevance: The population of patients with newly diagnosed cirrhosis in Indiana has experienced changes in the age distribution and cause of cirrhosis, with decreasing mortality rates. These findings support investment in the prevention and treatment of alcoholic liver disease and nonalcoholic steatohepatitis, particularly in younger and older patients. Additional study is needed to identify the reasons for decreasing mortality rates

    The burden of hepatocellular carcinoma in non-alcoholic fatty liver disease: Screening issue and future perspectives

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    In recent decades, non-alcoholic fatty liver disease (NAFLD) has become the most common liver disease in the Western world, and the occurrence of its complications, such as hepatocellular carcinoma (HCC), has rapidly increased. Obesity and diabetes are considered not only the main triggers for the development of the disease, but also two independent risk factors for HCC. Single nucleotide polymorphisms (such as PNPLA3, TM6SF2 and MBOAT7) are related to the susceptibility to the development of HCC and its progression. Therefore, an appropriate follow-up of these patients is needed for the early diagnosis and treatment of HCC. To date, international guidelines recommend the use of ultrasonography with or without alpha-fetoprotein (AFP) in patients with advanced fibrosis. Furthermore, the use of non-invasive tools could represent a strategy to implement surveillance performance. In this review, we analyzed the main risk factors of NAFLD-related HCC, the validated screening methods and the future perspectives
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