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Díaz LA, Villota-Rivas M, Barrera F, Lazarus JV, Arrese M. The burden of liver disease in Latin America. Ann Hepatol 2024; 29:101175. [PMID: 37922988 DOI: 10.1016/j.aohep.2023.101175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023]
Abstract
Liver disease poses a substantial burden in Latin America. This burden is primarily attributed to a high level of alcohol consumption and the increasing prevalence of risk factors associated with metabolic dysfunction-associated steatotic liver disease (MASLD), such as sedentary lifestyles, easy access to ultra-processed foods, obesity, and type 2 diabetes mellitus. These epidemiological trends are cause for concern, especially considering that there are significant challenges in addressing them due to disparities in access to liver disease screening and care. In this article, we aim to provide an overview of the current situation regarding liver disease in Latin America. We also discuss recent multinational proposals designed to address the growing MASLD burden via its integration into existing non-communicable diseases policies, at both local and global levels. Additionally, we emphasize the urgent need to establish effective public health policies that target both MASLD risk factors and excessive alcohol consumption. Furthermore, we discuss the development of liver transplantation programs, areas for improvement in medical education and research capabilities, and how the fostering of extensive collaboration among all stakeholders is crucial for addressing liver disease in the region.
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Affiliation(s)
- Luis Antonio Díaz
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Observatorio Multicéntrico de Enfermedades Gastrointestinales (OMEGA), Santiago, Chile
| | - Marcela Villota-Rivas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Francisco Barrera
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Observatorio Multicéntrico de Enfermedades Gastrointestinales (OMEGA), Santiago, Chile
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, United States; Global NASH Council, Washington DC, United States
| | - Marco Arrese
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Observatorio Multicéntrico de Enfermedades Gastrointestinales (OMEGA), Santiago, Chile; Global NASH Council, Washington DC, United States.
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Haddad L, Gadano A. HBV elimination in Central and South America: Current status and challenges. Clin Liver Dis (Hoboken) 2024; 23:e0226. [PMID: 38860128 PMCID: PMC11164009 DOI: 10.1097/cld.0000000000000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/16/2024] [Indexed: 06/12/2024] Open
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Hepatocellular carcinoma in Colombia 2017 - 2021. Ann Hepatol 2023; 28:100902. [PMID: 36925211 DOI: 10.1016/j.aohep.2023.100902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 03/18/2023]
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Garcia-Monaco RD, Chung JW, Vilgrain V, Bouattour M, Covey AM. Summary of key guidelines for locoregional treatment of HCC in Asia, Europe, South and North America. Br J Radiol 2022; 95:20220179. [PMID: 35848758 PMCID: PMC9815746 DOI: 10.1259/bjr.20220179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/01/2022] [Accepted: 07/13/2022] [Indexed: 01/26/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide accounting for over 800,000 new cases in 2018, with the highest incidence in Asia and Africa where hepatitis B is the most common risk factor. In Europe, Japan, and the United States, hepatitis C chronic alcohol abuse and non-alcoholic fatty liver disease are more common risk factors. Five-year survival is low, less than 20% worldwide. HCC is a particularly challenging disease to treat because therapeutic options and prognosis must also consider hepatitis or cirrhosis independent of the malignancy. Locoregional therapies (LRT) including ablation, arterially directed therapy and external beam radiation are the preferred treatments for patients with good performance status, unresectable disease limited to the liver and preserved liver function. In practice, patients with portal vein tumor thrombus and limited extrahepatic disease may also be considered candidates for LRT. There are several guidelines developed by expert panels provide recommendations on treating this challenging disease including the Barcelona Clinic Liver Cancer, European Association for the Study of the Liver, European Society for Medical Oncology, American Association for the Study of the Liver Diseases, and the National Comprehensive Cancer Network. The purpose of this paper is to review the guidelines as they are applied clinically in regions with high incidence of HCC.
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Affiliation(s)
- Ricardo D Garcia-Monaco
- Vascular and Interventional Radiology Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina
| | - Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Valérie Vilgrain
- Department of Radiology, Department of OncHepatology Hopital Beaujon, APHP.Nord, Clichy, France
| | - Mohamed Bouattour
- Department of Radiology, Department of OncHepatology Hopital Beaujon, APHP.Nord, Clichy, France
| | - Anne M Covey
- Memorial Sloan Kettering Cancer Center Professor of Radiology, Weill Cornell Medical Center, New York, United States
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Barrera-Cortés RI, Rodriguez-Torres EE, Vázquez-Mendoza E, Ruvalcaba-Ledezma JC, Soria-Jasso LE, Ortiz MI, Fernández-Martínez E. Liver cancer in Hidalgo State, Mexico: analysis of the status, risk factors and regional public health policy requirements: a cross-sectional correlational study. SAO PAULO MED J 2022; 140:574-582. [PMID: 35766636 PMCID: PMC9491469 DOI: 10.1590/1516-3180.2021.0601.r1.121121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/12/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In Latin America, liver cancer is one of the top causes of cancer mortality. It is the fifth most common cause of death among malignant tumors in Mexico and is the leading cause in Hidalgo State (43.8% of the population living in poverty). OBJECTIVE To conduct a correlational analysis on the main risk factors for liver cancer in Hidalgo State, Mexico, including municipal disaggregation and comparison with the national level. DESIGN AND SETTING Cross-sectional, correlational, descriptive and comparative epidemiological study using Mexican governmental databases covering 1990-2019. METHODS A comprehensive review of the databases of the General Directorate of Health Information (DGIS) was performed to analyze official death figures, hospital discharges and national and municipal population projections, using specific search criteria defined in the Global Burden of Disease classification, based on the risk factors for liver cancer. RESULTS Liver cancer rates showed an evident rise in Hidalgo (183%), moving from 21st place in Mexico in 1990 to 9th place in 2019. This increase was correlated with alcoholism. An increasing trend for liver cancer deaths, of 133.89%, is projected for 2030. Females and the population over 60 years of age are more affected. There are some critical regions with liver cancer death rates twice the national rate or more. CONCLUSION Targeted effective public health strategies should be structured by identifying, characterizing and regionalizing critical marginalized municipalities that are vulnerable to alcoholism and other risk factors for liver cancer. This approach may be helpful for other states in Mexico or similar countries.
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Affiliation(s)
- Rosa Isela Barrera-Cortés
- MD, MPH. Family Medicine Specialty Student, Department of Medicine, School of Health Sciences, Universidad Autónoma del Estado de Hidalgo (UAEH), Pachuca, Hidalgo, Mexico
| | - Erika Elizabeth Rodriguez-Torres
- BSc, MSc, PhD. Full Professor, Department of Mathematics and Physics, School of Basic Sciences and Engineering, Universidad Autónoma del Estado de Hidalgo (UAEH), Pachuca, Hidalgo, Mexico
| | - Enrique Vázquez-Mendoza
- BSc, MSc. Doctoral Student, Department of Mathematics and Physics, School of Basic Sciences and Engineering, Universidad Autónoma del Estado de Hidalgo (UAEH), Pachuca, Hidalgo, Mexico
| | - Jesús Carlos Ruvalcaba-Ledezma
- MD, PhD. Full Professor, Department of Medicine, School of Health Sciences, Universidad Autónoma del Estado de Hidalgo (UAEH), Pachuca, Hidalgo, Mexico
| | - Luis Enrique Soria-Jasso
- MD, PhD. Full Professor, Department of Medicine, School of Health Sciences, Universidad Autónoma del Estado de Hidalgo (UAEH), Pachuca, Hidalgo, Mexico
| | - Mario Isidoro Ortiz
- MD, MSc, PhD. Full Professor, Department of Medicine, School of Health Sciences, Universidad Autónoma del Estado de Hidalgo (UAEH), Pachuca, Hidalgo, Mexico
| | - Eduardo Fernández-Martínez
- BSc, MSc, PhD. Full Professor, Department of Medicine, School of Health Sciences, Universidad Autónoma del Estado de Hidalgo (UAEH), Pachuca, Hidalgo, Mexico
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Liver Diseases in Latin America: Current Status, Unmet Needs, and Opportunities for Improvement. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2022; 20:261-278. [PMID: 35729970 PMCID: PMC9202671 DOI: 10.1007/s11938-022-00382-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
Abstract
Purpose of review
To assess the current challenges regarding liver diseases, including the burden of disease, access to care, screening, and treatment needs in Latin America. Recent findings Latin America is a region with a rich multicultural heritage and important socioeconomic differences. The burden of liver diseases is high and mainly determined by a high level of alcohol intake and the surge of risk factors associated with NAFLD (i.e., sedentary lifestyles, broader access to highly processed foods, obesity, and type 2 diabetes mellitus). Hepatotropic viruses also play a role in the development of chronic liver diseases, although their comparative frequency has been decreasing over the last decades. There are important disparities in access to screening and treatment for liver diseases in Latin America, which are reflected in low access to critical treatments such as direct-acting antiviral agents and drugs to treat hepatocellular carcinoma. Also, important barriers to liver transplantation are present in multiple countries, including a low deceased donors’ rate and a lack of availability in several countries (especially in Central America). Our region also has disadvantages in research and education in liver diseases, which limits regional academic development and improvement in quality of care of liver diseases. Summary In order to tackle an increasing health burden due to liver diseases, Latin America urgently needs tailored interventions aiming to control the main risk factors for these disorders through the establishment of effective public health policies. Also, development of liver transplantation programs and improvement of medical education and research capabilities as well as extensive collaboration between all stakeholders are keys to address the liver disease agenda in the region.
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Rim Enhancement after Technically Successful Transarterial Chemoembolization in Hepatocellular Carcinoma: A Potential Mimic of Incomplete Embolization or Reactive Hyperemia? Tomography 2022; 8:1148-1158. [PMID: 35448728 PMCID: PMC9028792 DOI: 10.3390/tomography8020094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022] Open
Abstract
Contrast enhancement at the margins/rim of embolization areas in hepatocellular-carcinoma (HCC) lesions treated with transarterial chemoembolization (TACE) might be an early prognostic indicator for HCC recurrence. The aim of this study was to evaluate the predictive value of rim perfusion for TACE recurrence as determined by perfusion CT (PCT). A total of 52 patients (65.6 ± 9.3 years) underwent PCT directly before, immediately after (within 48 h) and at follow-up (95.3 ± 12.5 days) after TACE. Arterial-liver perfusion (ALP), portal-venous perfusion (PVP) and hepatic-perfusion index (HPI) were evaluated in normal liver parenchyma, and on the embolization rim as well as the tumor bed. A total of 42 lesions were successfully treated, and PCT measurements showed no residually vascularized tumor areas. Embolization was not entirely successful in 10 patients with remaining arterialized focal nodular areas (ALP 34.7 ± 10.1 vs. 4.4 ± 5.3 mL/100 mL/min, p < 0.0001). Perfusion values at the TACE rim were lower in responders compared to normal adjacent liver parenchyma and edges of incompletely embolized tumors (ALP liver 16.3 ± 10.1 mL/100 mL/min, rim responder 8.8 ± 8.7 mL/100 mL/min, rim non-responder 23.4 ± 8.6 mL/100 mL/min, p = 0.005). At follow-up, local tumor relapse was observed in 17/42, and 15/42 showed no recurrence (ALP 39.1 ± 10.1 mL/100 mL/min vs. 10.0 ± 7.4 mL/100 mL/min, p = 0.0008); four patients had de novo disseminated disease and six patients were lost in follow-up. Rim perfusion was lower compared to adjacent recurring HCC and not different between groups. HCC lesions showed no rim perfusion after TACE, neither immediately after nor at follow-up at three months, both for mid-term responders and mid-term relapsing HCCs, indicating that rim enhancement is not a sign of reactive hyperemia and not predictive of early HCC recurrence.
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Gomez-Quiroz LE, Roman S. Influence of genetic and environmental risk factors in the development of hepatocellular carcinoma in Mexico. Ann Hepatol 2022; 27 Suppl 1:100649. [PMID: 34902602 DOI: 10.1016/j.aohep.2021.100649] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023]
Abstract
The latest studies on the epidemiology of diverse types of cancers have located in the scene the relevance of liver tumors, particularly hepatocellular carcinoma (HCC). HCC is a life-threatening malignancy triggered by chronic exposure to hepatitis B and C viruses, excessive alcohol intake, hepatic lipid droplet accumulation, and aflatoxins that lead to persistent liver damage. The occurrence of such etiological risk factors deeply marks the variability in the incidence of HCC worldwide reflected by geography, ethnicity, age, and lifestyle factors influenced by cultural aspects. New perspectives on the primary risk factors and their potential gene-environment interactions (GxE) have been well-addressed in some cancers; however, it continues to be a partially characterized issue in liver malignancies. In this review, the epidemiology of the risk factors for HCC are described enhancing the GxE interactions identified in Mexico, which could mark the risk of this liver malignancy among the population and the measures needed to revert them. Updated healthcare policies focusing on preventive care should be tailored based on the genetic and environmental risk factors, which may influence the effect of the etiological agents of HCC. Robust regional investigations related to epidemiological, clinical, and basic studies are warranted to understand this health problem complying with the rules of ethnic, genetic, environmental, and social diversity.
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Affiliation(s)
- Luis E Gomez-Quiroz
- Área de Medicina Experimental y Traslacional, Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico
| | - Sonia Roman
- Department of Genomic Medicine in Hepatology, Civil Hospital of Guadalajara, "Fray Antonio Alcalde," Guadalajara, Jalisco, Mexico; Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico.
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Laguna-Meraz S, Roman S, Jose-Abrego A, Sigala-Arellano R, Panduro A. A hospital-based study of the prevalence of HBV, HCV, HIV, and liver disease among a low-income population in West Mexico. Ann Hepatol 2022; 27 Suppl 1:100579. [PMID: 34793967 DOI: 10.1016/j.aohep.2021.100579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES Viral hepatitis is a global health problem with unequal distribution of disease burden in which low-income people are at higher risk for acquisition and underlying liver diseases. This study aimed to seek the prevalence of hepatitis B and C viruses, HIV, and liver damage among low-income patients attending a public tertiary care hospital in West Mexico. METHODS A retrospective/cross-sectional study at the Department of Genomic Medicine in Hepatology was conducted between March 1, 2016 to March 30, 2017. A total of 10,352 patients tested for anti-HCV, HBsAg, or anti-HIV (n=23,074) were included. Age, gender, and hospital service were registered. Liver fibrosis was assessed using APRI and FIB-4 scores. RESULTS Overall, 3.9% were anti-HCV+ (305/7848), 1.0% were HBsAg+ (80/7894), and 2.9% were anti-HIV+ (210/7332). A 43.8% (750/1959) of patients negative for all viruses had either abnormal AST, ALT, or GGT (≥40 UI/L). Also, significant liver fibrosis (APRI ≥ 0.7) was prevalent in 10.6% (191/1804). In patients who tested positive for viral infections, liver fibrosis was detected in 20.4% (11/54) of HBsAg+, 34.2% (53/155) in anti-HCV+ and 15.5% (16/103) in anti-HIV+. Anti-HCV+ was highest in Geriatrics (11.1%), HBsAg+ in HIV patients (3.0%) and anti-HIV+ in Emergency room attendees (33.3%). CONCLUSION High seroprevalence of HCV, HBV, and HIV infections was found among the studied population. Significant liver fibrosis was detected in negative and positive patients for viral infections. Medical services need to continuously test for viral infections, promote early detection of chronic liver damage and identify target patients for elimination strategies to decrease disease burden.
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Affiliation(s)
- Saul Laguna-Meraz
- Department of Genomic Medicine in Hepatology, Civil Hospital of Guadalajara, "Fray Antonio Alcalde," Guadalajara, Jalisco, Mexico; Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Sonia Roman
- Department of Genomic Medicine in Hepatology, Civil Hospital of Guadalajara, "Fray Antonio Alcalde," Guadalajara, Jalisco, Mexico; Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Alexis Jose-Abrego
- Department of Genomic Medicine in Hepatology, Civil Hospital of Guadalajara, "Fray Antonio Alcalde," Guadalajara, Jalisco, Mexico; Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Ramon Sigala-Arellano
- Laboratory of Clinical Pathology, Civil Hospital of Guadalajara, "Fray Antonio Alcalde," Guadalajara, Jalisco, Mexico
| | - Arturo Panduro
- Department of Genomic Medicine in Hepatology, Civil Hospital of Guadalajara, "Fray Antonio Alcalde," Guadalajara, Jalisco, Mexico; Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico.
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Traditional Chinese medicine for prevention and treatment of hepatocellular carcinoma: A focus on epithelial-mesenchymal transition. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2021; 19:469-477. [PMID: 34538644 DOI: 10.1016/j.joim.2021.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/21/2021] [Indexed: 12/24/2022]
Abstract
Hepatocellular carcinoma (HCC) is one of the most prevalent malignant cancers worldwide. Epithelial-mesenchymal transition (EMT), which endows epithelial cells with mesenchymal properties, plays an important role in the early stages of metastasis. Conventional cancer therapies have promising effects, but issues remain, such as high rates of metastasis and drug resistance. Thus, exploring and evaluating new therapies is an urgent need. Traditional Chinese medicines (TCMs) have been acknowledged for their multi-target and coordinated intervention effects against HCC. Accumulating evidence indicates that TCM can inhibit the malignancy of cells and the progression of EMT in HCC. However, studies on the effects of TCM on EMT in HCC are scarce. In this review, we summarized recent developments in anti-EMT TCMs and formulae, focusing on their underlying pharmacological mechanisms, to provide a foundation for further research on the exact mechanisms through which TCM affects EMT in HCC.
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Hu S, Chen Y, Liu L, Yin X, Yang Y, Tang L. PLZF and PLZF-MAPK10 can predict the prognosis of postoperative patients with hepatocellular carcinoma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:3158-3166. [PMID: 33425116 PMCID: PMC7791377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The current study aimed to explore the expression level of promyelocytic leukaemia zinc finger (PLZF) in hepatocellular carcinoma tissues and to investigate the value of detecting the expression levels of PLZF and mitogen-activated protein kinase 10 (MAPK10) on predicting prognosis. METHODS This study selected data from 53 patients with HCC who had undergone hepatectomy in our hospital. The expressions of PLZF and MAPK10 in tumor tissues and normal tissues were compared and related clinical factors were analyzed. The clinical data including patient's gender, age, hepatitis B virus infection (HBV), alpha-fetoprotein levels (AFP), tumor size, TNM stage (AJCC), cirrhosis, portal vein tumor thrombus (PVTT), bile duct tumor thrombus (BDTT), and OS (Overall survival) was collected. RESULTS We found that PLZF expression was significantly down-regulated in HCC samples compared with that in adjacent non-tumor tissues (P=0.001). The expression level of PLZF was correlated with patients' gender (P=0.046), tumor stage (P=0.039), and OS (P=0.015). Moreover, the expression level of PLZF-MAPK10 (P-M protein) was correlated with gender (P=0.000) and tumor stage (P=0.045). Multivariate analyses showed that microsatellite nodules, PLZF, and P-M protein were independent risk factors of HCC prognosis. Postoperative patients with a normal expression level of PLZF and MAPK10 have a longer overall survival than those with abnormal levels (P=0.039). CONCLUSION PLZF expression was significantly down-regulated in HCC tissues and itself and PLZF-MAPK10 were both independent prognostic factors for the OS of patients with HCC.
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Affiliation(s)
- Shanshan Hu
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical UniversityChongqing, China
| | - Yue Chen
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical UniversityChongqing, China
| | - Liheng Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical UniversityChongqing, China
| | - Xuedong Yin
- Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical UniversityChongqing, China
| | - Yaying Yang
- Department of Pathology, Molecular Medicine and Cancer Research Center, Chongqing Medical UniversityChongqing, China
| | - Liping Tang
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical UniversityChongqing, China
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Fernandes GDS, Campos D, Ballalai A, Palhares R, da Silva MRA, Palhares DMF, Neto BHF, Barros FMDR, Gil RDA, Chagas A, Carrilho FJ. Epidemiological and Clinical Patterns of Newly Diagnosed Hepatocellular Carcinoma in Brazil: the Need for Liver Disease Screening Programs Based on Real-World Data. J Gastrointest Cancer 2020; 52:952-958. [PMID: 32918274 PMCID: PMC8376733 DOI: 10.1007/s12029-020-00508-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose Describe sociodemographic and clinical characteristics of patients with hepatocellular carcinoma (HCC) and establish their history in the Brazilian public health system. Methods Retrospective observational study was conducted using the database from the Department of Informatics of the Unified Health System (DataSUS). Patients with at least one claim of HCC between July/2011 and June/2016 were included. A record linkage methodology was performed to obtain longitudinal data across different databases. Demographic and clinical data were evaluated, including the time elapsed between diagnosis of HCC risk-factors and the cancer development. Data was analyzed using descriptive statistics. Results A total of 28,822 HCC cases were identified between July/2011 and June/2016. Mean age was 59.7 years (SD = 14.7), and most patients were men (55.9%). The highest relative number of HCC cases was detected in the south of Brazil (> 20 cases/100,000 inhabitants). About 86.5% of the patients had diagnosis of HCC without previous liver diseases. Only 8% had diagnosis of chronic viral hepatitis and 3.5% cirrhosis. About 76% were diagnosed at an advanced stage, and only 11% of the patients had early stage HCC. Approximately 58% of patients with previous underlying liver diseases were diagnosed at early stages, compared with only 24% of patients without prior record of underlying diseases. Conclusion The diagnosis of HCC in the Brazilian public health is usually made in patients with no previous diagnosis of liver disease and in advanced stages, when no curative treatment is available and survival rates are low. Public health policies are key for the screening and monitoring liver disease and, consequently, HCC.
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Affiliation(s)
- Gustavo Dos Santos Fernandes
- Centro de Oncologia, Hospital Sírio-Libanês, SGAS 613/614, Conjunto E, Lote 95, Brasilia, DF, CEP 70200730, Brazil. .,Sociedade Brasileira de Oncologia Clínica, Sao Paulo, SP, Brazil.
| | | | | | | | - Mario R A da Silva
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Daniel M F Palhares
- Centro de Oncologia, Hospital Sírio-Libanês, SGAS 613/614, Conjunto E, Lote 95, Brasilia, DF, CEP 70200730, Brazil
| | - Ben-Hur F Neto
- Consultant Surgeon at Diagnósticos da América SA (DASA) e Associação Brasileira de Linfoma e Leucemia (ABRALE), Sao Paulo, SP, Brazil
| | | | - Roberto de A Gil
- Serviço de Oncologia Clínica do INCA e Oncoclínica Centro de Tratamento Oncológico, Rio de Janeiro, RJ, Brazil
| | - Aline Chagas
- Hospital das Clínicas da Faculdade de Medicina da USP e Instituto do Câncer do Estado de São Paulo (ICESP), Sao Paulo, SP, Brazil
| | - Flair José Carrilho
- Hospital das Clínicas da Faculdade de Medicina da USP e Instituto do Câncer do Estado de São Paulo (ICESP), Sao Paulo, SP, Brazil
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de Guevara LL, Dagher L, Arruda VM, Nakajima K, Kudo M. Sorafenib treatment by Child-Pugh score in Latin American patients with hepatocellular carcinoma. Future Oncol 2020; 16:2511-2520. [PMID: 32783460 DOI: 10.2217/fon-2020-0323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aim: To evaluate sorafenib treatment in Latin American patients with unresectable hepatocellular carcinoma in the real-world GIDEON study. Patients & methods: Sorafenib administration, safety and efficacy were analyzed by Child-Pugh status. Results: Of 90 evaluable patients (37% Child-Pugh A, 46% Child-Pugh B and 3% Child-Pugh C at study entry), 97% started sorafenib at 800 mg/day. Patients with Child-Pugh B7 had the longest median treatment duration of sorafenib (33.1 weeks). Sorafenib-related adverse events occurred in 58% of patients with Child-Pugh A (21% grade 3/4) and 46% with Child-Pugh B (7% grade 3/4). Conclusion: Sorafenib had a similar safety profile across patients with Child-Pugh A and B and is a treatment option for both groups.
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Affiliation(s)
- Laura L de Guevara
- Department of Internal Medicine, Hospital Angeles Clínica Londres, Mexico City, 06700, Mexico
| | - Lucy Dagher
- Department of Hepatology, Policlínica Metropolitana, Caracas, 1061, Venezuela
| | - Vanessa Mv Arruda
- Medical Affairs LATAM, Bayer HealthCare Pharmaceuticals, Whippany, NJ 07981, USA
| | - Keiko Nakajima
- Global Medical Affairs, Bayer HealthCare Pharmaceuticals, Whippany, NJ 07981, USA
| | - Masatoshi Kudo
- Department of Gastroenterology & Hepatology, Kindai University Faculty of Medicine, Osaka, 577-8502, Japan
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Hu J, Chen S, Wang X, Lin N, Yang J, Wu S. Image-Guided Percutaneous Microwave Ablation Versus Cryoablation For Hepatocellular Carcinoma In High-Risk Locations: Intermediate-Term Results. Cancer Manag Res 2019; 11:9801-9811. [PMID: 31819618 PMCID: PMC6873974 DOI: 10.2147/cmar.s227961] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/25/2019] [Indexed: 12/24/2022] Open
Abstract
Objective The aims of this study were to compare the clinical outcomes between image-guided percutaneous microwave ablation (MWA) and cryoablation (CRA) in patients with hepatocellular carcinoma (HCC) in high-risk locations and to identify the prognostic factors associated with the two treatment methods. Methods This retrospective study was institutional review board approved. A total of 120 patients (88 men and 32 women) with one hundred and thirty-four HCC lesions in high-risk locations from April 2014 to March 2018 were reviewed. Sixty-four patients underwent MWA and 56 patients underwent CRA. Survival, recurrence and complications were compared between the two groups. Effect of changes in key outcomes (i.e., overall survival (OS), recurrence-free survival (RFS) and local tumor progression (LTP)) was statistically analyzed with the log rank test. Univariate and multivariate analysis were performed on clinicopathological variables to identify factors affecting intermediate-term outcomes. Results The OS and RFS after MWA were comparable to those of CRA (P =0.141, and P=0.469, respectively). The LTP and major complication in MWA group was higher than those in CRA group (P=0.003, and P=0.039). Univariate analysis showed that age (P=0.007), tumor size (P=0.001), and Child-Turcotte-Pugh (CTP) grade (P=0.003) were risk factors for OS, and multivariate analysis results showed that older age (≥65 years) (P=0.002, HR:3.338, 95% CI:1.928–5.281), 3.0–5.0 cm in size (P<0.001, HR: 3.312, 95% CI: 1.872–4.489) and CTP grade B (P=0.001, HR:3.382, 95% CI: 1.882–5.902) were independently associated with poor OS. Conclusion CRA had comparable oncologic outcomes with MWA and could be a safe and effective treatment for HCC in high-risk locations.
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Affiliation(s)
- Jiahui Hu
- Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing 100020, People's Republic of China
| | - Sheng Chen
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, People's Republic of China
| | - Xin Wang
- Department of Oncology, Fuzhou Hospital of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350001, People's Republic of China
| | - Ning Lin
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, People's Republic of China
| | - Jianchuan Yang
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, People's Republic of China
| | - Songsong Wu
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, People's Republic of China
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Freitas LBRD, Longo L, Santos D, Grivicich I, Álvares-da-Silva MR. Hepatocellular carcinoma staging systems: Hong Kong liver cancer vs Barcelona clinic liver cancer in a Western population. World J Hepatol 2019; 11:678-688. [PMID: 31602288 PMCID: PMC6783400 DOI: 10.4254/wjh.v11.i9.678] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/08/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite being the world’s most widely used system for staging and therapeutic guidance in hepatocellular carcinoma (HCC) treatment, the Barcelona clinic liver cancer (BCLC) system has limitations, especially regarding intermediate-grade (BCLC-B) tumors. The recently proposed Hong Kong liver cancer (HKLC) staging system appears useful but requires validation in Western populations.
AIM To evaluate the agreement between BCLC and HKLC staging on the management of HCC in a Western population, estimating the overall patient survival.
METHODS This was a retrospective study of HCC patients treated at a university hospital in southern Brazil between 2011 and 2016. Demographic, clinical, and laboratory data were collected. HCC staging was carried out according to the HKLC and BCLC systems to assess treatment agreement. Overall survival was estimated based on the treatment proposed in each system.
RESULTS A total of 519 HCC patients were assessed. Of these, 178 (34.3%) were HKLC-I; 95 (18.3%) HKLC-IIA; 47 (9.1%) HKLC-IIB; 29 (5.6%) HKLC-IIIA; 30 (5.8%) HKLC-IIIB; 75 (14.4%) HKLC-IV; and 65 (12.5%) HKLC-V. According to the BCLC, 25 (4.9%) were BCLC-0; 246 (47.4%) BCLC-A; 107 (20.6%) BCLC-B; 76 (14.6%) BCLC-C; and 65 (12.5%) BCLC-D. The general agreement between the two systems was 80.0% - BCLC-0 and HKLC-I (100%); BCLC-A and HKLC-I/HKLC-II (96.7%); BCLC-B and HKLC-III (46.7%); BCLC-C and HKLC-IV (98.7%); BCLC-D and HKLC-V (41.5%). When sub-classifying BCLC-A, HKLC-IIB, HKLC-IIIA and HKLC-IIIB stages according to the up-to-7 in/out criterion, 13.4, 66.0, 100 and 36.7%, respectively, of the cases were classified as up-to-7 out.
CONCLUSION In a Western population, the general agreement between the two systems was 80.0%, although in BCLC-B cases the agreement was low, suggesting that some individuals could be candidates for the curative treatment recommended by the HKLC. The authors suggest that the BCLC system should be routinely employed, although for BCLC-B cases it should be associated with the HKLC system.
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Affiliation(s)
- Laura Bainy Rodrigues de Freitas
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
- Experimental Hepatology and Gastroenterology Laboratory, Center for Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-003, Brazil
| | - Larisse Longo
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
- Experimental Hepatology and Gastroenterology Laboratory, Center for Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-003, Brazil
| | - Deivid Santos
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
| | - Ivana Grivicich
- Graduate Program in Health-Applied Cellular and Molecular Biology, ULBRA. Canoas, RS 92425-900, Brazil
| | - Mário Reis Álvares-da-Silva
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
- Experimental Hepatology and Gastroenterology Laboratory, Center for Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-003, Brazil
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
- Department of Gastroenterology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-003, Brazil
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Piñero F, Marciano S, Fernández N, Silva J, Anders M, Zerega A, Ridruejo E, Romero G, Ameigeiras B, D’Amico C, Gaite L, Bermúdez C, Reggiardo V, Colombato L, Gadano A, Silva M. Intermediate-advanced hepatocellular carcinoma in Argentina: Treatment and survival analysis. World J Gastroenterol 2019; 25:3607-3618. [PMID: 31367160 PMCID: PMC6658387 DOI: 10.3748/wjg.v25.i27.3607] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/05/2019] [Accepted: 06/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) represents the sixteenth most frequent cancer in Argentina. The rise of new therapeutic modalities in intermediate-advanced HCC opens up a new paradigm for the treatment of HCC.
AIM To describe real-life treatments performed in patients with intermediate-advanced HCC before the approval of new systemic options.
METHODS This longitudinal observational cohort study was conducted between 2009 and 2016 in 14 different regional hospitals from Argentina. Included subjects had intermediate-advanced Barcelona Clinic Liver Cancer (BCLC) HCC stages (BCLC B to D). Primary end point analyzed was survival, which was assessed for each BCLC stage from the date of treatment until last patient follow-up or death. Kaplan Meier survival curves and Cox regression analysis were performed, with hazard ratios (HR) calculations and 95% confidence intervals (95%CI).
RESULTS From 327 HCC patients, 41% were BCLC stage B, 20% stage C and 39% stage D. Corresponding median survival were 15 mo (IQR 5-26 mo), 5 mo (IQR 2-13 mo) and 3 mo (IQR 1-13 mo) (P < 0.0001), respectively. Among BCLC-B patients (n = 135), 57% received TACE with a median number of 2 sessions (IQR 1-3 sessions). Survival was significantly better in BCLC-B patients treated with TACE HR = 0.29 (CI: 0.21-0.40) than those without TACE. After tumor reassessment by RECIST 1.1 criteria following the first TACE, patients with complete response achieved longer survival [HR = 0.15 (CI: 0.04-0.56, P = 0.005)]. Eighty-two patients were treated with sorafenib, mostly BCLC-B and C (87.8%). However, 12.2% were BCLC-D. Median survival with sorafenib was 4.5 mo (IQR 2.3-11.7 mo); which was lower among BCLC-D patients 3.2 mo (IQR 2.0-14.1 mo). A total of 36 BCLC-B patients presented tumor progression after TACE. In these patients, treatment with sorafenib presented better survival when compared to those patients who received sorafenib without prior TACE [HR = 0.26 (CI: 0.09-0.71); P = 0.013].
CONCLUSION In this real setting, our results were lower than expected. This highlights unmet needs in Argentina, prior to the introduction of new treatments for HCC.
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Affiliation(s)
- Federico Piñero
- Hospital Universitario Austral, Facultad de Ciencias Biomédicas, Universidad Austral, Buenos Aires B1629HJ, Argentina
- Latin American Liver Research Educational and Awareness Network (LALREAN), Buenos Aires B1629HJ, Argentina
| | - Sebastián Marciano
- Hospital Italiano de Buenos, Cuidad Autónoma de Buenos Aires, Buenos Aires C1424BYE, Argentina
| | - Nora Fernández
- Hospital Británico, Cuidad Autonoma de Buenos Aires, Buenos Aires C1280AEB, Argentina
| | | | - Margarita Anders
- Latin American Liver Research Educational and Awareness Network (LALREAN), Buenos Aires B1629HJ, Argentina
- Hospital Aleman, Cuidad Autonoma de Buenos Aires, Buenos Aires C1280AEB, Argentina
| | - Alina Zerega
- Sanatorio Allende from Córdoba, Córdoba 5016, Argentina
| | - Ezequiel Ridruejo
- Hospital Universitario Austral, Facultad de Ciencias Biomédicas, Universidad Austral, Buenos Aires B1629HJ, Argentina
- Latin American Liver Research Educational and Awareness Network (LALREAN), Buenos Aires B1629HJ, Argentina
- Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno” (CEMIC), Ciudad de Buenos Aires 1431, Argentina
| | - Gustavo Romero
- Hospital Udaondo, Cuidad Autonoma de Buenos Aires C1264AAA, Argentina
| | | | - Claudia D’Amico
- Centro Especialidades Medicas Ambulatorias (CEMA), Mar del Plata, Buenos Aires 7600, Argentina
| | - Luis Gaite
- Clínica de Nefrología, Santa Fe 3000, Argentina
| | - Carla Bermúdez
- Hospital Italiano de Buenos, Cuidad Autónoma de Buenos Aires, Buenos Aires C1424BYE, Argentina
| | | | - Luis Colombato
- Hospital Británico, Cuidad Autonoma de Buenos Aires, Buenos Aires C1280AEB, Argentina
| | - Adrián Gadano
- Hospital Italiano de Buenos, Cuidad Autónoma de Buenos Aires, Buenos Aires C1424BYE, Argentina
| | - Marcelo Silva
- Hospital Universitario Austral, Facultad de Ciencias Biomédicas, Universidad Austral, Buenos Aires B1629HJ, Argentina
- Latin American Liver Research Educational and Awareness Network (LALREAN), Buenos Aires B1629HJ, Argentina
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Columbamine suppresses hepatocellular carcinoma cells through down-regulation of PI3K/AKT, p38 and ERK1/2 MAPK signaling pathways. Life Sci 2018; 218:197-204. [PMID: 30582951 DOI: 10.1016/j.lfs.2018.12.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) as primary liver cancer in adults is the most common cause led to internal cirrhosis responsible for patients' death, which resulted in nearly a million deaths worldwide on both males and females in the developing and developed countries. Unfortunately, up to date, there are no highly effective treatment of medicine on HCC as lack of comprehensive cellular and molecular mechanism. According to the sources of human ancient history of medicine, traditional medicine could provide unique treatment to discontinue the challenging HCC. In this study, we inspected the effect of Columbamine (Col; C20H21NO5), an alkaloid isolated from calumba, on HCC utilizing three HCC cell-lines i.e. SMMC7721, HepG2 and Hep3B. Our data collected from these cell-lines exhibit strong Col suppression on the cell growth accompanying the dosage-dependent suppression, and we further confirmed the suppression on the tumor-growth in animal model. Rational of the Col suppression presents cellular mechanism by limiting the proliferation and colony formation of the cells marked with decreased expression of PCNA. Meanwhile decreases of migration indicated with increasing expression of E-cadherin and decreasing expression of N-cadherin, and of invasion labelled with decreasing expressions of MMP2 and MMP9, are accompanying the Col suppression along with the Col promoted apoptosis of the tumor cells. This programmed cell death marketed with cleaved Caspase 3 plus PAPR proteins, up-regulation of BAD and down-regulation of BCL2 is linked the Col suppression to unique calcium-related pathways. Our results unveiled that the Columbamine suppression on HCC based on the traditional medicine are clearly associated with PI3K/AKT, p38 and ERK1/2 MAPKs signaling pathways and guide further research orientation for developing the Col medicine against hepatocellular carcinoma.
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