Impact of metformin, statin, aspirin and insulin on the prognosis of uHCC patients receiving first line Lenvatinib or Atezolizumab plus Bevacizumab.

Recently, in Hepatocellular carcinoma (HCC) setting, the use of metformin has been associated to a trend toward worse response rate, overall survival and progression free survival in patients who received immunotherapy. The study population included individuals from both Eastern and Western regions with a confirmed diagnosis of HCC and receiving first line treatment with Atezolizumab plus bevacizumab or Lenvatinib. Univariate and multivariate analyses were performed by Cox proportional. For the analysis, patients were stratified based on their use of concomitant medication or not. At the time of database lock, 319 deaths were observed: 209 in the Lenvatinib cohort, 110 in the Atezolizumab plus bevacizumab cohort. In the Atezolizumab plus Bevacizumab arm, 50 (16.5%) patients were on chronic metformin use. At the univariate analysis for OS, patients who used metformin showed significantly shorter OS compared to patients who did not use metformin (HR 1.9, 95% CI 1.1-3.2). Multivariate analysis confirmed that patients in metformin group had significantly shorter OS compared to patients in no-metformin group (HR 1.9; 95% CI 1.1-3.1). At the univariate analysis for PFS, patients in metformin group had significantly shorter PFS compared to patients in no-metformin group (HR 1.6, 95% CI 1.0-2.6). Multivariate analysis confirmed that patients in metformin group had significantly shorter PFS compared to patients in no-metformin group (HR 1.7; 95% CI 1.1-2.7; p = 0.0147). No differences were reported in terms of ORR and DCR between patients in metformin group and those in no-metformin group. In the Lenvatinib cohort, 65 (15%) patients were recorded to chronically use metformin. No statistically significant differences in terms of both OS and PFS were found between patients in metformin group and patients in no-metformin group. This analysis unveils a negative prognostic role associated with metformin use specifically within the Atezolizumab plus Bevacizumab group.

Checklist of gypsophilous vascular flora in Italy.

Our understanding of the richness and uniqueness of the flora growing on gypsum substrates in Italy has grown significantly since the 19th century and, even today, new plant species are still being discovered. However, the plants and plant communities, growing on gypsum substrates in Italy, are still a relatively unknown subject. The main aim of this paper was to elaborate a checklist of the Italian gypsophilous flora, to increase knowledge about this peculiar flora and for which conservation efforts need to be addressed. Through a structured group communication process of experts (application of the Delphi technique), a remarkable number of experienced Italian botanists have joined together to select focal plant species linked to gypsum substrates. From the results obtained, 31 plant species behave as absolute or preferent taxa (gypsophytes and gypsoclines) and form the 'core' Italian gypsophilous flora. The most abundant life forms were chamaephytes and hemicryptophytes, belonging to Poaceae and Brassicaceae; as for chorotypes, the most represented are Mediterranean and narrow endemics. By improving on previously available information about the flora with a clear preference for gypsum in Italy, this undertaking represents an important contribution to the knowledge of a habitat which is today considered a priority for conservation.