1
|
Qin S, Fang W, Ren Z, Ou S, Lim HY, Zhang F, Lee KC, Choi HJ, Tong J, Tao M, Xu A, Cheng A, Lu CH, Chiu CF, Abdul Wahid MI, Kamble S, Norquist JM, Zhong W, Li C, Chen Z. A Phase 3 Study of Pembrolizumab versus Placebo for Previously Treated Patients from Asia with Hepatocellular Carcinoma: Health-Related Quality of Life Analysis from KEYNOTE-394. Liver Cancer 2024; 13:389-400. [PMID: 39114760 PMCID: PMC11305669 DOI: 10.1159/000535338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/13/2023] [Indexed: 08/10/2024] Open
Abstract
Introduction KEYNOTE-394 showed pembrolizumab significantly improved overall survival, progression-free survival, and objective response rate with manageable safety versus placebo for patients from Asia with previously treated advanced hepatocellular carcinoma. We present results on health-related quality of life (HRQoL). Methods HRQoL was evaluated using the EORTC Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and EuroQol-5D-3L (EQ-5D-3L) questionnaires. Key HRQoL endpoints were least squares mean (LSM) score changes from baseline to week 12 and time to deterioration (TTD) for EORTC QLQ-C30 global health status (GHS)/QoL. p values were one-sided and nominal without adjustment for multiplicity. Results The HRQoL population included patients randomly assigned to pembrolizumab (n = 298) and placebo (n = 152). From baseline to week 12, a greater decline in EORTC QLQ-C30 GHS/QoL score was observed with placebo (LSM, -8.4; 95% CI: -11.7 to -5.1) versus pembrolizumab (-4.0; 95% CI: -6.4 to -1.6; difference vs. placebo: 4.4; 95% CI: 0.5-8.4; nominal p = 0.0142). Similarly, a greater decline in the EQ-5D-3L visual analog scale score was observed with placebo (-6.9; 95% CI: -9.4 to -4.5) versus pembrolizumab (-2.7; 95% CI: -4.5 to -1.0; difference vs. placebo: 4.2; 95% CI: 1.2-7.2; nominal p = 0.0030). TTD in EORTC QLQ-C30 GHS/QoL score was similar between arms (hazard ratio, 0.85; 95% CI: 0.58-1.25; nominal p = 0.1993). Conclusion Patients receiving placebo showed a greater decline in HRQoL than those receiving pembrolizumab. Combined with efficacy and safety data from KEYNOTE-394 and the global KEYNOTE-240 and KEYNOTE-224 trials, our data support the clinically meaningful benefit and manageable tolerability of pembrolizumab as second-line therapy for patients with advanced hepatocellular carcinoma.
Collapse
Affiliation(s)
- Shukui Qin
- GI Cancer Center, Nanjing Tianyinshan Hospital, Nanjing, China
| | - Weijia Fang
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhenggang Ren
- Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Ho Yeong Lim
- Samsung Medical Center, Seoul, Republic of Korea
| | | | - Kin Chung Lee
- Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR
| | - Hye Jin Choi
- Severance Hospital Yonsei University Health System, Seoul, Republic of Korea
| | | | - Min Tao
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Aibing Xu
- Nantong Tumor Hospital, Nantong, China
| | - Ashley Cheng
- Princess Margaret Hospital, Kwai Chung, Hong Kong SAR
| | | | | | | | | | | | | | | | - Zhendong Chen
- The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
2
|
Simmons DJ, Valerio SJ, Thomas DS, Healey MJ, Jiang Z, Levingston Mac Leod JM, Lin Y, Sah J. Incidence and Costs of Clinically Significant Events with Systemic Therapy in Patients with Unresectable Hepatocellular Carcinoma: A Retrospective Cohort Study. Adv Ther 2024; 41:1711-1727. [PMID: 38443649 PMCID: PMC10960903 DOI: 10.1007/s12325-024-02790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Systemic therapies have been associated with clinically significant events (CSEs) in patients with unresectable hepatocellular carcinoma (uHCC). We evaluated the incidence of CSEs (bleeding, clotting, encephalopathy, and portal hypertension), and their impact on healthcare resource utilization (HCRU) and costs, in patients with uHCC treated with first-line (1L) atezolizumab plus bevacizumab (A + B), lenvatinib (LEN), or sorafenib (SOR) in the USA. METHODS A retrospective cohort study was performed using medical/pharmacy claims from Optum® Clinformatics® Data Mart. Patients diagnosed with HCC who initiated 1L A + B between June 01, 2020 and December 31, 2020 or LEN/SOR between January 01, 2016 and May 31, 2020 were included. Outcomes included incidence rates of CSEs, HCRU, and costs. Subgroup analysis was performed in patients with no CSEs or ≥ 1 CSE. RESULTS In total, 1379 patients were selected (A + B, n = 271; LEN, n = 217; SOR, n = 891). Clotting (incidence rate per 100 patient-years [PY] 94.9) and bleeding (88.1 per 100 PY) were the most common CSEs in the A + B cohort. The most common CSEs in the LEN cohort were clotting (78.6 per 100 PY) and encephalopathy (66.3 per 100 PY). Encephalopathy (73.0 per 100 PY) and portal hypertension (72.3 per 100 PY) were the most common CSEs in the SOR cohort. Mean total all-cause healthcare costs per patient per month (PPPM) were $32,742, $35,623, and $29,173 in the A + B, LEN, and SOR cohorts, respectively. Mean total all-cause healthcare costs PPPM were higher in patients who had ≥ 1 CSE versus those who did not (A + B $34,304 versus $30,889; LEN $39,591 versus $30,621; SOR $31,022 versus $27,003). CONCLUSION Despite improved efficacy of 1L systemic therapies, CSEs remain a concern for patients with uHCC, as well as an economic burden to the healthcare system. Newer treatments that reduce the risk of CSEs, while improving long-term survival in patients with uHCC, are warranted.
Collapse
Affiliation(s)
- Daniel J Simmons
- AstraZeneca, 200 Orchard Ridge Drive, Gaithersburg, MD, 20878, USA.
| | | | | | - Marcus J Healey
- AstraZeneca, 200 Orchard Ridge Drive, Gaithersburg, MD, 20878, USA
| | - Zhuoxin Jiang
- AstraZeneca, 200 Orchard Ridge Drive, Gaithersburg, MD, 20878, USA
| | | | - Yian Lin
- AstraZeneca, South San Francisco, CA, USA
| | - Janvi Sah
- AstraZeneca, 200 Orchard Ridge Drive, Gaithersburg, MD, 20878, USA
| |
Collapse
|
3
|
Costa F, Wiedenmann B, Roderburg C, Mohr R, Abou‐Alfa GK. Systemic treatment in patients with Child-Pugh B liver dysfunction and advanced hepatocellular carcinoma. Cancer Med 2023; 12:13978-13990. [PMID: 37162288 PMCID: PMC10358256 DOI: 10.1002/cam4.6033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/27/2023] [Accepted: 04/23/2023] [Indexed: 05/11/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a major cause of death among patients with liver cirrhosis. The rise of immuno-oncology has revolutionized treatment for advanced HCC. However, most pivotal randomized controlled trials have excluded patients with moderate liver dysfunction (Child-Pugh-Turcotte B), despite the high incidence of liver disease in patients with HCC at the time of diagnosis. Overall survival in patients with HCC and moderate liver dysfunction treated with sorafenib has been found to be only approximately 3-5 months, underlining the need for improved treatment algorithms for this increasingly important subgroup of patients. In this review, we summarize available data on the treatment of patients with HCC and moderate liver dysfunction. Opportunities, as well as clinical challenges, are discussed in detail, highlighting potential changes to the therapeutic landscape.
Collapse
Affiliation(s)
| | - Bertram Wiedenmann
- Department of Hepatology and GastroenterologyCharité University HospitalBerlinGermany
| | - Christoph Roderburg
- Clinic for Gastroenterology, Hepatology and Infectious DiseasesUniversity Hospital DüsseldorfDüsseldorfGermany
| | - Raphael Mohr
- Department of Hepatology and GastroenterologyCharité University HospitalBerlinGermany
| | - Ghassan K. Abou‐Alfa
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Weill Medical School at Cornell UniversityNew YorkNew YorkUSA
| |
Collapse
|
4
|
Tiyuri A, Baghermanesh SS, Davatgaran-Taghipour Y, Eslami SS, Shaygan N, Parsaie H, Barati M, Jafari D. Diagnostic accuracy of serum derived exosomes for hepatocellular carcinoma: a systematic review and meta-analysis. Expert Rev Mol Diagn 2023; 23:971-983. [PMID: 37715364 DOI: 10.1080/14737159.2023.2260306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Early and non-invasive detection of hepatocellular carcinoma (HCC), which is usually asymptomatic, can improve overall survival outcomes. The objective of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of serum-derived exosomes for diagnosing HCC. METHODS PubMed, Web of Science, and Scopus databases were searched for relevant studies up to April 2023. The quality of included studies was assessed using the QUADAS-2 checklist, and data were extracted. Statistical analysis was performed on 18 studies from 3,993 records, and a diagnostic meta-analysis was conducted. Biomarkers were categorized into four groups based on their type (exosomal miRNAs, exosomal RNAs, alpha-fetoprotein (AFP), and exosomal RNAs+AFP panel), and a meta-analysis was conducted for each category separately. RESULTS The highest pooled sensitivity was 0.86 for exosomal miRNAs, and exosomal RNAs+AFP had the highest pooled specificity; (0.89). Furthermore, exosomal RNAs+AFP had the highest pooled positive likelihood ratio; (7.55), the highest pooled diagnostic odds ratio (35.96) and the highest pooled area under the curve (0.93). Exosomal miRNAs had the lowest pooled negative likelihood ratio; (0.17). CONCLUSIONS The diagnostic accuracy of exosomal biomarkers is superior to that of AFP, and combining the two in a panel yields the better results.
Collapse
Affiliation(s)
- Amir Tiyuri
- Department of Epidemiology and Biostatistics, School of Health, Birjand University of Medical Sciences, Birjand, Iran
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Shayeste Sadat Baghermanesh
- Department of Medical Biotechnology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Yasamin Davatgaran-Taghipour
- Department of Medical Nanotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Sadegh Eslami
- Institut National de la Recherche Scientifique (INRS), Centre Armand-Frappier Santé Biotechnologie, Laval, Canada
| | - Nasibeh Shaygan
- Department of Plant Breeding and Biotechnology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Houman Parsaie
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Mahmood Barati
- Department of Medical Biotechnology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Davod Jafari
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
- Department of Medical Biotechnology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Tan DJH, Quek SXZ, Yong JN, Suresh A, Koh KXM, Lim WH, Quek J, Tang A, Tan C, Nah B, Tan E, Keitoku T, Muthiah MD, Syn N, Ng CH, Kim BK, Tamaki N, Ho CSH, Loomba R, Huang DQ. Global prevalence of depression and anxiety in patients with hepatocellular carcinoma: Systematic review and meta-analysis. Clin Mol Hepatol 2022; 28:864-875. [PMID: 36263668 PMCID: PMC9597225 DOI: 10.3350/cmh.2022.0136] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/17/2022] [Accepted: 07/20/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/AIMS Depression and anxiety are associated with poorer outcomes in patients with hepatocellular carcinoma (HCC). However, the prevalence of depression and anxiety in HCC are unclear. We aimed to establish the prevalence of depression and anxiety in patients with HCC. METHODS MEDLINE and Embase were searched and original articles reporting prevalence of anxiety or depression in patients with HCC were included. A generalized linear mixed model with Clopper-Pearson intervals was used to obtain the pooled prevalence of depression and anxiety in patients with HCC. Risk factors were analyzed via a fractional-logistic regression model. RESULTS Seventeen articles involving 64,247 patients with HCC were included. The pooled prevalence of depression and anxiety in patients with HCC was 24.04% (95% confidence interval [CI], 13.99-38.11%) and 22.20% (95% CI, 10.07-42.09%) respectively. Subgroup analysis determined that the prevalence of depression was lowest in studies where depression was diagnosed via clinician-administered scales (16.07%;95% CI, 4.42-44.20%) and highest in self-reported scales (30.03%; 95% CI, 17.19-47.01%). Depression in patients with HCC was lowest in the Americas (16.44%; 95% CI, 6.37-36.27%) and highest in South-East Asia (66.67%; 95% CI, 56.68-75.35%). Alcohol consumption, cirrhosis, and college education significantly increased risk of depression in patients with HCC. CONCLUSION One in four patients with HCC have depression, while one in five have anxiety. Further studies are required to validate these findings, as seen from the wide CIs in certain subgroup analyses. Screening strategies for depression and anxiety should also be developed for patients with HCC.
Collapse
Affiliation(s)
- Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sabrina Xin Zi Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Adithya Suresh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ansel Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Caitlyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin Nah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Eunice Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Taisei Keitoku
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Mark D. Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Cyrus Su Hui Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rohit Loomba
- NAFLD Research Center, Division of Medicine, University of California San Diego, La Jolla, California, USA
| | - Daniel Q. Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- NAFLD Research Center, Division of Medicine, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
6
|
Zou H, Li M, Lei Q, Luo Z, Xue Y, Yao D, Lai Y, Ung COL, Hu H. Economic Burden and Quality of Life of Hepatocellular Carcinoma in Greater China: A Systematic Review. Front Public Health 2022; 10:801981. [PMID: 35530735 PMCID: PMC9068962 DOI: 10.3389/fpubh.2022.801981] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/11/2022] [Indexed: 12/12/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) accounts for more than 85%-90% of primary liver cancer globally, and approximately 45% of deaths from HCC occur in greater China. This disease poses a significant economic burden for patients, payers and society and significantly affects patients' quality of life (QoL). However, such impact of HCC in greater China has not been well characterized. This review was conducted to analyze the current evidence about the economic and humanistic impact of HCC in greater China for informing national disease management and identifying clinical gaps yet to be resolved. Methods A systematic search literature using seven databases (Web of Science, PubMed, Medline, Cochrane Central, China National Knowledge Infrastructure, Wanfang, and Weipu) was performed to identify interventional and observational studies that reported the impact of HCC on cost or QoL and published before April 6, 2021. The focus population included adult patients with HCC in greater China. This review excluded any studies that focused on any specific treatment. Study quality was assessed using the Effective Public Health Practice Project tool. Results Of 39,930 studies retrieved, 27 were deemed eligible for inclusion. The methodologies, perspectives and data sources used in studies were heterogeneous. In greater China, while few studies reported the health expenditures of HCC patients and investigations about economic burden at national level was lacking, the significant economic impact of HCC on patients and their families had been reported. Health-related costs increased as the disease deteriorated. Additionally, HCC also has a negative impact on the QoL of patients, mostly in terms of physical, cognitive, social functioning and severe symptoms. Conclusions HCC has brought significant economic and QoL burden to patients in greater China. Both physical and psychological factors predicted QoL in patients with HCC in greater China. Future studies should explore the disease-related economic effects on Chinese patients and their families, the effects of physical and psychological factors on QoL and the relationships of physical and psychological factors in the region. Systematic Review Registration:www.crd.york.ac.uk/prospero/display_record.php?RecordID=278421, PROSPERO: CRD42021278421
Collapse
Affiliation(s)
- Huimin Zou
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, Macao SAR, China
| | - Meng Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, Macao SAR, China
| | - Qing Lei
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, Macao SAR, China
| | - Zejun Luo
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, Macao SAR, China
| | - Yan Xue
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, Macao SAR, China
| | - Dongning Yao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, Macao SAR, China
| | - Yunfeng Lai
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, Macao SAR, China.,School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, Macao SAR, China.,Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, Macao SAR, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, Macao SAR, China.,Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, Macao SAR, China
| |
Collapse
|
7
|
Younossi I, Stepanova M, Walters M, Golabi P, Srishord M, Younossi ZM. Health-Related Quality of Life and Health Care Resource Utilization in Patients With Chronic Liver Disease and Primary Liver Cancer in the United States: Analysis of Medical Expenditure Panel Survey. J Clin Exp Hepatol 2022; 12:272-277. [PMID: 35535094 PMCID: PMC9077230 DOI: 10.1016/j.jceh.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background Worldwide, liver cancer (LC) is the fifth and third most common type of cancer and cancer-related mortality, respectively. Our aim was to assess health-related quality of life (HRQL) and resource utilization in chronic liver disease (CLD) patients with LC. Methods We used the Medical Expenditure Panel Survey 2004-2013. All patients had HRQL (Short Form-12, Patient Health Questionnaire-2, Kessler Psychological Distress Scale) and resource utilization data. We used patients with CLD without LC and colon cancer (CC) as controls. Results A total of 1882 CLD patients (53 ± 14 years, 45% male, 53% white, 15% black, 23% Hispanic, 6% Asian, 42% employed, 48% private insurance, and 11% uninsured) were included. Of the cohort, 102 (5.4%) patients had LC. LC patients were older, more likely to be male and white, less employed but less likely uninsured than CLD patients without LC (all P < 0.05). In comparison to both non-LC CLD and CC controls, LC had worse health: 40% vs. 27% vs. 25% reported fair health and 29% vs. 20% vs. 16% poor health status (P < 0.05). Furthermore, LC patients more frequently reported physical limitations: 51% vs. 35% vs. 35%, respectively (P = 0.01). Physical HRQL scores were lower in LC patients compared with both CLD and CC controls. Although mental health scores in LC were similar to non-LC CLD controls, they were lower than in CC. In addition, most aspects of healthcare resource utilization were higher for LC patients compared with both non-LC CLD and CC controls. Conclusion While having CLD causes impairment of patients' HRQL, LC further adds to this impairment and also contributes to a substantial resource utilization.
Collapse
Key Words
- CC, Colon cancer
- CLD, Chronic liver disease
- HCC, hepatocellular carcinoma
- HRQL, Health-related quality-of-life
- LC, Liver cancer
- LD, Liver disease
- LT, Liver transplantation
- MEPS, Medical Expenditure Panel Survey
- QoL, quality of life
- SEER, Surveillance, Epidemiology, and End Results Program
- disease burden
- metabolic syndrome
- national survey
- outcomes
- patient-reported outcomes
Collapse
Affiliation(s)
- Issah Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States,Center for Outcomes Research in Liver Diseases, Washington DC, United States
| | - Maria Stepanova
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States,Center for Outcomes Research in Liver Diseases, Washington DC, United States
| | - Mercedes Walters
- Center for Outcomes Research in Liver Diseases, Washington DC, United States
| | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States,Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States,Inova Medicine, Inova Health System, Falls Church, VA, United States
| | - Manirath Srishord
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States,Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Zobair M. Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States,Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States,Inova Medicine, Inova Health System, Falls Church, VA, United States,Address for correspondence. Zobair M. Younossi, Betty and Guy Beatty Center for Integrated Research, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA 22042, United States.
| |
Collapse
|
8
|
Williams SJ, Rilling WS, White SB. Quality of Life and Cost Considerations: Y-90 Radioembolization. Semin Intervent Radiol 2021; 38:482-487. [PMID: 34629718 DOI: 10.1055/s-0041-1735570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective Transarterial radioembolization (TARE) offers a minimally invasive and safe treatment option for primary and metastatic hepatic malignancies. The benefits of TARE are manifold including prolonged overall survival, low associated morbidities, and improved time to progression allowing prolonged treatment-free intervals. The rapid development of new systemic therapies including immunotherapy has radically changed the treatment landscape for primary and metastatic liver cancer. Given the current climate, it is critical for interventional oncologists to understand the benefits of TARE relative to these other therapies. Therefore, this report aims to review quality-of-life outcomes and the cost comparisons of TARE as compared with systemic therapies.
Collapse
Affiliation(s)
- Stephen J Williams
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William S Rilling
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sarah B White
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
9
|
Zhang M, Li Y, Fan Z, Shen D, Huang X, Yu Q, Liu M, Ren F, Wang X, Dai L, Wang P, Ye H, Shi J, Yang X, Zhang S, Zhang J. Assessing health-related quality of life and health utilities in patients with chronic hepatitis B-related diseases in China: a cross-sectional study. BMJ Open 2021; 11:e047475. [PMID: 34526336 PMCID: PMC8444251 DOI: 10.1136/bmjopen-2020-047475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The health-related quality of life (HRQoL) and utilities of patients with chronic hepatitis B (CHB) virus infection, including compensated cirrhosis (CC), decompensated cirrhosis (DC) and different stages of hepatocellular carcinoma (HCC), have not been well described in China. This study aimed to evaluate HRQoL and utilities and provide parameters for the economic evaluation of CHB-related diseases. METHODS We conducted a multicentre cross-sectional and study to measure the HRQoL of patients with CHB, CC, DC and HCC using the Chinese short form (SF) 36 health survey V.2. The utilities were extracted based on the SF-six dimension scoring model. Multivariable regression analyses identified the effects on HRQoL. RESULTS A total of 1071 patients (639 with CHB, 125 with CC, 85 with DC and 222 with HCC) were invited to complete the questionnaire. Physical HRQoL was not impaired in the CHB stage, while mental HRQoL was significantly impaired. Physical composite summary scores have a more significant decrease than mental composite summary scores at the advanced stages (CC, DC and HCC). The utility scores of CHB only, CC, DC and HCC were 0.773, 0.750, 0.683 and 0.640, respectively. The utility scores in the early, middle and terminal stages of HCC were 0.656, 0.635 and 0.615, respectively. CONCLUSION Slowing the progress of CHB-related diseases and providing psychological support early are the key points to improving the quality of life with the diseases. The utility values estimated in this study can provide a vital instrument for cost-effectiveness studies on CHB-related diseases.
Collapse
Affiliation(s)
- Meng Zhang
- Department of Epidemiology and Health Statistics & Henan Key Laboratory for Tumor Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yaoguang Li
- Department of Epidemiology and Health Statistics & Henan Key Laboratory for Tumor Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Zihao Fan
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dongqi Shen
- Hepatobiliary and Pancreatic Surgery, The First Affillated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xueying Huang
- Department of Oncology, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qi Yu
- Department of Interventional Radiology, The First Affillated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Mei Liu
- Department of Oncology, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Feng Ren
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiao Wang
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Henan Academy of Medical and Pharmaceutical Sciences & BGI College, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Liping Dai
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Henan Academy of Medical and Pharmaceutical Sciences & BGI College, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Peng Wang
- Department of Epidemiology and Health Statistics & Henan Key Laboratory for Tumor Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hua Ye
- Department of Epidemiology and Health Statistics & Henan Key Laboratory for Tumor Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jianxiang Shi
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Henan Academy of Medical and Pharmaceutical Sciences & BGI College, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xiaoang Yang
- Henan Academy of Medical and Pharmaceutical Sciences & BGI College, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shunxiang Zhang
- Department of Epidemiology and Health Statistics & Henan Key Laboratory for Tumor Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Henan Academy of Medical and Pharmaceutical Sciences & BGI College, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jianying Zhang
- Department of Epidemiology and Health Statistics & Henan Key Laboratory for Tumor Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Henan Academy of Medical and Pharmaceutical Sciences & BGI College, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| |
Collapse
|
10
|
Psychometric validation of the EORTC QLQ-HCC18 in patients with previously treated unresectable hepatocellular carcinoma. Qual Life Res 2021; 31:937-950. [PMID: 34518988 PMCID: PMC8921023 DOI: 10.1007/s11136-021-02992-1] [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] [Accepted: 09/03/2021] [Indexed: 11/06/2022]
Abstract
To demonstrate the measurement properties of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Hepatocellular Carcinoma 18-question module (EORTC QLQ-HCC18) within a previously treated, unresectable hepatocellular carcinoma (HCC) clinical trial population that was distinct from the published QLQ-HCC18 validation population. Analyses were conducted using data from BGB-A317-208, an open label, international, clinical trial assessing efficacy and safety of the monoclonal antibody tislelizumab in adult HCC patients. The EORTC Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and QLQ-HCC18 instruments were assessed at baseline and weeks 3 and 9 follow-up visits. Per US Food and Drug Administration guidance, psychometric validation of the QLQ-HCC18 included reliability (internal consistency and test–retest), construct validity (convergent and discriminant validity and known-groups validity), ability to detect change, and meaningful within-patient change (MWPC). Known-groups validity and MWPC analyses were also stratified on several pre-defined subgroups. A total of 248 patients were included. Only the QLQ-HCC18 fatigue, nutrition, and index domains demonstrated acceptable internal consistency; acceptable test–retest reliability was found for fatigue, body image, nutrition, pain, sexual interest, and index domains. The QLQ-HCC18 fatigue domain achieved the pre-specified criterion defining acceptable convergent and discriminant validity for 13 of 16 correlations, whereas the index domain achieved the pre-specified criterion for 14 of 16 correlations. Clear differentiation of the QLQ-HCC18 change scores between improvement and maintenance anchor groups were observed for body image, fatigue, pain, and index domains, whereas differentiation between deterioration and maintenance anchor groups were observed for fever and fatigue domains. MWPC point estimates defining improvement for the QLQ-HCC18 fatigue and index domains were −7.18 and −4.07, respectively; MWPC point estimates defining deterioration were 5.34 and 3.16, respectively. The EORTC QLQ-HCC18 fatigue and index domains consistently demonstrated robust psychometric properties, supporting the use of these domains as suitable patient-reported endpoints within a previously treated, unresectable HCC patient population.
Collapse
|
11
|
Greten TF, Abou-Alfa GK, Cheng AL, Duffy AG, El-Khoueiry AB, Finn RS, Galle PR, Goyal L, He AR, Kaseb AO, Kelley RK, Lencioni R, Lujambio A, Mabry Hrones D, Pinato DJ, Sangro B, Troisi RI, Wilson Woods A, Yau T, Zhu AX, Melero I. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of hepatocellular carcinoma. J Immunother Cancer 2021; 9:e002794. [PMID: 34518290 PMCID: PMC8438858 DOI: 10.1136/jitc-2021-002794] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 12/11/2022] Open
Abstract
Patients with advanced hepatocellular carcinoma (HCC) have historically had few options and faced extremely poor prognoses if their disease progressed after standard-of-care tyrosine kinase inhibitors (TKIs). Recently, the standard of care for HCC has been transformed as a combination of the immune checkpoint inhibitor (ICI) atezolizumab plus the anti-vascular endothelial growth factor (VEGF) antibody bevacizumab was shown to offer improved overall survival in the first-line setting. Immunotherapy has demonstrated safety and efficacy in later lines of therapy as well, and ongoing trials are investigating novel combinations of ICIs and TKIs, in addition to interventions earlier in the course of disease or in combination with liver-directed therapies. Because HCC usually develops against a background of cirrhosis, immunotherapy for liver tumors is complex and oncologists need to account for both immunological and hepatological considerations when developing a treatment plan for their patients. To provide guidance to the oncology community on important concerns for the immunotherapeutic care of HCC, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew on the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for HCC, including diagnosis and staging, treatment planning, immune-related adverse events (irAEs), and patient quality of life (QOL) considerations. The evidence- and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers treating patients with HCC.
Collapse
Affiliation(s)
- Tim F Greten
- Thoracic and GI Malignancies Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Ghassan K Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Medical College at Cornell University, New York, New York, USA
| | - Ann-Lii Cheng
- Department of Medical Oncology, National Taiwan University Cancer Center and National Taiwan University Hospital, Taipei, Taiwan
| | - Austin G Duffy
- The Mater Hospital/University College Dublin, Dublin, Ireland
| | - Anthony B El-Khoueiry
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Richard S Finn
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - Lipika Goyal
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aiwu Ruth He
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robin Kate Kelley
- Department of Medicine (Hematology/Oncology), UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Riccardo Lencioni
- Department of Radiology, University of Pisa School of Medicine, Pisa, Italy
- Miami Cancer Institute, Miami, Florida, USA
| | - Amaia Lujambio
- Oncological Sciences Department, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Donna Mabry Hrones
- Thoracic and GI Malignancies Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Bruno Sangro
- Clinica Universidad de Navarra-Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | - Andrea Wilson Woods
- Blue Faery: The Adrienne Wilson Liver Cancer Association, Birmingham, Alabama, USA
| | - Thomas Yau
- Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - Andrew X Zhu
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
- Jiahui Health, Jiahui International Cancer Center, Shanghai, China
| | - Ignacio Melero
- Clinica Universidad de Navarra-Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Spain
- Foundation for Applied Medical Research (FIMA), Pamplona, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| |
Collapse
|
12
|
Sachar Y, Brahmania M, Dhanasekaran R, Congly SE. Screening for Hepatocellular Carcinoma in Patients with Hepatitis B. Viruses 2021; 13:1318. [PMID: 34372524 PMCID: PMC8310362 DOI: 10.3390/v13071318] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 12/18/2022] Open
Abstract
Chronic hepatitis B (CHB) infection is a significant risk factor for developing hepatocellular carcinoma (HCC). As HCC is associated with significant morbidity and mortality, screening patients with CHB at a high risk for HCC is recommended in an attempt to improve these outcomes. However, the screening recommendations on who to screen and how often are not uniform. Identifying patients at the highest risk of HCC would allow for the best use of health resources. In this review, we evaluate the literature on screening patients with CHB for HCC, strategies for optimizing adherence to screening, and potential risk stratification tools to identify patients with CHB at a high risk of developing HCC.
Collapse
Affiliation(s)
- Yashasavi Sachar
- London Health Sciences Center, Department of Medicine, Division of Gastroenterology, Western University, London, ON N6A 5A5, Canada; (Y.S.); (M.B.)
| | - Mayur Brahmania
- London Health Sciences Center, Department of Medicine, Division of Gastroenterology, Western University, London, ON N6A 5A5, Canada; (Y.S.); (M.B.)
- Centre for Quality, Innovation and Safety, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5W9, Canada
| | - Renumathy Dhanasekaran
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA 94305, USA;
| | - Stephen E. Congly
- Department of Medicine, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, AB T2N 4Z6, Canada
| |
Collapse
|
13
|
Morishita J, Inoue T. Determining desire to live among patients with advanced hepatobiliary-pancreatic cancer for whom curative treatment is not indicated. Glob Health Med 2021; 3:163-170. [PMID: 34250292 DOI: 10.35772/ghm.2021.01017] [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: 02/10/2021] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 11/08/2022]
Abstract
This study aimed to evaluate the desire to live among patients with advanced hepatobiliary-pancreatic cancer who were excluded from radical treatment and to examine the ideal nursing support for them. We recruited 18 patients in a department specializing in the treatment of hepatobiliary-pancreatic cancer at a university hospital in the metropolitan area of Japan. We included those with advanced hepatobiliary-pancreatic cancer who received a treatment other than definitive treatment. We conducted semi-structured interviews, and the responses were analyzed qualitatively and descriptively. Events experienced by patients with advanced hepatobiliary-pancreatic cancer and out of indication for radical treatment were divided into five major phases, while desire to live was divided into 11 categories. Two of these categories were represented by the word "death". The desire to live was present in all phases, and the expressions of these desires were diverse. Patients suppressed expressing their desire to live because they understood that their situation was challenging. In addition, there was a tendency to avoid expressing their desire to live to medical staff and their families. We found that nurses need to establish a medical relationship in which patients can express their desire to live and become connected to nursing support.
Collapse
|
14
|
Hassanin TM, Fouad Y, Hassnine A, Eisawy M, Farag N, Abdel Ghany W. Quality of Life after Transcatheter Arterial Chemoembolization Combined with Radiofrequency Ablation in Patients with Unresectable Hepatocellular Carcinoma Compared with Transcatheter Arterial Chemoembolization alone. Asian Pac J Cancer Prev 2021; 22:1255-1261. [PMID: 33906320 PMCID: PMC8325141 DOI: 10.31557/apjcp.2021.22.4.1255] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Indexed: 01/08/2023] Open
Abstract
Aim: The aim of this study was to assess quality of life (QoL) in patients with unresectable hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) compared to TACE plus radiofrequency ablation (RFA) done at the same sitting, and to assess tumor therapy response after these 2 palliative interventions. Methods: 73 patients with unresectable HCC (BCLC-B) were included. Patients with tumor ≤ 5 cm were subjected to TACE (N = 45) while patients with tumors > 5 cm were subjected to TACE followed immediately by RFA (N = 28). QoL was evaluated with two validated questionnaires (EORTC QLQ-30 and EORTC HCC18). These questionnaires were filled out before intervention, 2 weeks and 2 months after intervention. Pre/post interventional changes were analyzed. The modified response evaluation criteria in solid tumor (mRECIST) were employed for the evaluation of therapeutic efficacy. Results: Baseline global health status/QoL was significantly higher in TACE group (64.1%) compared to TACE-RFA group (51.2%). Two weeks after intervention: the absolute decrease in global health state was higher in TACE-RFA (- 12.1%) compared to TACE (- 6.3%, p = 0.411). Less impairment was found in TACE group compared to TACE-RFA group for physical/social functioning, fatigue and pain but it was statistically insignificant. Two months after intervention; TACE-RFA group showed significant improvement in global health score, social and physical functioning scores, as well as significant improvement in pain and fatigue compared to TACE group. The therapeutic efficacy of TACE-RFA was better than TACE alone: complete remission, partial remission, stable disease and progressive disease were 17.9%, 32.1%, 42.9% and 7.1% Vs11.1%, 22.2%, 48.9% and 17.8%, respectively). Conclusion: Neither TACE nor TACE-RFA showed a significant decrease in QoL in patients with unresectable HCC two weeks after intervention. However, two months after intervention; TACE-RFA showed significant improvement in global health score compared to TACE monotherapy. TACE-RFA appeared safe, effective and more favorable than TACE monotherapy.
Collapse
Affiliation(s)
- Taha M Hassanin
- Department of Endemic Medicine and Gastroenterology, Faculty of Medicine, Minia University, Egypt
| | - Yasser Fouad
- Department of Endemic Medicine and Gastroenterology, Faculty of Medicine, Minia University, Egypt
| | - Alshymaa Hassnine
- Department of Endemic Medicine and Gastroenterology, Faculty of Medicine, Minia University, Egypt
| | - Mohamad Eisawy
- Department of Radiology Medicine and Gastroenterology, Faculty of Medicine, Minia University, Egypt
| | - Naglaa Farag
- Department of Radiology, Faculty of Medicine, Minia University, Egypt
| | - Wael Abdel Ghany
- Department of Endemic Medicine and Gastroenterology, Faculty of Medicine, Minia University, Egypt
| |
Collapse
|
15
|
Ishinuki T, Ota S, Harada K, Tatsumi H, Harada K, Miyanishi K, Nagayama M, Takemasa I, Ohyanagi T, Hui TT, Mizuguchi T. Health-related quality of life in patients that have undergone liver resection: A systematic review and meta-analysis. World J Meta-Anal 2021; 9:88-100. [DOI: 10.13105/wjma.v9.i1.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mortality after hepatectomy has decreased, and the quality of various surgical approaches to hepatectomy have been evaluated. Various assessments of quality of life (QOL) after hepatectomy have been developed and investigated in different clinical settings.
AIM To conduct a systematic review and meta-analysis to examine two clinical topics: Laparoscopic hepatectomy vs open hepatectomy, and preoperative QOL status vs postoperative QOL status.
METHODS A systematic literature search was performed using PubMed and MEDLINE, including the Cochrane Library Central. The following inclusion criteria were set for inclusion in this meta-analysis: (1) Studies comparing preoperative QOL and postoperative QOL; and (2) Studies comparing QOL between laparoscopic hepatectomy and open hepatectomy.
RESULTS A total of 8 articles were included in this meta-analysis. QOL was better after laparoscopic hepatectomy than after open hepatectomy.
CONCLUSION The outcomes of evaluations of QOL after hepatectomy can depend on the type of questionnaire used, the timing of the assessment, and the etiology of the hepatic disease.
Collapse
Affiliation(s)
- Tomohiro Ishinuki
- Department of Nursing, Surgical Sciences, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Shigenori Ota
- Departments of Surgery, Surgical Science and Oncology, Sapporo Medical University, Sapporo 060-8543, Japan
| | - Kohei Harada
- Division of Radiology, Sapporo Medical University, Sapporo 060-8543, Japan
| | - Hiroomi Tatsumi
- Department of Intensive Care Medicine, Sapporo Medical University Hospital, Sapporo 060-8543, Japan
| | - Keisuke Harada
- Department of Emergency Medicine, Sapporo Medical University Hospital, Sapporo 060-8543, Japan
| | - Koji Miyanishi
- Department of Medical Oncology, Sapporo Medical University Hospital, Sapporo 060-8543, Japan
| | - Minoru Nagayama
- Departments of Surgery, Surgical Science and Oncology, Sapporo Medical University, Sapporo 060-8543, Japan
| | - Ichiro Takemasa
- Departments of Surgery, Surgical Science and Oncology, Sapporo Medical University, Sapporo 060-8543, Japan
| | - Toshio Ohyanagi
- Department of Liberal Arts and Sciences, Center for Medical Education, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Thomas T Hui
- Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, CA 94598, United States
| | - Toru Mizuguchi
- Department of Nursing, Surgical Sciences, Sapporo Medical University, Sapporo 060-8556, Japan
| |
Collapse
|
16
|
Firkins JL, Tarter R, Driessnack M, Hansen L. A closer look at quality of life in the hepatocellular carcinoma literature. Qual Life Res 2021; 30:1525-1535. [PMID: 33625648 DOI: 10.1007/s11136-021-02789-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Adults with hepatocellular carcinoma (HCC) have a high symptom burden. Their quality of life (QOL) has been shown to be significantly impacted by both the disease and its treatment, adding to the high symptom burden that these patients experience. The primary aims of this paper are as follows: (1) to identify how QOL is being defined in HCC literature and (2) to identify how QOL is being measured in the HCC literature using Ferrell's model of QOL. METHODS A systematic review was completed of relevant studies published after 2014, using PubMed, CINHAL, and PsycInfo. Relevant studies were reviewed by 2 reviewers using PRISMA guidelines. RESULTS From a total of 1312 papers obtained in the initial database search, 30 met inclusion criteria and are included in this review. From the included articles, 10% included a definition of QOL and 3% addressed the spiritual domain of QOL. Majority of study participants were in the early stage of HCC, though the majority of adults with HCC are diagnosed in the advanced stage. Only 3% of included studies included greater than 22% population of advanced stage of HCC. CONCLUSION The results of this systematic review demonstrate the need for future research into QOL in the advanced stage of QOL. It also identified gap in the literature concerning the definition of QOL in HCC and the spiritual domain of QOL in HCC.
Collapse
Affiliation(s)
- Jenny L Firkins
- School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA.
| | - Robin Tarter
- School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Martha Driessnack
- School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Lissi Hansen
- School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| |
Collapse
|
17
|
Kang D, Shim S, Cho J, Lim HK. Systematic Review of Studies Assessing the Health-Related Quality of Life of Hepatocellular Carcinoma Patients from 2009 to 2018. Korean J Radiol 2020; 21:633-646. [PMID: 32410403 PMCID: PMC7231617 DOI: 10.3348/kjr.2019.0808] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 02/07/2023] Open
Abstract
We reviewed all studies assessing the health-related quality of life (HRQoL) in patients with hepatocellular carcinoma (HCC) between 2009 and 2018 (n = 45). Most studies assessed HRQoL as an outcome, and evaluated or compared the HRQoL of HCC patients depending on the type of treatment or stage of disease. HCC patients had a worse HRQoL than the general population, including in those with early-stage HCC. Patients commonly experienced pain, fatigue, sleep disturbance, distress, and lack of appetite, and these symptoms remained problematic even a few years after treatment. TNM classification of malignant tumors stage, tumor stage, presence of cirrhosis, being Asian, being female, living alone, or being unemployed were associated with a poor HRQoL. While recent studies have included a more diverse patient population, various topics, and different study designs, there were limited studies on supportive interventions. Given the increase in HCC cases and HCC survivors, addressing the HRQoL of HCC patients requires more attention.
Collapse
Affiliation(s)
- Danbee Kang
- Department of Clinical Research Design and Evaluation, SAISHT, Sungkyunkwan University, Seoul, Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sungkeun Shim
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, SAISHT, Sungkyunkwan University, Seoul, Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAISHT, Sungkyunkwan University, Seoul, Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, SAISHT, Sungkyunkwan University, Seoul, Korea.,Department of Health Sciences and Technology, SAISHT, Sungkyunkwan University, Seoul, Korea
| | - Hyo Keun Lim
- Department of Health Sciences and Technology, SAISHT, Sungkyunkwan University, Seoul, Korea.,Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
18
|
Deng Y, Zhu J, Liu Z, Huang M, Chang DW, Gu J. Elevated systemic inflammatory responses, factors associated with physical and mental quality of life, and prognosis of hepatocellular carcinoma. Aging (Albany NY) 2020; 12:4357-4370. [PMID: 32145060 PMCID: PMC7093167 DOI: 10.18632/aging.102889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/24/2020] [Indexed: 12/13/2022]
Abstract
Impaired quality of life (QOL) is common in hepatocellular carcinoma (HCC) patients. In this study, we used a large hospital-based multiethnic HCC patient cohort to systematically identify factors associated with QOL and investigate the prognostic value of QOL. The Short Form-12 questionnaire was used to assess QOL. The Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were categorized into three groups (low, medium, and high) and ordered logistic regression analysis was used to analyze the association of PCS and MCS scores with patient characteristics. The association of PCS and MCS scores with mortality was assessed by Cox regression analysis. Notably, a panel of elevated systemic inflammatory response markers was associated with poor QOL. Other significant factors associated with QOL included age, liver function, sex, smoking, HCC etiology, and major clinical features. Patients with low (hazard ratio [95% CI], 1.72 [1.36-2.17]) and medium (1.52 [1.23-1.89]) PCS scores exhibited higher risks of death compared to patients with high PCS score. The association of MCS with the risk of death was not significant. These observations were consistent across all the different ethnicities. The identified factors associated with QOL may help clinicians formulate interventions to improve QOL and outcomes in HCC patients.
Collapse
Affiliation(s)
- Yang Deng
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.,Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jian Zhu
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ziyi Liu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Maosheng Huang
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - David W Chang
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jian Gu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|
19
|
Li D, Sedano S, Allen R, Gong J, Cho M, Sharma S. Current Treatment Landscape for Advanced Hepatocellular Carcinoma: Patient Outcomes and the Impact on Quality of Life. Cancers (Basel) 2019; 11:E841. [PMID: 31216701 PMCID: PMC6627588 DOI: 10.3390/cancers11060841] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 12/24/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer mortality worldwide. Heterogeneity of clinical conditions contributes to the complex management of care for patients with advanced HCC. Recently, the treatment landscape for advanced HCC has expanded rapidly, with the additional FDA approvals of several oral tyrosine kinase inhibitors (lenvatinib, regorafenib, and cabozantinib), as well as immunotherapies such as immune check point inhibitors (nivolumab and pembrolizumab) and the monoclonal IgG1 antibody, ramucirumab. This expansion has generated a need for novel treatment sequencing strategies in this patient population. In light of these developments, an evaluation of the impact of FDA-approved therapeutics on patient-centered outcomes such as health-related quality of life (HRQoL) is warranted. An increased understanding of HRQoL in patients included in advanced HCC clinical trials could potentially help physician decision-making for treatment sequencing in patients with advanced HCC.
Collapse
Affiliation(s)
- Daneng Li
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA.
| | - Sabrina Sedano
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA.
| | - Rebecca Allen
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA.
| | - Jun Gong
- Department of Gastrointestinal Malignancies, Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA 90048, USA.
| | - May Cho
- Department of Internal Medicine, UC Davis Comprehensive Cancer Center, Sacramento, CA 95817, USA.
| | - Sunil Sharma
- Division of Clinical Sciences, Translational Genomics Research Institute, Phoenix, AZ 85004, USA.
| |
Collapse
|
20
|
Humanized Mouse Models for the Study of Hepatitis C and Host Interactions. Cells 2019; 8:cells8060604. [PMID: 31213010 PMCID: PMC6627916 DOI: 10.3390/cells8060604] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/09/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022] Open
Abstract
Hepatitis C virus (HCV) infection is commonly attributed as a major cause of chronic hepatotropic diseases, such as, steatosis, cirrhosis and hepatocellular carcinoma. As HCV infects only humans and primates, its narrow host tropism hampers in vivo studies of HCV-mammalian host interactions and the development of effective therapeutics and vaccines. In this context, we will focus our discussion on humanized mice in HCV research. Here, these humanized mice are defined as animal models that encompass either only human hepatocytes or both human liver and immune cells. Aspects related to immunopathogenesis, anti-viral interventions, drug testing and perspectives of these models for future HCV research will be discussed.
Collapse
|
21
|
Shi J, Sun J, Liu C, Chai Z, Wang N, Zhang H, Cheng S. All-trans-retinoic acid (ATRA) plus oxaliplatin plus 5-fluorouracil/leucovorin (FOLFOX) versus FOLFOX alone as palliative chemotherapy in patients with advanced hepatocellular carcinoma and extrahepatic metastasis: study protocol for a randomized controlled trial. Trials 2019; 20:245. [PMID: 31036040 PMCID: PMC6489221 DOI: 10.1186/s13063-019-3349-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/03/2019] [Indexed: 12/20/2022] Open
Abstract
Background Among patients with hepatocellular carcinoma (HCC), 85% of patients have an advanced disease stage at diagnosis and curative therapies cannot be performed. Prognosis has been quite poor as until recently there was no proven effective chemotherapy. Our group found that all-trans-retinoic acid (ATRA) could improve the efficacy of platinum in HCC in vivo and in vitro, thus we wish to validate the efficiency of ATRA in clinical practice. Methods This is a double-blinded, 1:1 randomized, controlled, multicenter clinical trial. Three hundred and sixty-eight patients with HCC and extrahepatic metastases will receive palliative chemotherapy at the Eastern Hepatobiliary Surgery Hospital, First Hospital of Jilin University and Fujian Provincial Cancer Hospital. Subjects will be randomly assigned to one of the two arms, either ATRA + oxaliplatin + 5-fluorouracil/leucovorin (FOLFOX4) or FOLFOX4 alone. ATRA 20 mg will be given orally three times/day for 3 days prior to the initiation of FOLFOX4. ATRA will be discontinued at the end of FOLFOX4. Discussion Overall survival rate is the primary endpoint. Secondary endpoints are time to progression according to the modified response evaluation criteria in solid tumors (mRECIST) criteria, acute and chronic adverse events, and quality of life. Trial registration Chinese Clinical Trial Registry, ChiCTR-IIR-17012916. Registered on 9 October 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3349-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jie Shi
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Rd No.225, Shanghai, 200438, China
| | - Juxian Sun
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Rd No.225, Shanghai, 200438, China
| | - Chang Liu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Rd No.225, Shanghai, 200438, China
| | - Zongtao Chai
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Rd No.225, Shanghai, 200438, China
| | - Nanya Wang
- Department of Cancer Center, First Hospital of Jilin University, Xinmin Rd No71, Changchun, 130021, Jilin Province, China
| | - Hui Zhang
- Department of Surgery of Hepato-Biliary & Pancreatic Tumor, Fujian Provincial Cancer Hospital, Fuma Rd No.420, Fuzhou, 350011, Fujian Province, China
| | - Shuqun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Rd No.225, Shanghai, 200438, China.
| |
Collapse
|
22
|
Abstract
Liver cancer is one of the leading causes of cancer-related mortality around the world. Hepatocellular carcinoma (HCC) is the primary cancer of the liver, accounting for the majority of liver cancers. The risk factors associated with HCC include chronic infections with HBV and HCV, alcoholic liver disease, and nonalcoholic fatty liver disease. Additionally, male patients have higher risk for than females, and the risk increases with older age. Mortality rates for HCC parallel its increasing incidence rates. In this context, incidence rate for HCC shows geographic variations in different parts of the world and is heavily affected by regional differences in risk factor for liver disease. The highest incidence rates for HCC are observed in Asia and Africa, while Europe and North America have lower rates. In fact, HBV is still regarded as the leading cause of HCC globally, while HCV is the most common cause of HCC in the USA. Recently, it has been suggested that HCC cases related to nonalcoholic fatty liver disease is on the rise, while the proportion of HCC attributed to alcoholic liver disease remains stable.
Collapse
|
23
|
Anderson C, Park EM, Rosenstein DL, Nichols HB. Suicide rates among patients with cancers of the digestive system. Psychooncology 2018; 27:2274-2280. [PMID: 29956393 PMCID: PMC6584762 DOI: 10.1002/pon.4827] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Previous studies have suggested that suicide rates are elevated among cancer patients relative to the general population. In this analysis, we comprehensively evaluated characteristics associated with higher suicide rates among patients with cancers of the digestive system. METHODS Using the United States Surveillance, Epidemiology, and End Results database, we identified all patients diagnosed with digestive system cancers during 2000 to 2014. Patients were classified as having died of suicide if their cause of death in Surveillance, Epidemiology, and End Results was listed as "suicide and self-inflicted injury." Suicide rates were compared to age-, sex-, and race-adjusted rates in the general population. RESULTS A total of 881 suicides were identified among 856 293 patients diagnosed with digestive system cancers. The suicide rate in this population was 32.8 per 100 000 person-years and was nearly twice that in the general population (standardized mortality ratio [SMR] = 1.91; 95% CI, 1.79-2.04). Suicide rates were significantly elevated for all cancer sites but were highest for esophageal (SMR = 5.03), pancreatic (SMR = 5.28), stomach (SMR = 2.84), and liver (SMR = 2.14) cancers. Standardized mortality ratios for suicide were highest within the first 5 years of diagnosis and increased with age at diagnosis for all sites except colon and stomach. CONCLUSIONS Patients with cancers of the digestive system have a higher incidence of suicide than the general population. Suicide rates among esophageal and pancreatic cancer patients are more than 5 times general population rates. The involvement of psychiatrists and other mental health professionals may be a critical component of cancer care for these high-risk patient subgroups.
Collapse
Affiliation(s)
- Chelsea Anderson
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Eliza M. Park
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Donald L. Rosenstein
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hazel B. Nichols
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
24
|
Kim HJ, Chu H, Lee S. Factors influencing on health-related quality of life in South Korean with chronic liver disease. Health Qual Life Outcomes 2018; 16:142. [PMID: 30021601 PMCID: PMC6052687 DOI: 10.1186/s12955-018-0964-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/02/2018] [Indexed: 01/12/2023] Open
Abstract
Background The objective of this study was to determine health-related quality of life (HRQoL) among chronic liver disease (CLD) subjects in South Korea using EuroQol five-dimension questionnaire (EQ-5D). Method The sample consisted of 139 subjects with CLD from the sixth Korean National Health and Nutrition Examination Survey (KNHNES VI). Data were analyzed using SPSS program for descriptive statistics, t-test, ANOVA, Scheffe’s test and hierarchical multiple regression. Results Results indicated that marital status (P < 0.01), occupation (P < 0.01), basic livelihood security recipient status (P < 0.05), hepatocellular carcinoma (P < 0.05), subjective health status (P < 0.01), and depression (P < 0.001) were significant predictors of HRQoL. Health behaviors (alcohol intake, sleep duration) variables were insignificant. Conclusion In conclusion, marital status, occupation, basic livelihood security recipient status (BLSRS), hepatocellular carcinoma (HCC), subjective health status (SHS), and depression were confirmed to be factors affecting the HRQoL. We should be provide to continuous monitoring and education of adequate alcohol intake for patients with CLD. Findings of this study might be used to develop community based health programs and policies for CLD.
Collapse
Affiliation(s)
- Hyun Jin Kim
- Department of Quality Improvement, Hanyang University Hospital, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Hyeonsik Chu
- Hanyang Cell Therapy Center, Hanyang University Hospital, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Seonhye Lee
- Department of Nursing, Gyeongnam National University of Science and Technology, 33, Dongjin-ro, Jinju-si, Gyeongsangnam-do, 52725, Republic of Korea.
| |
Collapse
|
25
|
Quality of life in patients undergoing repetitive TACE for the treatment of intermediate stage HCC. J Cancer Res Clin Oncol 2018; 144:1991-1999. [PMID: 30008024 DOI: 10.1007/s00432-018-2704-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 07/05/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE With a limited overall survival (OS) of 20 months in patients diagnosed with intermediate stage hepatocellular carcinoma (HCC), the preservation of quality of life (QoL) during transarterial chemoembolization (TACE) procedures remains a primary goal. The aim of our study was to evaluate the change in QoL amongst patients undergoing repetitive TACE and to identify specific risk factors that may predict change in QoL. METHODS QoL was assessed in 82 patients undergoing at least two TACE, before and 14 days after TACE, using validated EORTC QLQ-C30 and EORTC HCC18 questionnaires. Tumour response was assessed using established response criteria. Laboratory and clinical parameters were analysed. RESULTS Functional scores decreased due to first TACE treatment (p < 0.01), conversely symptom scores increased significantly (p < 0.01). During repetitive TACE no statistically significant changes were observed. Higher Global Health- and Physical Functioning scores at baseline were identified as independent prognostic factors for greater decrease in QoL. Tumour response did not alter QoL at all. Furthermore higher symptom scales including pain (p = 0.00), nausea and vomiting (p = 0.00) and fever (p < 0.01 for repetitive TACE) at baseline were predictive of a significantly lesser increase of symptom severity, and a greater reduction in pain during a course of TACE. Higher C-reactive protein (CRP) at baseline and female gender were associated with a greater decrease of functional scales and increase of symptom scales. CONCLUSION QoL amongst patients receiving repetitive TACE showed neither significant nor clinically relevant changes over time. Pre-treatment assessment of QoL-scores, clinical and laboratory parameters can improve patient selection for TACE whilst optimizing QoL.
Collapse
|
26
|
Palliative Care for People With Hepatocellular Carcinoma, and Specific Benefits for Older Adults. Clin Ther 2018; 40:512-525. [PMID: 29571567 DOI: 10.1016/j.clinthera.2018.02.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, has a rapidly rising prevalence in the United States and a very poor overall rate of survival. This epidemic is driven by the cohort of aging Baby Boomers with hepatitis C viral infection and the increasing prevalence of cirrhosis as a result of nonalcoholic steatohepatitis. Because curative options are limited, the disease course creates, in patients and their families, distressing uncertainty around prognosis and treatment decisions. Older adults are disproportionately affected by HCC and have more comorbidities, adding to the complexity of the disease. This population would benefit from increased access to palliative care services, which can potentially complement the treatments throughout the disease trajectory. The purpose of this review was to use existing evidence to propose a new model of palliative care integration in patients with HCC. Thus, we focus on the HCC stage and the treatment algorithm, the ways that palliative care can offer support in this population at each stage, as well as elements that can enhance patient and family support throughout the entire disease trajectory, with an emphasis on the care of older adults with HCC. METHODS This is a narrative review in which we identify evidence-based ways that palliative care can help younger and older adults with HCC and their families, at each stage of HCC and throughout the disease trajectory. FINDINGS We propose ways to integrate HCC and palliative care based on the existing evidence in both fields. Palliative care offers support in symptom management, advanced care planning, and decision making in ways that are specific to each stage of HCC. We also discuss the evidence that illustrates the palliative care needs of patients with HCC that span the entire course of illness, including coping with the stigmatization of liver disease, addressing informational needs at different stages, and discussing quality of life longitudinally. IMPLICATIONS Integrating palliative care into the treatment of patients with HCC has the potential to improve outcomes, although more research is needed to build this evidence base.
Collapse
|
27
|
Reassessment of different criteria for diagnosing post-hepatectomy liver failure: a single-center study of 1683 hepatectomy. Oncotarget 2017; 8:89269-89277. [PMID: 29179518 PMCID: PMC5687688 DOI: 10.18632/oncotarget.19360] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/20/2017] [Indexed: 12/15/2022] Open
Abstract
Assessing the incidence and severity of post-hepatectomy liver failure (PHLF) can be based on different criteria, and we wished to compare the diagnostic efficiency and specificity of different PHLF criteria. Data from patients (n=1683) who received hepatectomies in the liver surgery department of Peking Union Medical College Hospital from April 2008 to August 2014 were retrospectively analyzed. Possible PHLF patients were screened according to the criteria of the International Study Group of Liver Surgery (ISGLS). Subsequently, other PHLF evaluation methods, including Child-Pugh score, “50-50” criteria, Model for End-Stage Liver Disease (MELD) score, and Clavien-Dindo classification were used to assess the suspected PHLF patients, and statistical analysis was performed for correlation of these methods with clinical prognoses. Using ISGLS grading, 40 cases (2.38%) were suspected to have PHLF, among whom 5 (0.30%) patients died. Of the 40 cases there were 9 patients of ISGLS grade A, 21 of grade B, and 10 of grade C. Among the entire group, Child-Pugh scoring showed 3 patients in grade A, 35 in grade B, and 2 in grade C, while only 5 patients met the “50-50” criteria. Interestingly, MELD scores ≥11 points were found only in 3 cases. Twenty-eight patients were classified as Clavien-Dindo grade I, 8 as grade II, 3 as grade III, and 1 as grade IV. Prothrombin time on postoperative day 5 (PT5), ISGLS, and Clavien-Dindo were found to have significant correlation with the prognosis of PHLF (r>0.5, p <0.05), thus can be used as prognosis predictors for PHLF patients.
Collapse
|
28
|
Mutsaers A, Greenspoon J, Walker-Dilks C, Swaminath A. Systematic review of patient reported quality of life following stereotactic ablative radiotherapy for primary and metastatic liver cancer. Radiat Oncol 2017; 12:110. [PMID: 28662680 PMCID: PMC5492951 DOI: 10.1186/s13014-017-0818-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/03/2017] [Indexed: 12/26/2022] Open
Abstract
Background Stereotactic ablative radiotherapy (SABR) is a safe and effective modality in patients with liver cancer who are ineligible for other local therapies. However SABR is not current standard of practice and requires further validation. Patient reported quality of life (QOL) is key to this validation, yet no systematic reviews to date have been performed to analyse QOL following liver SABR. QOL is a critical part of therapy evaluation, particularly in disease states with short life expectancy. The purpose of this study was to conduct a systematic review of QOL outcomes for liver SABR. Materials and methods MEDLINE and EMBASE databases from 1996 to October 2015 were queried to obtain English language studies analysing QOL following liver SABR. Included studies described patient-reported QOL as either a primary or secondary endpoint, and analysed QOL change over time. Studies were screened, and relevant data were abstracted and analysed. Results Of 2181 initially screened studies, 5 met all inclusion criteria. Extracted studies included a total of 392 eligible patients with hepatocellular carcinoma, liver metastases and intrahepatic cholangiocarcinoma. Four studies were prospective in design, and only one study was a conference abstract. Extracted studies were heterogeneous in dose prescription used (11–70 Gy in 3–30 fractions), in addition to reported QOL metrics (EORTC QLQ C-15 PAL,/C-30/LM-21, EuroQol 5D, FACT-Hep, FLIC) and final endpoints (range 6 weeks to 12 months). Despite this there were few statistically significant declines in QOL scores following SABR. Four studies demonstrated transient fatigue in the first 1–4 weeks, while 2 studies showed transient worsening of appetite at 1 month. In all but one instance (loss of appetite at 6 weeks), levels returned to insignificant difference baseline by the final endpoints. All studies showed no significant QOL decline in any domain at their respective endpoints. In studies with overlapping QOL tools, estimates of 3-month post SABR global QOL were similar. Conclusion Results of this systematic review demonstrate well-preserved post liver SABR QOL. These findings strengthen the argument for liver SABR, and should aim to support future comparative effectiveness trials with other local modalities including surgery, chemoembolization and radiofrequency ablation, with a focus on QOL outcomes as an important endpoint. Electronic supplementary material The online version of this article (doi:10.1186/s13014-017-0818-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Adam Mutsaers
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 L8, Canada.
| | - Jeffrey Greenspoon
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Oncology, McMaster University, Juravinski Cancer Centre, 699 Concession St, Hamilton, ON, L8V 5C2, Canada
| | - Cindy Walker-Dilks
- Program in Evidence Based Care, McMaster University, Juravinski Hospital, 60 (G) Wing, 2nd Floor, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada
| | - Anand Swaminath
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Oncology, McMaster University, Juravinski Cancer Centre, 699 Concession St, Hamilton, ON, L8V 5C2, Canada
| |
Collapse
|
29
|
Khazaei S, Abdul Hamid R, Mohd Esa N, Ramachandran V, Aalam GTF, Etemad A, Ismail P. Promotion of HepG2 cell apoptosis by flower of Allium atroviolaceum and the mechanism of action. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:104. [PMID: 28187719 PMCID: PMC5303252 DOI: 10.1186/s12906-017-1594-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 01/20/2017] [Indexed: 02/06/2023]
Abstract
Background Liver cancer is a high incidence and fatal disease, the fifth most frequent cancer worldwide that is usually diagnosed at an advanced stage. The number of deaths from liver cancer has not declined even following various therapies. Plant secondary metabolites and their semi-synthetic derivatives play a principal role in anti-cancer drug therapy, since they are effective in the treatment of specific characteristics while also reducing side effects. Allium atroviolaceum, a plant of the genus Allium has been used in folk medicine to protect against several diseases. However, cytotoxicity and the anti-proliferative effect of Allium atroviolaceum remain unclear. This work aims to investigate the anticancer properties of Allium atroviolaceum and the mechanism of action. Methods To evaluate the in vitro cytotoxicity of flower of Allium atroviolaceum, methanol extract at a dose range from 100 to 3.12 μg/ml was assessed against the HepG2 hepatocarcinoma cell line, and also on normal 3T3 cells, by monitoring proliferation using the MTT assay method. A microscopy study was undertaken to observe morphological changes of HepG2 cells after treatment and cell cycle arrest and apoptosis were studied using flow cytometry. The apoptosis mechanism of action was assessed by the level of caspase-3 activity and expression of apoptosis related genes, Bcl-2, Cdk1 and p53. The combination effect of the methanolic extract with doxorubicin was also investigated by determination of a combination index. Results The results demonstrated growth inhibition of cells in both dose- and time-dependent manners, while no cytotoxic effect on normal cell 3T3 was found. The results revealed the occurrence of apoptosis, illustrated by sub-G0 cell cycle arrest, the change in morphological feature and annexin-V and propidium iodide staining, which is correlated with Bcl-2 downregulation and caspase-3 activity, but p53-independent. In addition, a combination of Allium atroviolaceum and doxorubicin led to a significant synergistic effect. Conclusion These findings suggest that Allium atroviolaceum flower extract has potential as a potent cytotoxic agent against HepG2 cell lines, as it has commendable anti-proliferative activities against human hepatocarcinoma and it can be considered as an effective adjuvant therapeutic agent after the clinical trials.
Collapse
|
30
|
Xie F, Zhu F, Lu Z, Liu Z, Wang H. Investigation of potential molecular biomarkers and small molecule drugs for hepatocellular carcinoma transformed from cirrhosis. Oncol Lett 2016; 12:495-503. [PMID: 27347171 PMCID: PMC4906898 DOI: 10.3892/ol.2016.4615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/12/2016] [Indexed: 12/16/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China and the third leading cause of cancer-associated morality. The aim of the present study was to investigate and analyze differentially-expressed genes (DEGs) between cirrhosis and HCC, in order to screen the key genes involved in the transformation from cirrhosis to HCC and provide novel targets for the diagnosis and treatment of HCC in patients with cirrhosis. The gene expression profile, GSE17548, was obtained from Gene Expression Omnibus database and the DEGs were identified by LIMMA package in R language. Kyoto Encyclopedia of Genes and Genomes and gene ontology biology process analysis were performed for the DEGs. Differential co-expression network (DEN) analysis was conducted and the network was visualized using Cytoscape. Small molecule drugs were also screened from the Comparative Toxicogenomics Database for higher degree DEGs. A total of 95 DEGs were obtained, including 46 upregulated and 49 downregulated genes. The upregulated DEGs were primarily involved in biological processes and pathways associated with the cell cycle, while the downregulated DEGs were primarily involved in immune-associated biological processes. A total of 22 key DEGs were identified by DEN analysis, which distinguished HCC from cirrhosis samples. Furthermore, estradiol, benzo(a)pyrene, acetaminophen, copper sulfate and bisphenol A were identified as the five most associated chemicals to these 22 DEGs. In conclusion, the hub genes and chemicals identified by the present study may provide a theoretical basis for additional research on diagnosis and treatment of HCC transformed from cirrhosis.
Collapse
Affiliation(s)
- Feng Xie
- Department of Nuclear Medicine, The People's Hospital of Liaoning, Shenyang, Liaoning 110016, P.R. China
| | - Fang Zhu
- Cardiovascular Center, The People's Hospital of Liaoning, Shenyang, Liaoning 110016, P.R. China
| | - Zaiming Lu
- Department of Radiology, China Medical University Shengjing Hospital, Shenyang, Liaoning 110004, P.R. China
| | - Zhengrong Liu
- Department of General Surgery, The People's Hospital of Liaoning, Shenyang, Liaoning 110016, P.R. China
| | - Hongyan Wang
- Department of General Surgery, The People's Hospital of Liaoning, Shenyang, Liaoning 110016, P.R. China
| |
Collapse
|
31
|
Sun Q, Guo X, Wang Q, Zhao F. The association of TNF-308 (G/A) gene polymorphisms and hepatocellular carcinoma risk: a meta-analysis. Chin J Cancer Res 2016; 28:536-542. [PMID: 27877013 PMCID: PMC5101228 DOI: 10.21147/j.issn.1000-9604.2016.05.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Many studies have examined the association between the TNF-308 G/A polymorphism gene polymorphisms and hepatocellular carcinoma risk in various populations, but their results have been inconsistent. To assess this relationship more precisely, a meta-analysis was performed. Methods The PubMed and CNKI (China National Knowledge Infrastructure) database was searched for case-control studies. Odds ratios (OR) with 95% CIs were used to determine the strength of association between the TNF-308 G/A polymorphisms and HCC risk. The pooled ORs for the risk associated with the TNF-308 G/A genotype, the A carriers (A/G + A/A) vs. the wild-type homozygotes (G/G), A/A vs. G/G were calculated, respectively. Subgroup analyses were done by ethnicity and smoking status. Heterogeneity assumptions were assessed by chi-square-based Q-test. Results Ultimately, 21 studies, comprising 2,923 hepatocellular carcinoma cases and 4,323 controls were included. Overall, the A carriers (G/A + A/A) vs. the wild-type homozygotes (G/G), the pooled OR was 1.05 (95% CI, 0.93-1.19; P=0.000 for heterogeneity), for A/A vs. G/G the pooled OR was 1.07 (95% CI, 0.95-1.21; P=0.007 for heterogeneity). In the stratified analysis by ethnicity, the significantly risks were found among non-Asians. However, for Asians, significantly risks were not found. Conclusions The TNF-308 G/A polymorphisms are not associated with hepatocellular carcinoma risk among Asians, but for non-Asians.
Collapse
Affiliation(s)
- Qing Sun
- Department of Oncology, Wuxi 2nd People's Hospital, Affiliated to Nanjing Medical University, Wuxi 214002, China
| | - Xuedan Guo
- Department of Oncology, Wuxi 2nd People's Hospital, Affiliated to Nanjing Medical University, Wuxi 214002, China
| | - Qi Wang
- Department of Oncology, Wuxi 2nd People's Hospital, Affiliated to Nanjing Medical University, Wuxi 214002, China
| | - Fan Zhao
- Department of Oncology, Wuxi 2nd People's Hospital, Affiliated to Nanjing Medical University, Wuxi 214002, China
| |
Collapse
|
32
|
Ahmed S, de Souza NN, Qiao W, Kasai M, Keem LJ, Shelat VG. Quality of Life in Hepatocellular Carcinoma Patients Treated with Transarterial Chemoembolization. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2016; 2016:6120143. [PMID: 27143815 PMCID: PMC4838811 DOI: 10.1155/2016/6120143] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 03/13/2016] [Accepted: 03/24/2016] [Indexed: 02/05/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the most commonly diagnosed cancers worldwide. Majority of patients with HCC are diagnosed in the advanced stages of disease and hence they are only suitable for palliative therapy. TACE (transarterial chemoembolization) is the most commonly used treatment for unresectable HCC. It is however unclear if TACE improves the quality of life (QoL) in patients with HCC. The aim of this review is to evaluate the impact of TACE on QoL of HCC patients.
Collapse
Affiliation(s)
- Saleem Ahmed
- 1Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433
- 2Ministry of Health Holdings, 1 Maritime Square, Singapore 099253
| | - Nurun Nisa de Souza
- 3Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857
- 4Singapore Clinical Research Institute, 31 Biopolis Way, Singapore 138669
| | - Wang Qiao
- 2Ministry of Health Holdings, 1 Maritime Square, Singapore 099253
| | - Meidai Kasai
- 5Department of Gastroenterological Surgery, Sendai Kousei Hospital, 8-15 Hirosemachi, Aoba-ku, Sendai-shi, Miyagi 9800873, Japan
| | - Low Jee Keem
- 1Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433
| | - Vishal G. Shelat
- 1Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433
- *Vishal G. Shelat:
| |
Collapse
|
33
|
Zhang H, Li G, Zhang Z. Association between MTHFR A1298C polymorphism and hepatocellular carcinoma risk. Int J Clin Exp Med 2015; 8:9135-41. [PMID: 26309569 PMCID: PMC4538033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/21/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Hepatocarcinogenesis is a complex process that is influenced by many factors. Several studies have investigated the relationship between MTHFR A1298C polymorphism and hepatocellular carcinoma (HCC) risk, but the results are inconsistent. Therefore, we performed a meta-analysis covering a large sample size to address this controversy. METHODS Eligible studies were searched using PubMed, EMBASE, and China National Knowledge Infrastructure (CNKI) databases. A total of 7 studies from 6 publications with 2035 cases and 3096 controls were included. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) was calculated by the fixed or random effects to evaluate the correlation between MTHFR A1298C polymorphism and HCC risk. The Q statistic and I(2) statistic were used to assess the statistical heterogeneity among studies. Publication bias was evaluated by Egger's linear regression test and Begg's funnel plot. RESULTS In present study, the results showed that MTHFR A1298C polymorphism was not significantly associated with risk of HCC based on CC + AC vs. AA genetic model (OR=1.01, 95% CI=0.90-1.13). Similarly, in the subgroup analysis by ethnicity, no significant HCC risk was found in Asian population (OR=1.02, 95% CI=0.91-1.14). In the subgroup analysis based on source of control, we found that MTHFR A1298C polymorphism showed no effects on the occurrence of HCC in the population-based (PB) and hospital-based (HB) group (OR=0.97, 95% CI=0.83-1.15; OR=1.04, 95% CI=0.89-1.21). CONCLUSION This meta-analysis suggested that MTHFR A1298C polymorphism may not be a risk factor for HCC.
Collapse
Affiliation(s)
- Haiyan Zhang
- Gynaecology Ward-1 and Linyi City People’s HospitalLinyi 276000, Shandong Province, China
| | - Guang Li
- Gastrointestinal Surgery, Linyi City People’s HospitalLinyi 276000, Shandong Province, China
| | - Zhen Zhang
- Gynaecology Ward-1 and Linyi City People’s HospitalLinyi 276000, Shandong Province, China
| |
Collapse
|
34
|
Misra SR, Shankar YU, Rastogi V, Maragathavalli G. Metastatic hepatocellular carcinoma in the maxilla and mandible, an extremely rare presentation. Contemp Clin Dent 2015; 6:S117-21. [PMID: 25821363 PMCID: PMC4374307 DOI: 10.4103/0976-237x.152966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Malignancy is characterized by anaplasia, invasiveness, and metastasis. Primary oral squamous cell carcinoma is the most prevalent oral malignancy, but secondary malignancy from distant sites have also been reported. Hepatocellular carcinoma (HCC) is a common primary liver malignancy that frequently metastasizes during the course of the disease, but < 1% of cases show oral involvement. Such secondary neoplasms do not have any pathognomonic clinical or radiologic findings, and therefore they pose a diagnostic challenge. Hence, in the differential diagnosis of malignant tumors of the oral cavity, it is essential to consider the occurrence of both primary as well as metastatic tumors despite the low incidence of the latter. A rare case of HCC metastasizing to both the maxilla and mandible is presented, in which the patient succumbed to the disease as a result of the delay in diagnosis.
Collapse
Affiliation(s)
- Satya Ranjan Misra
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, Bhubaneswar, Odisha, India
| | - Y Uday Shankar
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Fasalwadi, Sangareddy, Telangana, India
| | - Varun Rastogi
- Department of Oral and Maxillofacial Pathology, Kalka Dental College, Meerut, Uttar Pradesh, India
| | - G Maragathavalli
- Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India
| |
Collapse
|