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1.
Medicine (Baltimore) ; 99(41): e22118, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031259

RESUMO

It is controversial regarding the treatment allocation for patients with stage I hepatocellular carcinoma (SI-HCC). The aim of the present study was to compare the long-term survival in SI-HCC patients undergoing liver transplantation (LT), liver resection (LR), local tumor destruction (LTD), or none. SI-HCC patients diagnosed between 2004 and 2015 were extracted from the SEER 18 registry database. Multivariable Cox models and propensity score matching (PSM) method were used to explore the association between surgical methods and long-term prognosis. A total of 5165 patients with stage I (AJCC, 6th or 7th) HCC were included in the study. Only 36.9% of patients diagnosed with HCC in stage I received surgical therapy. The incidence of LT was decreased over time (P < .001). In the multivariable-adjusted cohort (n = 5165), after adjusting potential confounding factors, a clear prognostic advantage of LT was observed in OS (P < .0001) compared with patients after LR. Patients undergoing LTD had a worse OS in comparison with patients who underwent LR (P < .0001). Patients who received no surgical treatment had the worst OS (P < .0001) among 4 treatment groups. In stratified analyses, the salutary effects of LT vs LR on OS were consistent across all subgroups except for a similar result in the noncirrhotic subgroup (P = .4414). The inferior survival effects of LTD vs LR on OS were consistent across all subgroups, and even in the subgroup with tumor size < 3 cm (P = .0342). In the PSM cohort, patients in LT group showed a better OS (P < .001) than patients in LR group (P < .0001) and patients undergoing LTD had a worse OS compared with patients who underwent LR (P = .00059). In conclusion, LT offered a survival advantage compared with LR among patients with Stage I HCC. LT is the best surgical treatment for stage I HCC in patients with advanced fibrosis, whereas LR provides comparable long-term outcomes to LT in patients without advanced fibrosis and should be considered as the first-line surgical option. LTD can be used as an alternative method when LR and LT are unavailable.


Assuntos
Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/terapia , Feminino , Hepatectomia , Humanos , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Pontuação de Propensão , Programa de SEER , Análise de Sobrevida
2.
Medicine (Baltimore) ; 99(41): e22565, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031303

RESUMO

BACKGROUND: Kangai injection, a well-known insect-derived traditional Chinese medicine preparation, has been widely applied as a promising adjunctive drug for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). However, its exact clinical efficacy and safety is still not well investigated. In this study, we aimed to summarize the efficacy and safety of Kangai injection for patients with HBV-related HCC through the meta-analysis. METHODS: All available randomized controlled trials (RCTs) and high-quality prospective cohort studies that investigated the efficacy and safety of Kangai injection for patients with HBV-related HCC were searched from ten electronic databases including Google Scholar, PubMed, Excerpt Medica Database (Embase), Cochrane Library, Medline, Web of Science (WOS), China National Knowledge Infrastructure (CNKI), China Scientific Journal Database (CSJ) Chinese, Biomedical Literature Database (CBM) and Wanfang Database. Papers in Chinese or English published from January 2000 to September 2020 will be included without any restrictions.Study selection and data extraction will be performed independently by 2 researchers. The clinical outcomes including overall response rate (ORR), disease control rate (DCR), quality of life (QoL), clinical symptoms, virological indicators, immune function and adverse events, were systematically evaluated. Review Manager 5.3 and Stata 14.0 were used for data analysis, and the quality of the literatures was also evaluated. RESULTS: The results of this study will be published in a peer-reviewed journal, and provide a helpful evidence for clinicians to formulate the best postoperative adjuvant treatment strategy for HBV-related HCC patients. CONCLUSION: Our study will draw an objective conclusion of the efficacy of Kangai injection on curative effect (ORR and DCR), clinical symptoms, virological indicators, QoL, and immune function in patients with HBV-related HCC. INPLASY REGISTRATION NUMBER: INPLASY202090014.


Assuntos
Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/virologia , Quimioembolização Terapêutica , Medicamentos de Ervas Chinesas/uso terapêutico , Vírus da Hepatite B , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/virologia , Projetos de Pesquisa , Humanos , Metanálise como Assunto
4.
Medicine (Baltimore) ; 99(33): e20877, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871973

RESUMO

OBJECTIVE: The purpose of this study was to evaluate the efficacy of different nucleos(t)ide analogues in the prognosis of HBV-related hepatocellular carcinoma (HCC) patients after curative treatment by network meta-analysis. METHODS: Literature retrieval was conducted in globally recognized databases, namely, PubMed, EMBASE, Cochrane Library databases, and Science Citation Index Expanded, to address relative studies investigating nucleot(s)ide analogues for HBV-related HCC patients after curative resection. Relative parametric data, including 1-, 3-, and 5-year overall survival rate and 1-, 3-, and 5-year recurrence-free survival rate were quantitatively pooled and estimated. The inconsistency factor, the cumulative ranking curve, and the publication bias were evaluated. RESULTS: Fourteen observational studies of 2481 adults performed between 2000 and 2019 were eligible. In terms of overall survival, ADV (Adefovir dipivoxil) (Odds ratio (OR): 2.35, 95% confidence interval (CI): 1.17-4.73), Lamivudine (OR: 2.08, 95% CI: 1.78-5.58), and Entecavir (OR: 2.14, 95% CI: 1.59-2.88) were found to be more beneficial than control group while ADV has the highest probability of having the most efficacious treatment (SCURA values 66.3) for 5-year overall survival. In late recurrence-free survival, ADV (OR = 1.88, 95% CI: 1.77-4.60), Entecavir (OR = 1.96, 95% CI: 1.36-2.55), and Lamivudine (OR = 1.73, 95% CI: 1.06-2.82) all had better significant prognosis than patients without antiviral therapy postoperatively and patients with ADV as postoperative antiviral therapy has significantly recurrence-free survival benefit at 5-year follow-up compared to those undertaking Entecavir (OR = 1.96, 95% CI: 1.52-7.38) and Lamivudine (OR = 1.39, 95% CI: 1.09-3.01). Moreover, the application of ADV possessed the highest possibility of having the best clinical effects on 1- (surface under the cumulative ranking probabilities (SUCRA), 64.7), 3- (SUCRA, 64.7), and 5-year (SUCRA, 70.4) recurrence survival rate for HBV-related HCC patients. CONCLUSIONS: Patients with postoperative nucleos(t)ide analogues antiviral therapy had better survival benefit than those without antiviral therapy for HBV-related HCC patients after curative treatment. Additionally, nucleotide analogues like ADV and Tenofovir disoproxil fumarate has better impact on early and late recurrence-free survival of patients after curative treatment than those undertaking nucleoside analogues.


Assuntos
Antivirais/uso terapêutico , Carcinoma Hepatocelular/terapia , Hepatite B/complicações , Hepatite B/tratamento farmacológico , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/epidemiologia , Hepatite B/epidemiologia , Vírus da Hepatite B , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/epidemiologia , Metanálise em Rede
5.
Medicine (Baltimore) ; 99(32): e21489, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769883

RESUMO

For the treatment of huge unresectable hepatocellular carcinoma (HCC), transcatheter arterial chemoembolization (TACE) or transcatheter arterial embolization (TAE) generally had poor effects and high complication rates. Our previous study found that Hepatic arterial infusion chemotherapy (HAIC) is a safe procedure and provides better survival than symptomatic treatment for the patients with huge unresectable HCC. The aim of the study is to compare the effect of HAIC vs TAE in patients with huge unresectable HCC.Since 2000 to 2005, patients with huge (size > 8 cm) unresectable HCC were enrolled. Twenty-six patients received HAIC and 25 patients received TAE. Each patient in the HAIC group received 2.5 + 1.4 (range: 1-6) courses of HAIC and in the TAE group received 1.8 + 1.2 (range: 1-5) courses of TAE. Baseline characteristics and survival were compared between the HAIC and TAE group.The HAIC group and the TAE group were similar in baseline characteristics and tumor stages. The overall survival rates at 1 and 2 years were 42% and 31% in the HAIC group and 28% and 24% in the TAE group. The patients in the HAIC group had higher overall survival than the TAE group (P = .077). Cox-regression multivariate analysis revealed that HAIC is the significant factor associated with overall survival (relative risk: 0.461, 95% confidence interval: 0.218-0.852, P = .027). No patients died of the complications of HAIC but three patients (12%) died of the complications of TAE.In conclusion, HAIC is a safe procedure and provides better survival than TAE for patients with huge unresectable HCCs.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma Hepatocelular/terapia , Embolização Terapêutica/mortalidade , Infusões Intra-Arteriais/mortalidade , Neoplasias Hepáticas/terapia , Idoso , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Embolização Terapêutica/métodos , Feminino , Artéria Hepática , Humanos , Infusões Intra-Arteriais/métodos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Análise de Regressão , Resultado do Tratamento
6.
PLoS One ; 15(8): e0237316, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790706

RESUMO

AIM: Disease-associated healthcare expenditures are generally calculated using matched comparisons or regression-based analyses, but little is known about their differences in estimates. This aim of this study was to compare the differences between disease-associated healthcare expenditures estimated using these 2 methods. METHODS: In this retrospective cohort study, a matched comparison was first conducted by matching cases with controls using sex, age, and comorbidities to estimate disease-associated expenditures. The cases were then used in a fixed-effects analysis that compared expenditures before and after disease occurrence. The subjects were adults (≥20 years) with primary hepatocellular carcinoma (HCC) who underwent treatment (including surgical resection, locoregional therapy, transcatheter arterial chemoembolization, and transarterial embolization) at a Japanese hospital between April 2010 and March 2018. We calculated the total healthcare expenditures per patient per month according to treatment and disease phase (initial, continuing, and terminal). RESULTS: There were 14,923 cases in the initial/continuing phases and 15,968 cases in the terminal phase. In the initial/continuing phases, 3,552 patients underwent surgical resection only, with HCC-associated expenditures of $5,555 according to the matched comparison and $5,889 according to the fixed-effects analysis (proportional difference: 94.3%). The initial phase expenditures were approximately 9% higher in the fixed-effects analysis, whereas the continuing phase expenditures were approximately 7% higher in the matched comparison. The expenditures in the terminal phase were 93.1% higher in the fixed-effects analysis. CONCLUSIONS: The 2 methods produced similar estimates of HCC-associated healthcare expenditures in the initial/continuing phases. However, terminal phase expenditures were substantially different between the methods.


Assuntos
Carcinoma Hepatocelular/economia , Gastos em Saúde , Neoplasias Hepáticas/economia , Demandas Administrativas em Assistência à Saúde/economia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/terapia , Bases de Dados Factuais , Gerenciamento Clínico , Feminino , Humanos , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade
7.
Zhonghua Gan Zang Bing Za Zhi ; 28(6): 457-460, 2020 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-32660170

RESUMO

Hepatocellular carcinoma(HCC) is a common malignant tumor in China, which seriously threatens people's health and lives. In recent years, immunotherapy has provided new options for the treatment of HCC. Various emerging immunotherapy techniques, such as cell immunotherapy, tumor vaccines, oncolytic viruses and immune checkpoint inhibitors, are also gradually advancing to clinical applications. Immunotherapy for HCC should target the different immune characteristics of HCC patients and develop different individualized treatment strategies. In the process of formulating strategies, attention should be paid to key issues such as reversing the exhaustion of T cells, break through HCC immunosuppressive microenvironment, improving the immunotherapy specificity, enhancing the immune response of anti-HCC with adjuvant, timely and accurate evaluation of efficacy and safety, etc. In conclusion, individualization, specificity, safety and efficiency are the inevitable development trend of immunotherapy for HCC.


Assuntos
Carcinoma Hepatocelular , Imunoterapia , Neoplasias Hepáticas , Vacinas Anticâncer , Carcinoma Hepatocelular/terapia , China , Humanos , Neoplasias Hepáticas/terapia , Microambiente Tumoral
8.
Zhonghua Gan Zang Bing Za Zhi ; 28(6): 466-470, 2020 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-32660172

RESUMO

Hepatocellular carcinoma (HCC) is a chronic inflammation derived from the background of hepatitis B and C virus (HBV and HCV) infection, chemical intoxicants, or non-alcoholic fatty liver disease. Cancerous liver cells can express and secrete a variety of relatively specific markers, such as carcinoembryonic type of alpha-fetoprotein (AFP), phosphatidylinositol-3 (Glypican-3, GPC-3), Wnt/ß-Catenin key molecule of signaling pathway Wnt3a and liver cancer specific GGT-II (HS-GGT), etc. Clinical analysis of carcinoembryonic markers not only contributes to diagnosis and prognosis of HCC, but may also be the target of HCC immunotherapy with a promising prospect of development and application. This article reviews the latest valuable advances in carcinoembryonic type specific molecular markers and liver cancer immunotherapy.


Assuntos
Carcinoma Hepatocelular , Imunoterapia , Neoplasias Hepáticas , Biomarcadores Tumorais , Carcinoma Hepatocelular/terapia , Humanos , Neoplasias Hepáticas/terapia
9.
Zhonghua Gan Zang Bing Za Zhi ; 28(6): 471-474, 2020 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-32660173

RESUMO

Presently, the incidence of hepatocellular carcinoma (HCC) ranks fourth among common malignant tumors in China, and the mortality rate ranks second. The preferred method of clinical treatment for HCC is early surgical resection at this time, but most patients have reached to mid-advanced stage at the time of diagnosis, so surgery cannot be performed. Traditional radiotherapy and chemotherapy have poor prognosis and many adverse reactions, which make the current clinical treatment of HCC in China full of challenges. Therefore, new treatment strategies are urgently needed to improve the quality of life of liver cancer patients. With the advancement of modern medicine, the treatment of liver cancer is no longer limited to traditional treatments. Immunotherapy as a new treatment has become an important treatment for liver cancer. In recent years, immunotherapy and new targeted drugs for liver cancer have become a research hotspot, and many achievements have been made in the treatment of liver cancer. In this paper, the current situation and progress of single or combined immunotherapy for liver cancer of recent years are briefly reviewed.


Assuntos
Carcinoma Hepatocelular , Imunoterapia , Neoplasias Hepáticas , Carcinoma Hepatocelular/terapia , China , Humanos , Neoplasias Hepáticas/terapia , Qualidade de Vida
10.
Anticancer Res ; 40(7): 4191-4198, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620669

RESUMO

BACKGROUND/AIM: Tumoral calcification after chemotherapy or radiation therapy has been reported in various cancer patients, but not after radioembolization. The purpose of this study was to evaluate the prognostic value of radioembolization-induced tumor calcification of hepatocellular carcinoma (HCC) treated by radioembolization. PATIENTS AND METHODS: This retrospective study comprised patients with single nodular HCC who underwent yttrium-90 radioembolization between November 2015 and April 2019. The presence of tumoral calcification was visually assessed on a follow-up computed tomography (CT) scan. RESULTS: Fifty-five patients (64.8±11.8 years, 43 men) were evaluated. Tumoral calcification was present in 21 (38.2%) of 55 patients in the one-month CT scan (calcification group). The complete response rate for the primary index tumor was 72.7% (40 of 55) in the total study population, and 100% (21 of 21) in the calcification group, respectively. The calcification group had a longer local progression-free survival rate than the non-calcification group (p=0.017). CONCLUSION: Radioembolization-induced tumoral calcification is relatively common and can be used as an early surrogate marker of complete response.


Assuntos
Calcinose/etiologia , Carcinoma Hepatocelular/terapia , Embolização Terapêutica , Neoplasias Hepáticas/terapia , Compostos Radiofarmacêuticos/uso terapêutico , Radioisótopos de Ítrio/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Calcinose/diagnóstico por imagem , Carcinoma Hepatocelular/diagnóstico por imagem , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prognóstico , Tomografia Computadorizada por Raios X
11.
Medicine (Baltimore) ; 99(29): e20962, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702836

RESUMO

BACKGROUND: Trans-catheter arterial chemoembolization (TACE) plus Sorafenib is recommended as one of the primary means for treating hepatocellular carcinoma (HCC). This updated meta-analysis focuses on identifying the efficacy and safety of TACE plus Sorafenib versus TACE, which remains controversial despite years of exploration. METHOD: PubMed, Medline, Embase, China Journal Full-text Database, Wanfang Database, and Weipu Database were used to retrieve the studies which are about comparing the clinical efficacy and safety of TACE+Sorafenib with TACE alone. The Review Manager (Version 5. 3) software was used to perform a meta-analysis of the results of studies which met the inclusion criteria recommended by the Cochrane Collaboration. RESULT: Compared with TACE for treating primary HCC, TACE combined with Sorafenib can improve the 1 year, 2 years, 3 years, and 5 years overall survival rate (OS) of patients, respectively, and also improve disease control rate (DCR) and objective response rate (ORR). In terms of adverse reactions, the treatment group can lead to more complications significantly, such as hand-foot skin reaction, hypertension, diarrhea, rash, hair loss, and so on, most of which are relevant to Sorafenib related adverse reactions, but most patients have a good prognosis after symptomatic treatment. CONCLUSION: The clinical efficacy of TACE combined with Sorafenib in treating primary hepatocellular carcinoma is better than TACE, and the safety is acceptable.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Neoplasias Hepáticas/terapia , Inibidores de Proteínas Quinases/uso terapêutico , Sorafenibe/uso terapêutico , Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica/efeitos adversos , Terapia Combinada , Humanos , Neoplasias Hepáticas/mortalidade
12.
Anticancer Res ; 40(8): 4773-4777, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32727804

RESUMO

BACKGROUND/AIM: Recent studies have demonstrated the efficacy of salvage surgery following downstaging of hepatocellular carcinoma (HCC). The aim was to assess the outcomes of salvage surgery after successful downstaging using hepatic arterial infusion chemotherapy (HAIC). PATIENTS AND METHODS: Patients whose diagnosis was unresectable locally advanced HCC and who were resected after conversion to a resectable status by HAIC were included. The overall survival (OS) rate, and disease-free survival (DFS) rate were analyzed by stratifying patients into those with Vp3/4, Vv2/3, and those without major vascular invasion (MVI). RESULTS: Eighteen patients were censored. Among them, six patients had Vp3/4, four patients had Vv2/3, and eight patients had no MVI. The 5-year OS rates of patients with Vp3/4 and those without MVI were 83% and 73%, respectively, whereas those with Vv2/3 had 0% (p<0.001). CONCLUSION: Salvage surgery has the potential to provide excellent outcomes in resectable HCC patients, except for those with Vv2/3.


Assuntos
Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/uso terapêutico , Intervalo Livre de Doença , Feminino , Fluoruracila/uso terapêutico , Hepatectomia/métodos , Humanos , Infusões Intra-Arteriais/métodos , Masculino , Pessoa de Meia-Idade , Terapia de Salvação/métodos , Taxa de Sobrevida , Resultado do Tratamento
13.
Medicine (Baltimore) ; 99(28): e21161, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664152

RESUMO

In this study, we investigated the long-term survival of patients with hepatocellular carcinoma (HCC) after conventional treatment other than liver transplantation (LT) in our institute and discuss the limitation of non-transplant treatment for HCC and the proper indictors of LT in the recent comprehensive era.Between 2003 and 2016, 181 patients with HCC aged ≦70 years received active treatment including liver resection, radiofrequency ablation (RFA), and transcatheter arterial chemoembolization (TACE). We analyzed the factors associated with overall survival and proposed new priority for the indicators of LT in HCC patients according to the extracted factors by comparing the survival with 39 transplanted patients with HCC.Child-Turcotte-Pugh (CTP) score (HR: 1.276; 95% CI: 1.049-1.552, P = .015), and number of tumors (HR: 1.238; 95% CI: 1.112-1.377, P < .001) were selected as significant factors associated with the survival after active treatments for HCC. Patients with LT had significantly better long-term survival compared with those with non-transplant patients regardless of aforementioned factors. However, regarding relatively short survival (3 years), patients with CTP score of ≧9 and/or ≧3 tumors with non-transplant treatment had poorer survival compared with those of transplanted patients (P < .05).We propose that CTP score of 9 and/or 3 tumors before non-transplant, intensive treatment might be a new priority for considering indicators of LT in patients with HCC.


Assuntos
Carcinoma Hepatocelular/terapia , Ablação por Cateter/mortalidade , Quimioembolização Terapêutica/mortalidade , Hepatectomia/mortalidade , Neoplasias Hepáticas/terapia , Adulto , Idoso , Carcinoma Hepatocelular/mortalidade , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
14.
Dig Liver Dis ; 52(9): 937-941, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32703730

RESUMO

BACKGROUND: The COVID-19 pandemic had a huge impact on national and regional health systems. The impact of SARS-CoV-2 on the quality of care for patients with liver disease is still unknown. AIMS: The Italian Association for the Study of the Liver (AISF) conducted a survey to assess the impact of SARS-CoV-2 on hepatology units activities in Italy. METHODS: A prospective web-based survey was proposed to all AISF active members. The survey was available online from April 8 2020, to May 3 2020, (lockdown phase in Italy). RESULTS: 194 AISF members answered the questionnaire, most of whom were specialists in Gastroenterology (41%) or Internal Medicine (28%), and worked in Northern Italy (51%). 26% of hepatology wards had been converted into COVID-19 wards, and 33% had bed reductions. All hepatological activities, including the management of patients with decompensated liver disease, liver transplant and HCC had been significantly reduced/stopped. The number of physicians answering that their practices had not been modified ranged between 0.6% (for chronic hepatitis) to 47% (for the execution of paracentesis). The recorded answers were consistent among different regions, and did not show any north-south gradient CONCLUSION: COVID-19 outbreak significantly impacted on hepatological clinical activity. This survey can serve as a basis to compare the impact of future measures aimed at delivering an acceptable level of liver care during a national pandemic or crisis.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Gastroenterologia/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hepatopatias/terapia , Pneumonia Viral/epidemiologia , Antivirais/uso terapêutico , Betacoronavirus , Carcinoma Hepatocelular/terapia , Doença Crônica , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/cirurgia , Hepatite B Crônica/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Humanos , Itália/epidemiologia , Cirrose Hepática/terapia , Neoplasias Hepáticas/terapia , Transplante de Fígado/estatística & dados numéricos , Programas de Rastreamento , Pandemias , Paracentese/estatística & dados numéricos , Qualidade da Assistência à Saúde , Inquéritos e Questionários
15.
Am Surg ; 86(7): 865-872, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32721171

RESUMO

BACKGROUND: Hepatitis C virus (HCV) has historically been the most common cause of cirrhosis and hepatocellular carcinoma (HCC) in the United States. With improved HCV treatment, cirrhosis secondary to other etiologies is increasing. Given this changing epidemiology, our aim was to determine the impact of cirrhosis etiology on overall survival (OS) in patients with HCC. METHODS: All patients with cirrhosis and primary HCC from the US Safety Net Collaborative (2012-2014) database were included. Patients were grouped into "safety net" and "academic" based on where they received their care. The primary outcome was the OS. RESULTS: 1479 patients were included. The average age was 60 years and 78% (n = 1156) were male. 56% (n = 649) received care at academic and 44% (n = 649) at safety net hospitals. The median model for end-stage liver disease (MELD) was 10 (IQR 8-16). Median OS was 23 months. Etiology of cirrhosis was viral hepatitis 56% (n = 612), alcohol abuse 14% (n = 152), alcohol and hepatitis 23% (n = 251), and other 7% (n = 85). Patients with alcohol-related cirrhosis (alcohol alone or with hepatitis) were younger (59 vs 62 years), more likely to be male (86% vs 75%), treated at a safety net facility (45% vs 35%), uninsured (17% vs 13%), and had a higher MELD (median 12 vs 10) (all P < .003). They were less likely to have been screened for HCC within 1 year of diagnosis (20% vs 29%) and to receive treatment (69% vs 81%), and more likely to present with stage IV disease (21% vs 15%) (all P < .001). Patients with alcohol-related cirrhosis had decreased OS (5-year OS 24% vs 40%, P < .001), which persisted in a subset analysis of both academic and safety net populations. CONCLUSION: Although not significant on MVA, alcohol-related cirrhosis is associated with all factors that correlate with decreased survival from HCC. Efforts must focus on this vulnerable patient population to optimize screening, treatment, and outcomes.


Assuntos
Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Cirrose Hepática/etiologia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Provedores de Redes de Segurança/estatística & dados numéricos , Idoso , Carcinoma Hepatocelular/terapia , Feminino , Humanos , Cirrose Hepática/mortalidade , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Taxa de Sobrevida , Estados Unidos
16.
Clin Imaging ; 67: 146-151, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32659600

RESUMO

PURPOSE: To compare percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of Hepatocellular carcinoma (HCC) and to identify risk factors for treatment failure and local progression. METHODS: 145 unique HCC [87 (60%) RFA, 58 (40%) MWA] were retrospectively reviewed from a single tertiary medical center. Adverse events were classified as severe, moderate, or mild according to the Society of Interventional Radiology Adverse Event Classification system. Primary and secondary efficacy, as well as local progression, were determined using mRECIST. Predictors of treatment failure and time to local progression were analyzed using generalized estimating equations and Cox regression, respectively. RESULTS: Technical success was achieved in 143/145 (99%) HCC. There were 1 (0.7%) severe and 2 (1.4%) moderate adverse events. Of the 143 technically successful initial treatments, 136 (95%) completed at least one follow-up exam. Primary efficacy was achieved in 114/136 (84%). 9/22 (41%) primary failures underwent successful repeat ablation, so secondary efficacy was achieved in 128/136 (90%) HCC. Local progression occurred in 24 (19%) HCC at a median of 25 months (95% CI = 19-32 months). There was no difference in technical success, primary efficacy, or time to local progression between RFA and MWA. In HCC treated with MWA, same-day biopsy was associated with primary failure (RR = 9.0, 95% CI: 1.7-47, P = 0.015), and proximity to the diaphragm or gastrointestinal tract was associated with local progression (HR = 2.40, 95% CI:1.5-80, P = 0.017). CONCLUSION: There was no significant difference in primary efficacy or time to local progression between percutaneous RFA and MWA.


Assuntos
Carcinoma Hepatocelular/terapia , Ablação por Cateter , Micro-Ondas , Ablação por Radiofrequência , Biópsia , Carcinoma Hepatocelular/patologia , Progressão da Doença , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Resultado do Tratamento
17.
Radiologe ; 60(8): 693-703, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32666151

RESUMO

BACKGROUND: Transarterial radioembolization (TARE) is a locoregional minimally invasive therapeutic strategy to treat primary and secondary hepatic neoplasia. AIM: The objective was to assess TARE-induced immuno-oncological effects and its perspective for potential therapy improvement by using a combinatory strategy with immune checkpoint inhibitors (ICI). RESULTS: Yttrium-90 (90Y) TARE is used in patients with persisting liver function as the first- and second-line treatment for cholangiocarcinoma and hepatocellular carcinoma and chemotherapy refractory liver metastasis of different primaries. Combination therapy with 90Y TARE and ICI may synergistically improve antitumoral immunity and patient outcome. Currently, there are no clinical studies with published data regarding this combination therapy and the subsequently induced immunological effects. Clinical data on other isotopes, e.g., holmium-166 (166Ho), are also lacking. CONCLUSION: The clinical evidence of combined treatment with TARE and ICI must be considerably improved. This innovative therapy concept must be studied in new trials assessing the immunological data, including cellular phenotypes, activation, functions, and biomarkers. This may provide valid, sensitive, and specific models in order to evaluate the optimal therapy concept and/or the therapy combination for the best patient outcome.


Assuntos
Carcinoma Hepatocelular/terapia , Embolização Terapêutica/métodos , Imunoterapia/métodos , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/imunologia , Humanos , Neoplasias Hepáticas/imunologia , Resultado do Tratamento
18.
Radiologe ; 60(8): 687-692, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32671491

RESUMO

CLINICAL ISSUE: Hepatocellular carcinoma (HCC) is associated with a high mortality rate. STANDARD TREATMENT: For many years, sorafenib was the only, and frequently poorly tolerated systemic treatment option, which lead to the unreflected recurrent use of locoregional treatment modalities, such as transarterial chemoembolization (TACE). INNOVATIONS: Based on recent positive phase III trial results, we now have three systemic therapeutic options available in the first and second line of treatment, respectively. This development enables us to design sequential treatments concepts for patients with advanced HCC. DIAGNOSTIC WORK-UP: Beyond the assessment of tumor burden, the liver function of HCC patients needs to be closely monitored under therapy. PERFORMANCE: High response rates, including complete remissions have been documented for immuno-oncology-based combination regimens in HCC patients. Already today, a median overall survival (mOS) above 20 months can been achieved through the sequential application of systemic therapies in phase II studies in patients with advanced HCC and preserved liver function. ACHIEVEMENTS: Local therapies will remain an integral component of HCC therapy. However, recent advancements will shift the focus towards systemic treatment concepts. PRACTICAL RECOMMENDATIONS: The rigorous implementation of validated scoring systems can contribute towards an improved selection of patients that are suited to locoregional therapies. Longitudinal monitoring of liver function is fundamental to ensure that the optimal point in time for a switch towards systemic therapies is not missed.


Assuntos
Carcinoma Hepatocelular/terapia , Imunoterapia , Neoplasias Hepáticas/terapia , Ensaios Clínicos Fase III como Assunto , Humanos , Radiologia Intervencionista
19.
Acta Gastroenterol Belg ; 83(2): 309-312, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32603051

RESUMO

Major advances have been performed in the understanding of genomic dysregulation of hepatocellular carcinoma. A median of 40 to 60 somatic mutations in coding sequence per tumor was identified including 2 to 6 mutations per tumor in genes driving liver carcinogenesis. The main genetic alterations target the key signaling pathways of liver carcinogenesis : telomere maintenance, cell cycle gene, Wnt/beta-catenin pathway, epigenetic modifier gene, oxidative stress pathway, AKT/mTOR and Ras/Raf MAP kinase pathways. A genotype/phenotype classification between these genetic drivers the tumor and patient's features have been also described and was correlated with transcriptomic profiling. These data will be helpful to identify subgroups of HCC that will respond or resist to systemic treatments already used in clinical practice such as tyrosine kinase inhibitors, anti-VEGFR antibody or checkpoint inhibitors and will be useful to identify new therapeutic targets tested in future clinical trials.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinogênese , Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/terapia , Humanos , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/terapia , Mutação , Medicina de Precisão
20.
PLoS One ; 15(6): e0232371, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555707

RESUMO

Sarcopenia has been associated with lower overall survival in patients with cirrhosis and hepatocellular carcinoma (HCC) undergoing surgical resection, TACE, TARE, or transplantation. This monocentric study evaluated the prognostic significance of sarcopenia in patients affected by HCC who received bland transarterial embolization (TAE) therapy, by analyzing its impact on survival and treatment-related complications. All consecutive patients who underwent the 1st TAE between March 1st 2011 and July 1st 2019 in our Institution were retrospectively studied. To evaluate sarcopenia, the skeletal muscle index (SMI) was calculated by normalizing the cross-sectional muscle area at the level of L3 on an abdominal CT scan prior to embolization (cm2) by patient height (m2). SMI cut-off values for sarcopenia were considered ≤ 39 cm2/m2 for women and ≤55 cm2/m2 for men. Data about age, gender, body mass index (BMI), underlying liver disease, liver function, MELD score, Child-Pugh score, multifocal disease, performance status, previous interventions, length of stay (LOS), complications after the procedure, readmission rate within 30 days, survival time from TAE and total number and type of TAE received following the first procedure were collected. From 2011 to 2019, 142 consecutive patients underwent 305 TAEs. Observation time ranged from 1.4 to 100.5 months (median 20.1 SD = 22). Sarcopenia at baseline was present in 121 (85%) patients. Overall 87 (61.2%) patients died during follow-up with survival rates at 1-, 2-, 3-, 4-, and 5-year of 71%, 41%, 22%, 16% and 11% respectively. After multivariate analysis sarcopenia (HR = 2.22, p = 0.046), previous ablation/resection (HR = 0.51, p = 0.005) and multifocal disease (HR = 1.84, p = 0.02) were associated with reduced survival. Sarcopenia did not influence the safety of TAE in terms of LOS (2 days vs 1.5 days, p = 0.2), early complications rate (8% vs 5%, p = 0.5) and readmission rate within 30 days (7% vs 5%, p = 0.74). Sarcopenia, estimated by the L3SMI method, is an emerging prognostic factor in patients with HCC undergoing bland TAE therapy as it is associated with increased mortality, without impairing the safety of the locoregional treatment. Measures to ameliorate the SMI, such as nutritional support and physical exercise, should be evaluated in clinical trials for HCC patients receiving liver embolization to determine their impact on overall survival.


Assuntos
Carcinoma Hepatocelular/terapia , Embolização Terapêutica , Neoplasias Hepáticas/terapia , Sarcopenia/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação , Fígado/patologia , Fígado/fisiologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Sarcopenia/etiologia , Índice de Gravidade de Doença
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