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Su Z, Luo L, Wu X, Wei B, Wang L, Liu F, Cai B. Association of the MARCO polymorphism rs6761637 with hepatocellular carcinoma susceptibility and clinical characteristics. Immunol Res 2022; 70:400-407. [PMID: 35364781 DOI: 10.1007/s12026-022-09271-2] [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: 07/07/2021] [Accepted: 02/23/2022] [Indexed: 02/05/2023]
Abstract
Hepatocellular carcinoma (HCC) remains a significant health problem with a substantial genetic predisposition. The liver harbors the largest proportion of macrophages among all the solid organs. There is considerable controversy regarding the relationship between the macrophage receptor with collagenous structure (MARCO) and tumor development and progression. Accordingly, we performed this case-control study to determine whether associations exist between the MARCO single nucleotide polymorphism rs6761637 and HCC susceptibility and clinical characteristics. We successfully genotyped 586 HCC cases and 647 controls using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The overall genotype distribution of rs6761637 was similar in the HCC and control groups (P = 0.143). However, the CT + CC genotypes of rs6761637 were slightly more common in the HCC group among female (P = 0.021), overweight (body mass index ≥ 24 kg/m2, P = 0.003), and nonsmoking (P = 0.022) individuals. The minor C allele carriers had a 1.47-fold increased risk of developing large tumor nodules (P = 0.041). rs6761637 did not affect the recurrence-free or overall survival rate of patients with HCC (P = 0.247 and 0.304, respectively). In conclusion, this is the first report of the association between MARCO genetic variations and HCC risk. These results suggest that the MARCO rs6761637 polymorphism may play a regulatory role in HCC carcinogenesis, but it does not seem to predict prognosis.
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Affiliation(s)
- Zhenzhen Su
- Department of Laboratory Medicine, West China Hospital of Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Limei Luo
- Department of Laboratory Medicine, West China Hospital of Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Xiaojuan Wu
- Department of Laboratory Medicine, West China Hospital of Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Bin Wei
- Department of Laboratory Medicine, West China Hospital of Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Lu Wang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Fei Liu
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China.
| | - Bei Cai
- Department of Laboratory Medicine, West China Hospital of Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, China.
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2
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Rich NE, Singal AG. Overdiagnosis of hepatocellular carcinoma: Prevented by guidelines? Hepatology 2022; 75:740-753. [PMID: 34923659 PMCID: PMC8844206 DOI: 10.1002/hep.32284] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/27/2021] [Accepted: 12/04/2021] [Indexed: 12/13/2022]
Abstract
Overdiagnosis refers to detection of disease that would not otherwise become clinically apparent during a patient's lifetime. Overdiagnosis is common and has been reported for several cancer types, although there are few studies describing its prevalence in HCC surveillance programs. Overdiagnosis can have serious negative consequences including overtreatment and associated complications, financial toxicity, and psychological harms related to being labeled with a cancer diagnosis. Overdiagnosis can occur for several different reasons including inaccurate diagnostic criteria, detection of premalignant or very early malignant lesions, detection of indolent tumors, and competing risks of mortality. The risk of overdiagnosis is partly mitigated, albeit not eliminated, by several guideline recommendations, including definitions for the at-risk population in whom surveillance should be performed, surveillance modalities, surveillance interval, recall procedures, and HCC diagnostic criteria. Continued research is needed to further characterize the burden and trends of overdiagnosis as well as identify strategies to reduce overdiagnosis in the future.
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Affiliation(s)
- Nicole E Rich
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amit G Singal
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
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Benson AB, D'Angelica MI, Abbott DE, Anaya DA, Anders R, Are C, Bachini M, Borad M, Brown D, Burgoyne A, Chahal P, Chang DT, Cloyd J, Covey AM, Glazer ES, Goyal L, Hawkins WG, Iyer R, Jacob R, Kelley RK, Kim R, Levine M, Palta M, Park JO, Raman S, Reddy S, Sahai V, Schefter T, Singh G, Stein S, Vauthey JN, Venook AP, Yopp A, McMillian NR, Hochstetler C, Darlow SD. Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:541-565. [PMID: 34030131 DOI: 10.6004/jnccn.2021.0022] [Citation(s) in RCA: 430] [Impact Index Per Article: 143.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The NCCN Guidelines for Hepatobiliary Cancers focus on the screening, diagnosis, staging, treatment, and management of hepatocellular carcinoma (HCC), gallbladder cancer, and cancer of the bile ducts (intrahepatic and extrahepatic cholangiocarcinoma). Due to the multiple modalities that can be used to treat the disease and the complications that can arise from comorbid liver dysfunction, a multidisciplinary evaluation is essential for determining an optimal treatment strategy. A multidisciplinary team should include hepatologists, diagnostic radiologists, interventional radiologists, surgeons, medical oncologists, and pathologists with hepatobiliary cancer expertise. In addition to surgery, transplant, and intra-arterial therapies, there have been great advances in the systemic treatment of HCC. Until recently, sorafenib was the only systemic therapy option for patients with advanced HCC. In 2020, the combination of atezolizumab and bevacizumab became the first regimen to show superior survival to sorafenib, gaining it FDA approval as a new frontline standard regimen for unresectable or metastatic HCC. This article discusses the NCCN Guidelines recommendations for HCC.
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Affiliation(s)
- Al B Benson
- 1Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Robert Anders
- 5The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | - Prabhleen Chahal
- 11Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Jordan Cloyd
- 13The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Evan S Glazer
- 14St. Jude Children's Research HospitalThe University of Tennessee Health Science Center
| | | | - William G Hawkins
- 16Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - R Kate Kelley
- 19UCSF Helen Diller Family Comprehensive Cancer Center
| | - Robin Kim
- 20Huntsman Cancer Institute at the University of Utah
| | - Matthew Levine
- 21Abramson Cancer Center at the University of Pennsylvania
| | | | - James O Park
- 23Fred Hutchinson Cancer Research CenterSeattle Cancer Care Alliance
| | | | | | | | | | | | | | | | - Alan P Venook
- 19UCSF Helen Diller Family Comprehensive Cancer Center
| | - Adam Yopp
- 31UT Southwestern Simmons Comprehensive Cancer Center; and
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Nidoni R, Kandagaddala R, Agarwal S, Dey R, Chikkala BR, Gupta S. Living Donor Liver Transplant in Patients Aged 60 Years or Older: Experience from a Large Volume Centre in India. J Clin Exp Hepatol 2021; 11:3-8. [PMID: 33679042 PMCID: PMC7897854 DOI: 10.1016/j.jceh.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/12/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND With ageing population and higher prevalence of nonalcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC) in older patients, more and more living donor liver transplants (LDLTs) are being considered in this group of patients as eligibility for deceased donor liver transplant is restricted to those aged 65 years and younger. However, the short- and long-term outcomes of this group have not been reported from India, which does not have a robust national health scheme. The aim of this study was to provide guidelines for transplant in this group. METHODS All patients aged 60 years and older (group 1) who underwent LDLT in our centre between January 2006 and December 2017 were studied. A propensity score-matched group in 1:2 ratio was created with comparable sex and Model for End-Stage Liver Disease score (group 2). The 2 groups were compared for duration of hospital stay, surgical complications, hospital mortality and 1-, 3- and 5-year survival. RESULTS Group 1 consisted of 207 patients, and group 2 had 414 patients. The number of patients in group 1 gradually increased with time from 4 in 2006 to 33 in 2017 accounting for 15% of total cases. Group 1 had more patients with viral hepatitis, NASH and HCC, and they had a higher 30-day mortality due to cardiorespiratory complications. Although 1- and 3-year survival was similar, the 5-year survival was significantly lower in group 1. CONCLUSION Five-year survival was lower in the elderly group due to cardiorespiratory complications and recurrence of HCC. Outcomes in the elderly group can be improved with better patient selection and preventing HCC recurrence.
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Key Words
- BMI, Body Mass Index
- CIT, Cold Ischaemia Time
- CLD, Chronic Liver Disease
- GRWR, Graft Recipient Weight Ratio
- HAT, Hepatic Artery Thrombosis
- HCC, Hepatocellular Carcinoma
- LDLT, Living Donor Liver Transplant
- MELD, Model of End-Stage Liver Disease
- NASH, Nonalcoholic Steatohepatitis
- PVT, Portal Vein Thrombosis
- WIT, Warm Ischaemia Time
- elderly liver recipients
- liver transplant in India
- liver transplant in old patients
- liver transplant outcomes
- living donor liver transplantation
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Gómez-Gavara C, Charco R, Tapiolas I, Ridaura N, Campos-Varela I, Dopazo C, Pando E, Caralt M, Hidalgo E, Castells L, Bilbao I. Recipient Age for Liver Transplantation: Should It Be Limited? A Propensity Score Matching Analysis of a Large European Series. Transplant Proc 2020; 52:1442-1449. [PMID: 32387080 DOI: 10.1016/j.transproceed.2020.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The demand for older patients not to be denied access to liver transplantation (LT) has intensified as the European population continues to live longer and maintains better health. AIM This study aims to ascertain the impact of recipient age on the post-LT survival in 2 well-balanced populations at Vall d'Hebron University Hospital. METHODS From January 1990 to December 2016, LT recipients (young group: 50-65 years of age; elderly group: >65 years of age) were compared by means of a propensity score matching (PSM) method. RESULTS Prior to PSM, graft survival and patient survival were worse for the elderly group (P < .001). In 1126 LT recipients, a caliper width of 0.01 was used based on the donor (age, sex, cause of donor death, and donor intensive care unit stay) and recipient covariates (sex, body mass index, indication for LT, intraoperative blood transfusion, cardiovascular risk factors, and Model for End-Stage Liver Disease [MELD]-Era). After PSM, 206 patients were matched; 1-, 5-, and 10-year patient survival rates were 77%, 63%, and 52% vs 80%, 64%, and 45% (P = .50) for young vs elderly recipients, respectively. Similar graft survival rates were observed in both groups (P = .42). CONCLUSIONS Advanced age alone should not exclude patients from LT.
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Affiliation(s)
- Concepción Gómez-Gavara
- Department of HPB Surgery and Transplantation, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Ramón Charco
- Department of HPB Surgery and Transplantation, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ingrid Tapiolas
- Department of HPB Surgery and Transplantation, Vall d'Hebron University Hospital, Barcelona, Spain; Autonoma University Barcelona, Barcelona, Spain
| | - Núria Ridaura
- Department of HPB Surgery and Transplantation, Vall d'Hebron University Hospital, Barcelona, Spain; Autonoma University Barcelona, Barcelona, Spain
| | - Isabel Campos-Varela
- Liver Unit, Department of Internal Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Cristina Dopazo
- Department of HPB Surgery and Transplantation, Vall d'Hebron University Hospital, Barcelona, Spain; Autonoma University Barcelona, Barcelona, Spain
| | - Elizabeth Pando
- Department of HPB Surgery and Transplantation, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mireia Caralt
- Department of HPB Surgery and Transplantation, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ernest Hidalgo
- Department of HPB Surgery and Transplantation, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Lluís Castells
- Liver Unit, Department of Internal Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Itxarone Bilbao
- Department of HPB Surgery and Transplantation, Vall d'Hebron University Hospital, Barcelona, Spain; Autonoma University Barcelona, Barcelona, Spain
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Dolnikov S, Adam R, Cherqui D, Allard MA. Liver transplantation in elderly patients: what do we know at the beginning of 2020? Surg Today 2020; 50:533-539. [PMID: 32279191 PMCID: PMC7239827 DOI: 10.1007/s00595-020-01996-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/06/2020] [Indexed: 02/07/2023]
Abstract
An aging population has prompted us to evaluate the indications of liver transplantation (LT) in elderly patients more frequently. In this review, we summarize the short- and long-term results after LT in elderly patients and also discuss the criteria used to select patients and how recipient age can challenge current allocation systems. Briefly, the feasibility and early outcomes of LT in elderly patients compare favorably with those of younger patients. Although long-term survival is less than satisfactory, large-scale studies show that the transplant survival benefit is similar for elderly and younger patients. Therefore, age alone does not contraindicate LT; however, screening for cardiopulmonary comorbidities, and asymptomatic malignancies, evaluating nutritional status, and frailty, is crucial to ensure optimal results and avoid futile transplantation.
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Affiliation(s)
- Shimon Dolnikov
- Centre Hépatobiliaire, Paul Brousse Hospital, 14 avenue Paul Vaillant Couturier, 94800, Villejuif, France
| | - René Adam
- Centre Hépatobiliaire, Paul Brousse Hospital, 14 avenue Paul Vaillant Couturier, 94800, Villejuif, France
| | - Daniel Cherqui
- Centre Hépatobiliaire, Paul Brousse Hospital, 14 avenue Paul Vaillant Couturier, 94800, Villejuif, France
| | - Marc Antoine Allard
- Centre Hépatobiliaire, Paul Brousse Hospital, 14 avenue Paul Vaillant Couturier, 94800, Villejuif, France.
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7
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Gómez Gavara C, Esposito F, Gurusamy K, Salloum C, Lahat E, Feray C, Lim C, Azoulay D. Liver transplantation in elderly patients: a systematic review and first meta-analysis. HPB (Oxford) 2019; 21:14-25. [PMID: 30146227 DOI: 10.1016/j.hpb.2018.07.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/13/2018] [Accepted: 07/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Elderly recipients are frequently discussed by the scientific community but objective indication for this parameter has been provided. The aim of this study was to synthesize the available evidence on liver transplantation for elderly patients to assess graft and patient survival. METHODS A literature search of the Medline, EMBASE, and Scopus databases was carried out from January 2000 to August 2018. Clinical studies comparing the outcomes of liver transplantation in adult younger (<65 years) and elderly (>65 years) populations were analyzed. The primary outcomes were patient mortality and graft loss rates. This review was registered (Number CRD42017058261) as required in the international prospective register for systematic review protocols (PROSPERO). RESULTS Twenty-two studies were included involving a total of 242,487 patients (elderly: 23,660 and young: 218,827) were included in this study. In the meta-analysis, the elderly group had patient mortality (hazard ratio [HR]: 1.26; 95% confidence interval [CI]: 0.97-1.63; P = 0.09; I2 = 48%) and graft (HR: 1.09; 95% CI: 0.81-1.47; P = 0.59; I2 = 12%) loss rates comparable to those in the young group. CONCLUSIONS Elderly patients have similar long-term survival and graft loss rates as young patients. Liver transplantation is an acceptable and safe curative option for elderly transplant candidates.
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Affiliation(s)
- Concepción Gómez Gavara
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France; Department of Surgery, Royal Free Campus, UCL Medical School, Pond Street, London, NW3 2QG, UK
| | - Francesco Esposito
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Kurinchi Gurusamy
- Department of Surgery, Royal Free Campus, UCL Medical School, Pond Street, London, NW3 2QG, UK
| | - Chady Salloum
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Eylon Lahat
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Cyrille Feray
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France; Unité INSERM 955, Créteil, France
| | - Chetana Lim
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Daniel Azoulay
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France; Unité INSERM 955, Créteil, France.
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Yu B, Ding Y, Liao X, Wang C, Wang B, Chen X. Radiofrequency ablation versus surgical resection in elderly patients with early-stage hepatocellular carcinoma in the era of organ shortage. Saudi J Gastroenterol 2018; 24:317-325. [PMID: 30117492 PMCID: PMC6253917 DOI: 10.4103/sjg.sjg_261_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS To compare the survival benefits of surgical resection (SR) with those of radiofrequency ablation (RFA) in elderly patients (≥65 years) with single hepatocellular carcinoma (HCC) ≤5 cm. PATIENTS AND METHODS Using the Surveillance, Epidemiology, and End Results database, a total of 461 patients who underwent SR and 575 patients who underwent RFA were enrolled from 2004 to 2012. Overall survival (OS) and liver-cancer-specific survival (LCSS) comparisons were conducted between the two groups before and after propensity score matching (PSM). RESULTS Elderly patients with early-stage HCC had a lower rate of utilization of liver transplantation, and they were more likely to receive SR or RFA as their first-line treatment compared with younger patients (P < 0.05). In the whole cohort, the SR group had significantly better OS [RFA, hazard ratio (HR) = 1.680 (1.390, 2.031), P < 0.001] and LCSS (RFA, HR = 1.658 (1.327, 2.070), P < 0.001) than the RFA group. After PSM, the improved survival in the SR group was further confirmed (all P < 0.001). In the subgroup analyses, according to patients' age (65-75, >75 years) and tumor size (≤3.0, 3.1-5.0 cm), the SR group still presented better OS and LCSS than the RFA group (all P < 0.05), except for those older than 75 years with tumors ≤3.0 cm (all P > 0.05), both before and after PSM. CONCLUSION Treatment strategies for elderly patients (≥65 years) with single HCC ≤5 cm should emphasize SR as the primary therapy, while RFA can be an alternative to SR for those> 75 years with single HCC ≤3 cm.
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Affiliation(s)
- Bin Yu
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Youming Ding
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, China,Address for correspondence: Prof. Youming Ding, Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China. E-mail:
| | - Xiaofeng Liao
- Department of General Surgery, Xiangyang Central Hospital, Xiangyang, China
| | - Changhua Wang
- Department of Pathology and Pathophysiology, Wuhan University School of Basic Medical Sciences, Wuhan, China
| | - Bin Wang
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaoyan Chen
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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Older Patients With Hepatocellular Carcinoma Have More Advanced Disease, Lower Rates of Treatment, and Lower Survival. J Clin Gastroenterol 2017; 51:378-383. [PMID: 27380460 DOI: 10.1097/mcg.0000000000000590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
GOALS To evaluate age-specific disparities in cancer stage at diagnosis, receipt of treatment, and survival among adults with hepatocellular carcinoma (HCC). BACKGROUND HCC has become the fastest rising cause of cancer-related deaths in the United States. The aging population coupled with the rising incidence of HCC will result in an emerging cohort of older patients with HCC placing significant burden health care systems. STUDY Using 2003 to 2011 Surveillance, Epidemiology, and End Results data, a US population-based cancer registry, we retrospectively evaluated age-specific disparities in cancer stage at diagnosis, receipt of treatment, and survival among adults with HCC. Multivariate logistic regression models evaluated HCC stage at diagnosis and HCC treatment received. Multivariate Cox proportional hazard models evaluated long-term survival. RESULTS Compared with HCC patients below 50 years old, patients aged 70 years or older were less likely to have HCC within Milan criteria [odds ratio, 0.58; confidence interval (CI), 0.54-0.63; P<0.001]. Older age was also associated with significantly lower rates of receiving HCC treatment. Even after adjusting for stage of disease, patients aged 70 years or older had the lowest odds of receiving any HCC treatment compared with patients below 50 years old (odds ratio, 0.52; CI, 0.46-0.60; P<0.001). On multivariate Cox regression, HCC patients aged 70 years or older had significantly lower survival compared with patients below 50 years old (hazards ratio, 1.22; CI, 1.15-1.30; P<0.001). CONCLUSIONS Among US adults with HCC, patients aged 70 years or older were less likely to have HCC within Milan criteria at diagnosis, less likely to receive any HCC treatment, and had significantly lower long-term survival.
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10
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Hu Z, Zhou J, Li Z, Xiang J, Zhang Q, Yan S, Wu J, Zhang M, Wang W, Zheng S. Variant outcomes of liver transplantation for hepatitis C virus patients in different age categories: impact of the model for end-stage liver disease score. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:206-216. [PMID: 28107613 DOI: 10.1002/jhbp.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Whether the introduction of model for end-stage liver disease (MELD) has an effect on transplant outcome for different age categories remain unclear. METHODS We analyzed 49,762 adult hepatitis C virus (HCV) candidates through 1 January 1995 to 31 December 2012 from the Scientific Registry of Transplant Recipients. Patients were divided into four age categories (18-34, 35-49, 60-64, ≥65 years) in the pre-MELD era and MELD era, respectively. RESULTS Waiting list dropouts have decreased in the MELD era for all categories. A reduced trend in survival was observed for 18-34 years patients in the MELD era compared with the pre-MELD era, with 5-year intention-to-treat, overall and graft survival of 56.5%, 57.9%, 56.3% vs. 56.4%, 69.7%, 64.4% (P = 0.604, 0.034, and 0.071, respectively). For other age categories, survival rates were all superior in the MELD era. Cox-regression analysis showed values of hazard ratio for age increased with advanced age (all >1) in the pre-MELD era compared with the reference group (18-34 years), while these hazard ratios were <1 for overall and graft survival in MELD era. CONCLUSIONS Our study provides useful evidence that the introduction of MELD for liver allocation may adversely affect survival of specific HCV patients.
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Affiliation(s)
- Zhenhua Hu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang 310003, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang, China.,Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jie Zhou
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang 310003, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang, China.,Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhiwei Li
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang 310003, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang, China.,Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jie Xiang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang 310003, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang, China.,Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qijun Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang 310003, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang, China.,Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Sheng Yan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang 310003, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang, China.,Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jian Wu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang 310003, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang, China.,Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Min Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang 310003, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang, China.,Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Weilin Wang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang 310003, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang, China.,Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang 310003, China.,Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang, China.,Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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11
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Brunot A, Le Sourd S, Pracht M, Edeline J. Hepatocellular carcinoma in elderly patients: challenges and solutions. J Hepatocell Carcinoma 2016; 3:9-18. [PMID: 27574587 PMCID: PMC4994800 DOI: 10.2147/jhc.s101448] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the second most common cause of death by cancer in the world. Due to the delayed HCC development in hepatitis C carriers and nonalcoholic fatty liver disease, the incidence of HCC in the elderly is increasing and is becoming a global health issue. Elderly patients with HCC should be assessed through proper oncologic approach, namely, screening tools for frailty (Geriatric-8 or Vulnerable Elders Survey-13) and comprehensive geriatric assessment. This review of the literature supports the same treatment options for elderly patients as for younger patients, in elderly patients selected as fit following proper oncogeriatric assessment. Unfit patients should be managed through a multidisciplinary team involving both oncological and geriatrician professionals. Specific studies and recommendations for HCC in the elderly should be encouraged.
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Affiliation(s)
- Angélique Brunot
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Samuel Le Sourd
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Marc Pracht
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Julien Edeline
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
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12
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Gu XQ, Zheng WP, Teng DH, Sun JS, Zheng H. Impact of non-oncological factors on tumor recurrence after liver transplantation in hepatocellular carcinoma patients. World J Gastroenterol 2016; 22:2749-2759. [PMID: 26973413 PMCID: PMC4777997 DOI: 10.3748/wjg.v22.i9.2749] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/13/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary neoplasm of the liver and is one of the leading causes of cancer-related death worldwide. Liver transplantation (LT) has become one of the best curative therapeutic options for patients with HCC, although tumor recurrence after LT is a major and unaddressed cause of mortality. Furthermore, the factors that are associated with recurrence are not fully understood, and most previous studies have focused on the biological properties of HCC, such as the number and size of the HCC nodules, the degree of differentiation, the presence of hepatic vascular invasion, elevated serum levels of alpha-fetoprotein, and the tumor stage outside of the Milan criteria. Thus, little attention has been given to factors that are not directly related to HCC (i.e., “non-oncological factors”), which have emerged as predictors of tumor recurrence. This review was performed to assess the effects of non-oncological factors on tumor recurrence after LT. The identification of these factors may provide new research directions and clinical strategies for the prophylaxis and surveillance of tumor recurrence after LT, which can help reduce recurrence and improve patient survival.
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13
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Wang P, Wang C, Li H, Shi B, Wang J, Zhong L. Impact of age on the prognosis after liver transplantation for patients with hepatocellular carcinoma: a single-center experience. Onco Targets Ther 2015; 8:3775-81. [PMID: 26719705 PMCID: PMC4689267 DOI: 10.2147/ott.s93939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Liver transplantation (LT) offers the most effective treatment for hepatocellular carcinoma patients. Various preoperative variables are correlated with survival after LT, but the prognostic role of aging on LT remains controversial. METHODS Between January 2001 and December 2011, 290 consecutive transplants for patients with hepatocellular carcinoma performed in Shanghai First People's Hospital (People's Republic of China) were analyzed retrospectively. We compared patient characteristics and survival curves between a younger group (less than 49 years, n=135) and an aged group (50 years or older, n=155). We then performed Cox multivariate regression analysis of the risk factors for survival in aged and younger patients. RESULTS Younger age was associated with higher alpha-fetoprotein (P=0.014), larger tumor size (P=0.038), poorer differentiation (P=0.025), portal lymph node metastasis (P=0.001), and higher recurrence rate (P=0.038). Aged patients had significantly longer recurrence-free survival and overall survival (P=0.020 and P=0.014, respectively); however, there were no significant differences between the younger and aged patients who met the Milan criteria (P>0.05). The 1-, 3-, and 5-year recurrence-free survival rates were 59.7%, 44.5%, and 37.3%, respectively, in the younger group, and 67.9%, 55.3%, and 53.8%, respectively, in the aged group. The 1-, 3-, and 5-year overall survival rates were 68.4%, 45.5%, and 38.9%, respectively, in the younger group, and 76.1%, 59.7%, and 53.9%, respectively, in the aged group. Alpha-fetoprotein ≥400 ng/mL, microvascular invasion, and tumor size >5 cm were independent risk factors for prognosis in both groups. CONCLUSION Younger patients in our center tended to present with more aggressive tumors and have a higher risk of recurrence. Our single-center experience suggests that younger patients should be assessed more rigorously before LT, while aged patients should be actively considered for LT after appropriate selection.
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Affiliation(s)
- Pusen Wang
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai
| | - Chunguang Wang
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai
| | - Hao Li
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai
| | - Baojie Shi
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai
| | - Jianning Wang
- Department of Urology, Affiliated Qianfoshan Hospital, Shandong University, Jinan, People's Republic of China
| | - Lin Zhong
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai
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14
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Nagai S, Mangus RS, Anderson E, Ekser B, Kubal CA, Burch T, Fridell JA, Tector AJ. Post-transplant persistent lymphopenia is a strong predictor of late survival in isolated intestine and multivisceral transplantation. Transpl Int 2015; 28:1195-204. [DOI: 10.1111/tri.12620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/21/2015] [Accepted: 06/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Shunji Nagai
- Division of Transplant Surgery; Department of Surgery; Indiana University School of Medicine; Indianapolis IN USA
| | - Richard S. Mangus
- Division of Transplant Surgery; Department of Surgery; Indiana University School of Medicine; Indianapolis IN USA
| | - Eve Anderson
- Division of Transplant Surgery; Department of Surgery; Indiana University School of Medicine; Indianapolis IN USA
| | - Burcin Ekser
- Division of Transplant Surgery; Department of Surgery; Indiana University School of Medicine; Indianapolis IN USA
| | - Chandrashekhar A. Kubal
- Division of Transplant Surgery; Department of Surgery; Indiana University School of Medicine; Indianapolis IN USA
| | - Tracy Burch
- Division of Transplant Surgery; Department of Surgery; Indiana University School of Medicine; Indianapolis IN USA
| | - Jonathan A. Fridell
- Division of Transplant Surgery; Department of Surgery; Indiana University School of Medicine; Indianapolis IN USA
| | - A. Joseph Tector
- Division of Transplant Surgery; Department of Surgery; Indiana University School of Medicine; Indianapolis IN USA
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15
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Abstract
PURPOSE OF REVIEW To review and highlight recent literature regarding the medical management of adult patients undergoing liver transplantation. RECENT FINDINGS The addition of serum sodium concentration to the model for end-stage liver disease (MELD) score more accurately predicts 90-day waitlist mortality. Predictors of waitlist mortality and posttransplant survival include lower albumin and the presence of ascites, varices, and encephalopathy, as well as more nontraditional predictors such as older age, obesity, frailty, and sarcopenia. Indications for liver transplantation are evolving with the advent of effective therapy for hepatitis C and the increased prevalence of nonalcoholic steatohepatitis. Disparities persist in the current allocation system, including geographic variation and MELD inflation for hepatocellular carcinoma. Share 35 allows for broader regional sharing of organs for patients with the highest need, without detrimental effects on waitlist mortality or survival. Everolimus is a recently approved option for posttransplant immunosuppression that spares renal function. SUMMARY The MELD score has enabled the liver transplant community to equitably allocate organs. Recent literature has focused on the limitations of the MELD score and the disparities inherent in the current system. The next steps for liver transplantation will be to develop strategies to further optimize waitlist prioritization and organ allocation.
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