Favorable Survival with Non-curative Treatments for Patients with Early-Stage Hepatocellular Carcinoma After Liver Transplant Denial.

BACKGROUND: Many patients are not candidates for liver transplant for non-tumor-related reasons including medical comorbidities and non-adherence. The prognosis of patients with hepatocellular carcinoma (HCC) who are not liver transplant candidates in the era of locoregional therapy (LRT) including y90 is not well defined. AIMS: This study seeks to evaluate outcomes and the natural history of early-stage HCC in patients who were denied liver transplant listing due to non-tumor reasons and instead were treated with LRT. METHODS: A retrospective evaluation was performed for all patients who completed liver transplant evaluation with their tumor within Milan criteria but were denied due to non-tumor reasons and were treated with LRT at a single tertiary referral center. RESULTS: The 61 patients included had a favorable overall survival, with a median survival 60.3 months (86.9% at 1 year and 52.7% at 5 years). Patients with Child-Pugh A cirrhosis (n = 34) had significantly longer overall survival compared to those with Child-Pugh B/C cirrhosis (median survival of 70.3 months versus 26.1 months, p = 0.005). Survival in patients with Child-Pugh A at 1, 3, and 5 years was 97%, 80%, and 73%, respectively, compared to 74%, 41%, and 31% in patients with Child-Pugh B/C. CONCLUSIONS: In a small single-center cohort, patients with HCC who were denied liver transplant due to non-tumor reasons and underwent LRT and had Child-Pugh A cirrhosis had survival approaching the national average for patients who undergo liver transplantation. Patients with Child-Pugh B/C cirrhosis had significantly worse outcomes than those with Child-Pugh A.

Cancer Treatment Response to Checkpoint Inhibitors Is Associated with Cytomegalovirus Infection.

Programmed cell death protein-1 (PD-1) and programmed cell death-ligand 1 (PD-L1) checkpoint inhibitors induce tumor response by activating the patient's own immune system to fight cancer. Tumors with high tumor mutational burden or those that express high levels of PD-1/PD-L1 are more responsive to PD1/PDL1 inhibitors. There is much interest in determining how to improve response to PD-1/PD-L1 inhibitors. We report a case of a patient with metastatic bladder cancer who was primarily resistant to treatment with PD-1/PD-L1 inhibitors, then had a complete response after developing cytomegalovirus infection.

Mycobacterium tuberculosis infection of a tophaceous pseudogout nodule.

Musculoskeletal infections are uncommon complications of monosodium urate and calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, and frequently involve gram positive and negative organisms. Tumoral calcinosis (tophaceous pseudogout) is a rare manifestation of CPPD deposition disease. We describe a highly unusual case of an infection by Mycobacterium tuberculosis (TB) of a tophaceous pseudogout nodule in a patient with endstage renal disease. The highly destructive nature of this case of combined CPPD arthropathy and musculoskeletal TB underscores the urgency of diagnosing this infection in susceptible patients from countries with high prevalence rates of TB infection.