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Balbi E, Moreira JPDL, Luiz RR, Perez RDM, de Souza HSP. Time trends and geographic distribution of hepatocellular carcinoma in Brazil: An ecological study. Medicine (Baltimore) 2022; 101:e30614. [PMID: 36197232 PMCID: PMC9509041 DOI: 10.1097/md.0000000000030614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) is increasing globally, and HCC is the fourth leading cause of cancer-related death. This ecological study aimed to investigate the time trends and geographic distribution of HCC in Brazil. Data from the Brazilian Health Public System were retrospectively collected from January 2005 to December 2018. Hospitalization and intrahospital lethality rates for HCC were stratified by age and sex. Hospitalization rates and associated lethality per 100,000 inhabitants in each municipality were included in a worksheet to build maps displaying the estimates and the geographic distribution of HCC. From 2005 to 2018, a total of 75,466 admissions for HCC were registered and the mean hospitalizations increased from 2.1 to 5.8/100,000 inhabitants (176%). The greatest increase occurred among patients older than 50, particularly in males above 70 years old. Prevalence rates increased throughout the country, with the highest levels detected in the South and Southeast. However, the increase was proportionally higher in the Northeast (377%), especially in municipalities not integrated into metropolitan regions. The HCC lethality rate remained relatively stable in both sexes, ranging from 21% to 25% (19%), but it was higher among older patients. The length of hospital stay did not differ between survivors and nonsurvivors throughout the study period. HCC hospitalizations are rising, particularly above 50 years of age and in rural areas, not paralleled by lethality rates. This suggests ongoing changes in environmental and socioeconomic factors in Brazil.
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Affiliation(s)
- Elizabeth Balbi
- D’Or Institute for Research and Education (IDOR), Botafogo, Rio de Janeiro 22281-100, Brazil
- Quinta D’Or Hospital, São Cristóvão, Rio de Janeiro 20941-150, Brazil
| | | | - Ronir Raggio Luiz
- Institute of Collective Health Studies (IESC), Federal University of Rio de Janeiro, Rio de Janeiro 21944-970, Brazil
| | - Renata de Mello Perez
- D’Or Institute for Research and Education (IDOR), Botafogo, Rio de Janeiro 22281-100, Brazil
- Department of Clinical Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, 21941-913, Brazil
| | - Heitor Siffert Pereira de Souza
- D’Or Institute for Research and Education (IDOR), Botafogo, Rio de Janeiro 22281-100, Brazil
- Department of Clinical Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, 21941-913, Brazil
- * Correspondence: Heitor SP de Souza, Department of Clinical Medicine, University Hospital, Federal University of Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Rio de Janeiro, RJ 21941-913, Brazil (e-mail: )
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Fernandes GDS, Campos D, Ballalai A, Palhares R, da Silva MRA, Palhares DMF, Neto BHF, Barros FMDR, Gil RDA, Chagas A, Carrilho FJ. Epidemiological and Clinical Patterns of Newly Diagnosed Hepatocellular Carcinoma in Brazil: the Need for Liver Disease Screening Programs Based on Real-World Data. J Gastrointest Cancer 2020; 52:952-958. [PMID: 32918274 PMCID: PMC8376733 DOI: 10.1007/s12029-020-00508-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose Describe sociodemographic and clinical characteristics of patients with hepatocellular carcinoma (HCC) and establish their history in the Brazilian public health system. Methods Retrospective observational study was conducted using the database from the Department of Informatics of the Unified Health System (DataSUS). Patients with at least one claim of HCC between July/2011 and June/2016 were included. A record linkage methodology was performed to obtain longitudinal data across different databases. Demographic and clinical data were evaluated, including the time elapsed between diagnosis of HCC risk-factors and the cancer development. Data was analyzed using descriptive statistics. Results A total of 28,822 HCC cases were identified between July/2011 and June/2016. Mean age was 59.7 years (SD = 14.7), and most patients were men (55.9%). The highest relative number of HCC cases was detected in the south of Brazil (> 20 cases/100,000 inhabitants). About 86.5% of the patients had diagnosis of HCC without previous liver diseases. Only 8% had diagnosis of chronic viral hepatitis and 3.5% cirrhosis. About 76% were diagnosed at an advanced stage, and only 11% of the patients had early stage HCC. Approximately 58% of patients with previous underlying liver diseases were diagnosed at early stages, compared with only 24% of patients without prior record of underlying diseases. Conclusion The diagnosis of HCC in the Brazilian public health is usually made in patients with no previous diagnosis of liver disease and in advanced stages, when no curative treatment is available and survival rates are low. Public health policies are key for the screening and monitoring liver disease and, consequently, HCC.
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Affiliation(s)
- Gustavo Dos Santos Fernandes
- Centro de Oncologia, Hospital Sírio-Libanês, SGAS 613/614, Conjunto E, Lote 95, Brasilia, DF, CEP 70200730, Brazil. .,Sociedade Brasileira de Oncologia Clínica, Sao Paulo, SP, Brazil.
| | | | | | | | - Mario R A da Silva
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Daniel M F Palhares
- Centro de Oncologia, Hospital Sírio-Libanês, SGAS 613/614, Conjunto E, Lote 95, Brasilia, DF, CEP 70200730, Brazil
| | - Ben-Hur F Neto
- Consultant Surgeon at Diagnósticos da América SA (DASA) e Associação Brasileira de Linfoma e Leucemia (ABRALE), Sao Paulo, SP, Brazil
| | | | - Roberto de A Gil
- Serviço de Oncologia Clínica do INCA e Oncoclínica Centro de Tratamento Oncológico, Rio de Janeiro, RJ, Brazil
| | - Aline Chagas
- Hospital das Clínicas da Faculdade de Medicina da USP e Instituto do Câncer do Estado de São Paulo (ICESP), Sao Paulo, SP, Brazil
| | - Flair José Carrilho
- Hospital das Clínicas da Faculdade de Medicina da USP e Instituto do Câncer do Estado de São Paulo (ICESP), Sao Paulo, SP, Brazil
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Barbu MG, Thompson RJ, Thompson DC, Cretoiu D, Suciu N. The Impact of SARS-CoV-2 on the Most Common Comorbidities-A Retrospective Study on 814 COVID-19 Deaths in Romania. Front Med (Lausanne) 2020; 7:567199. [PMID: 33015111 PMCID: PMC7509043 DOI: 10.3389/fmed.2020.567199] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/17/2020] [Indexed: 01/09/2023] Open
Abstract
Background: The SARS-CoV2 infection has rapidly spread throughout the world, particularly affecting those with underlying conditions. Objective: To assess the impact of SARS-CoV-2 on the most prevalent comorbidities, among people who died of COVID-19 in Romania. Methods: The study comprised 814 deaths caused by COVID-19 between 22nd March and 8th May, 2020 as reported by the Ministry of Health. WHO data regarding deaths of the general population of Romania was used for comparison. The study analyzed the demographics, number and prevalence of comorbidities and calculated the relative risk for each comorbidity. Results: The study sample consisted of 61.4% males and 38.6% females; the mean age was 68.2 y; 90.9% of deaths occurred in people 50+ years. The mean number of pre-existing conditions was 2.73 (SD = 1.521), with 97.4% of the patients having at least one. The most prevalent comorbidities were hypertension (43.1%), diabetes (33.2%), and coronary heart disease (26.0%). The calculated relative risk of death due to COVID-19 was divided into 3 risk categories: high impact comorbidities (RR > 3) included diabetes RR = 6.426 (95% CI, 4.965–8.318), chronic renal disease RR = 4.338 (95% CI, 3.556–5.292) and hypertension RR=3.261 (95% CI, 2.687–3.958). The medium impact (RR = 2–3) group comprised chronic pulmonary disease RR = 2.615 (95% CI, 2.061–3.319) and chronic liver disease RR = 1.577 (95% CI, 1.183–2.104) and the low impact group (RR<2) –coronary heart disease RR = 0.664 (95% CI, 0.581–0.758), cancer RR = 0.515 (95% CI, 0.416–0.637) and stroke RR = 0.468 (95% CI, 0.370–0.593). Conclusion: In the studied sample, SARS-CoV-2 had a greater impact on people with diabetes, chronic renal disease and hypertension and a lesser impact on those with coronary heart disease, cancer and stroke. Therefore, future policies in Romania should focus on shielding people in the high-risk group and prioritizing them for vaccination, whilst encouraging those in the low risk group to continue seeking treatment for their underlying diseases.
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Affiliation(s)
- Madalina Gabriela Barbu
- Alessandrescu-Rusescu National Institute for Mother and Child Health, Fetal Medicine Excellence Research Center, Bucharest, Romania
| | | | - Dana Claudia Thompson
- Alessandrescu-Rusescu National Institute for Mother and Child Health, Fetal Medicine Excellence Research Center, Bucharest, Romania
| | - Dragos Cretoiu
- Alessandrescu-Rusescu National Institute for Mother and Child Health, Fetal Medicine Excellence Research Center, Bucharest, Romania.,Department of Cell and Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Nicolae Suciu
- Alessandrescu-Rusescu National Institute for Mother and Child Health, Fetal Medicine Excellence Research Center, Bucharest, Romania.,Division of Obstetrics, Gynecology and Neonatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Alessandrescu-Rusescu National Institute for Mother and Child Health, Department of Obstetrics and Gynecology, Polizu Clinical Hospital, Bucharest, Romania
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BCLC-B Subclassification and the Hong Kong Liver Cancer System in Intermediate Hepatocellular Carcinoma: Identifying Candidates for Curative Therapy. Am J Clin Oncol 2020; 42:466-471. [PMID: 30913090 DOI: 10.1097/coc.0000000000000539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The intermediate stage of the Barcelona Clinic Liver Cancer (BCLC) classification includes a heterogenous population of patients with hepatocellular carcinoma (HCC), and palliative treatment with transarterial chemoembolization is recommended for all of them. In this regard, 2 other classifications could be useful, the subclassification BCLC-B (SUB) and the classification Hong Kong Liver Cancer (HKLC). OBJECTIVE To determine the indication of curative or palliative treatment between SUB and HKLC in BCLC-B patients. PATIENTS AND METHODS A retrospective study in HCC patients seen between 2011 and 2016 in southern Brazil. Demographic, clinical, and laboratory data were collected. HCC staging was performed with BCLC, SUB, and HKLC. RESULTS A total of 570 patients with HCC were assessed, of whom 95 were classified as BCLC-B: 25 (26.0%) B1, 48 (50.5%) B2, 9 (9.5%) B3, and 13 (13.7%) B4. Overall median survival was 21.1 (95% confidence interval, 14.2-28.0) months. Median survival was higher for BCLC-B1 patients than in subgroups B3 (P=0.046) and B4 (P=0.001), and this was also seen for B2 versus B4 (P=0.044). Regarding the HKLC classification, a significantly higher median survival was observed for HKLC-I and HKLC-IIB in relation to the categories HKLC-IIIA (P<0.001 and 0.004, respectively) and HKLC-IIIB (P<0.001 and 0.006, respectively). When HKLC was applied, the following were identified as candidates for curative treatment: BCLC-B1, 24 (96.0%); BCLC-B2, 26 (54.2%); BCLC-B3, 0 (0%); and BCLC-B4, 3 (23.1%). CONCLUSION In intermediate HCC, SUB was able to identify a subset of patients with a higher overall survival. According to HKLC, 55.8% of BCLC-B patients could receive curative treatment.
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Sorafenib for Treatment of Hepatocellular Carcinoma: A Survival Analysis From the South American Liver Research Network. J Clin Gastroenterol 2019; 53:464-469. [PMID: 29952857 DOI: 10.1097/mcg.0000000000001085] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
GOALS We aim to describe the efficacy, safety profile, and variables associated with survival in patients with hepatocellular carcinoma (HCC) treated with sorafenib in South America. BACKGROUND Sorafenib has been shown to improve survival in patients with advanced HCC. There are few data on sorafenib use for HCC in South America. STUDY We performed a retrospective analysis of HCC cases treated with sorafenib from 8 medical centers in 5 South American countries, between January 2010 and June 2017. The primary endpoint was overall survival (OS), which was defined as time from sorafenib initiation to death or last follow-up. Risk factors for decreased OS were assessed using Cox proportional hazard regression and log-rank tests. RESULTS Of 1336 evaluated patients, 127 were treated with sorafenib and were included in the study. The median age of individuals was 65 years (interquartile range, 55 to 71) and 70% were male individuals. Median OS in all patients was 8 months (interquartile range, 2 to 17). Variables associated with survival on multivariate analysis were platelets >/<250,000 mm (2 vs. 8 mo, P=0.01) and Barcelona Clinic Liver Cancer (BCLC) stage (A/B, 13 vs. C/D, 6 mo; P=0.04). In a subanalysis of patients with BCLC stage C, platelets >/<250,000 mm were also independently associated with survival (2 vs. 5.5 mo, P=0.03). Patients lived longer if they experienced any side effects from sorafenib use (11 vs. 2 mo, P=0.009). Patients who stopped sorafenib because of side effects had shorter survival compared with patients who were able to tolerate side effects and continue treatment (7.5 vs. 13 mo, P=0.01). CONCLUSIONS Pretreatment elevation of platelets and advanced BCLC stage were independently associated with poor survival on sorafenib in a South American cohort.
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Perazzo H, Pacheco AG, Luz PM, Castro R, Hyde C, Fittipaldi J, Rigolon C, Cardoso SW, Grinsztejn B, Veloso VG. Age-standardized mortality rates related to viral hepatitis in Brazil. BMC Infect Dis 2017; 17:527. [PMID: 28760138 PMCID: PMC5537933 DOI: 10.1186/s12879-017-2619-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/18/2017] [Indexed: 12/31/2022] Open
Abstract
Background Liver-related mortality has been increasing worldwide. We aimed to estimate the age-standardized mortality rates from viral hepatitis in Brazil. Methods The Brazilian National Death Registry was analyzed from 2008 to 2014. Viral hepatitis deaths were defined by the following ICD-10 codes in the death certificate: hepatitis A [B15.0; B15.9]; hepatitis B [B16.2; B16.9; B18.1]; hepatitis C [B17.1; B18.2]; hepatitis Delta [B16.0; B16.1; B18.0; B17.0] and other viral hepatitis [B17.2; B17.8; B18.8; B18.9; B19.0; B19.9]. Crude mortality rates were calculated by the ratio between total number of deaths and estimated population. Mortality rates were age-standardized by the direct method using the WHO standard population. Results Thirty four thousand ,nine hundred seventy eight deaths had viral hepatitis mentioned in their death certificate [65% male, aged 58 years, 73% associated with hepatitis C]. Age-standardized mortality rate (95% CI) due to viral hepatitis was 2.695 (2.667–2.724) deaths per 100,000 inhabitants: South region had the higher rates [3.997 (3.911–4.085)]. Mortality rates associated with hepatitis A and Delta were 0.032 (0.029–0.035) and 0.028 (0.025–0.031), respectively. Hepatitis C mortality rates were 4-fold higher than those associated with hepatitis B [1.964 (1.940–1.989) vs 0.500 (0.488–0.512)]. South region had the higher rates for hepatitis C [3.163 (3.087–3.241)] and North had the higher rates for hepatitis A [0.066 (0.049–0.087)], B [0.986 (0.918–1.058)] and Delta [0.220 (0.190–0.253)]. Conclusion Viral hepatitis remains a major public health issue in Brazil. Mortality rates were not homogeneous across the country, suggesting that health policies should be customized according to geographical location. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2619-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hugo Perazzo
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Infectologia Evandro Chagas (INI), Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Rio de Janeiro, Brazil.
| | - Antonio G Pacheco
- Fundação Oswaldo Cruz (FIOCRUZ), Programa de Computação Científica (PROCC), Rio de Janeiro, Brazil
| | - Paula M Luz
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Infectologia Evandro Chagas (INI), Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Rio de Janeiro, Brazil
| | - Rodolfo Castro
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Infectologia Evandro Chagas (INI), Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Rio de Janeiro, Brazil
| | - Chris Hyde
- Institute of Health Research, Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, University of Exeter, England, UK
| | - Juliana Fittipaldi
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Infectologia Evandro Chagas (INI), Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Rio de Janeiro, Brazil
| | - Caroline Rigolon
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Infectologia Evandro Chagas (INI), Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Rio de Janeiro, Brazil
| | - Sandra W Cardoso
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Infectologia Evandro Chagas (INI), Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Infectologia Evandro Chagas (INI), Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Rio de Janeiro, Brazil
| | - Valdiléa G Veloso
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Infectologia Evandro Chagas (INI), Laboratório de Pesquisa Clínica em DST e AIDS (LAPCLIN-AIDS), Rio de Janeiro, Brazil
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