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Seung SJ, Saherawala H, Kim Y, Tieu J, Wang S, Shephard C, Bossé D. Real-World Treatment Patterns, Clinical Outcomes, Healthcare Resource Utilization, and Costs in Advanced Hepatocellular Carcinoma in Ontario, Canada. Cancers (Basel) 2024; 16:2232. [PMID: 38927937 PMCID: PMC11201404 DOI: 10.3390/cancers16122232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/06/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
The therapeutic landscape for aHCC has evolved in recent years, necessitating a comprehensive analysis of treatment patterns, clinical outcomes, HCRU, and costs to contextualize emerging treatments. This study aimed to investigate these outcomes using real-world data from Ontario, Canada. This retrospective cohort study was conducted using linked administrative databases from April 2010 to March 2020. Patients diagnosed with aHCC were included, and their clinical and demographic characteristics were analyzed, as well as treatment patterns, survival, HCRU, and economic burden. Among 7322 identified patients, 802 aHCC patients met the eligibility criteria for inclusion in the study. Treatment subgroups included 1L systemic therapy (53.2%), other systemic treatments (4.5%), LRT (9.0%), and no treatment (33.3%). The median age was 66 years, and the majority were male (82%). The mOS for the entire cohort from diagnosis was 6.5 months. However, patients who received 1L systemic therapy had an mOS of 9.0 months, which was significantly higher than the other three subgroups. The mean cost per aHCC-treated patient was $49,640 CAD, with oral medications and inpatient hospitalizations as the largest cost drivers. The results underscore the need for the continuous evaluation and optimization of HCC management strategies in the era of evolving therapeutic options.
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Affiliation(s)
- Soo Jin Seung
- HOPE Research Centre, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada;
| | - Hasnain Saherawala
- HOPE Research Centre, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada;
| | - YongJin Kim
- AstraZeneca Canada, 1004 Middlegate Road, Mississauga, ON L4Y 1M4, Canada; (Y.K.); (J.T.); (S.W.); (C.S.)
| | - Jimmy Tieu
- AstraZeneca Canada, 1004 Middlegate Road, Mississauga, ON L4Y 1M4, Canada; (Y.K.); (J.T.); (S.W.); (C.S.)
| | - Sharon Wang
- AstraZeneca Canada, 1004 Middlegate Road, Mississauga, ON L4Y 1M4, Canada; (Y.K.); (J.T.); (S.W.); (C.S.)
| | - Cal Shephard
- AstraZeneca Canada, 1004 Middlegate Road, Mississauga, ON L4Y 1M4, Canada; (Y.K.); (J.T.); (S.W.); (C.S.)
| | - Dominick Bossé
- Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada;
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2
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Seung SJ, Saherawala H, Zagorski B, Tong C, Lim H, Kim P, Marquez V, Gill S, Liu D, Davies JM. Treatment journey of patients with hepatocellular carcinoma using real-world data in British Columbia, Canada. Hepat Oncol 2023; 10:HEP50. [PMID: 38495452 PMCID: PMC10941055 DOI: 10.2217/hep-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/17/2024] [Indexed: 03/19/2024] Open
Abstract
Aim This study examined treatment patterns, survival outcomes and healthcare costs related to hepatocellular carcinoma (HCC) in British Columbia. Methods The study utilized data from two physician databases (HCC and MOTION) and the provincial British Columbia transplant database. Results The analysis revealed diverse treatment approaches and identified the varying treatment journeys of patients. Liver transplant and systemic therapies demonstrated improved survival rates. However, there was a scarcity of Canadian-specific cost data. Conclusion The research emphasizes the complexities of managing HCC and underscores the need for personalized treatment strategies to enhance patient outcomes. These findings contribute valuable insights into HCC management and provide a foundation for future studies and interventions aimed at optimizing care and resource allocation.
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Affiliation(s)
- Soo Jin Seung
- Sunnybrook Research Institute, HOPE Research Centre, Toronto, Canada
| | | | | | - Carman Tong
- Provincial Health Services Association, Vancouver, Canada
| | - Howard Lim
- Department of Medical Oncology, BC Cancer Agency, Vancouver, Canada
| | - Peter Kim
- Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Vladimir Marquez
- Division of Gastroenterology, Vancouver General Hospital, Vancouver, Canada
| | - Sharlene Gill
- Department of Medical Oncology, BC Cancer Agency, Vancouver, Canada
| | - David Liu
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | - Janine M Davies
- Department of Medical Oncology, BC Cancer Agency, Vancouver, Canada
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3
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Pan HY, Wu QQ, Yin QQ, Dai YN, Huang YC, Zheng W, Hui TC, Chen MJ, Wang MS, Zhang JJ, Huang HJ, Tong YX. LC/MS-Based Global Metabolomic Identification of Serum Biomarkers Differentiating Hepatocellular Carcinoma from Chronic Hepatitis B and Liver Cirrhosis. ACS OMEGA 2021; 6:1160-1170. [PMID: 33490775 PMCID: PMC7818305 DOI: 10.1021/acsomega.0c04259] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
Chronic hepatitis B virus (CHB) infection is one of the primary risk factors associated with the development of hepatocellular carcinoma (HCC). Despite having been extensively studied, diagnosing early-stage HCC remains challenging, and diagnosed patients have a poor (3-5%) survival rate. Identifying new approaches to detect changes in the serum metabolic profiles of patients with CHB and liver cirrhosis (LC) may provide a valuable approach to better detect HCC at an early stage when it is still amenable to treatment, thereby improving patient prognosis and survival. In the present study, we, therefore, employed a liquid chromatography-mass spectrometry (LC-MS)-based approach to evaluate the serum metabolic profiles of 30 CHB patients, 29 LC patients, and 30 HCC patients. We then employed appropriate statistical methods to identify those metabolites that were best able to distinguish HCC cases from LC and CHB controls. A mass-based database was then used to putatively identify these metabolites. We then confirmed the identities of a subset of these metabolites through comparisons with the MS/MS fragmentation patterns and retention times of reference standards. The serum samples were then reanalyzed to quantify the levels of these selected metabolites and of other metabolites that have previously been identified as potential HCC biomarkers. Through this approach, we observed clear differences in the metabolite profiles of the CHB, LC, and HCC patient groups in both positive- and negative-ion modes. We found that the levels of taurodeoxy cholic acid (TCA) and 1,2-diacyl-3-β-d-galactosyl-sn-glycerol rose with the progression from CHB to LC to HCC, whereas levels of 5-hydroxy-6E,8Z,11Z,14Z,17Z-eicosapentaenoic acid, and glycyrrhizic acid were gradually reduced with liver disease progression in these groups. The ROC analysis showed that taurodeoxy cholic acid (TCA), 1,2-diacyl-3-β-d-galactosyl-sn-glycerol, 5-hydroxy-6E,8Z,11Z,14Z,17Z-eicosapentaenoic acid, and glycyrrhizic acid had a diagnosis performance with liver disease progression. These four metabolites have a significant correlation with alpha fetal protein (AFP) level and age. Our results highlight novel metabolic biomarkers that have the potential to be used for differentiating between CHB, LC, and HCC patients, thereby facilitating the identification and treatment of patients with early-stage HCC.
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Affiliation(s)
- Hong Y. Pan
- Department
of Infectious Diseases, Zhejiang Provincial
People’s Hospital, People’s Hospital of Hangzhou Medical
College, No. 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
| | - Qing Q. Wu
- Department
of Infectious Diseases, Zhejiang Provincial
People’s Hospital, People’s Hospital of Hangzhou Medical
College, No. 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
- The
Second Clinical Medical College, Zhejiang
Chinese Medical University, No. 548 Binwen Road, Hangzhou, Zhejiang 310053, China
| | - Qiao Q. Yin
- Department
of Infectious Diseases, Zhejiang Provincial
People’s Hospital, People’s Hospital of Hangzhou Medical
College, No. 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
- Bengbu
Medical College, No.
2600 Donghai Road, Bengbu, Anhui 233030, China
| | - Yi N. Dai
- Department
of Infectious Diseases, Zhejiang Provincial
People’s Hospital, People’s Hospital of Hangzhou Medical
College, No. 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
| | - Yi C. Huang
- Department
of Infectious Diseases, Zhejiang Provincial
People’s Hospital, People’s Hospital of Hangzhou Medical
College, No. 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
| | - Wei Zheng
- Department
of Infectious Diseases, Zhejiang Provincial
People’s Hospital, People’s Hospital of Hangzhou Medical
College, No. 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
| | - Tian C. Hui
- Department
of Infectious Diseases, Zhejiang Provincial
People’s Hospital, People’s Hospital of Hangzhou Medical
College, No. 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
- Bengbu
Medical College, No.
2600 Donghai Road, Bengbu, Anhui 233030, China
| | - Mei J. Chen
- Department
of Infectious Diseases, Zhejiang Provincial
People’s Hospital, People’s Hospital of Hangzhou Medical
College, No. 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
| | - Ming S. Wang
- Department
of Infectious Diseases, Zhejiang Provincial
People’s Hospital, People’s Hospital of Hangzhou Medical
College, No. 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
| | - Jia J. Zhang
- Department
of Infectious Diseases, Zhejiang Provincial
People’s Hospital, People’s Hospital of Hangzhou Medical
College, No. 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
| | - Hai J. Huang
- Department
of Infectious Diseases, Zhejiang Provincial
People’s Hospital, People’s Hospital of Hangzhou Medical
College, No. 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
| | - Yong X. Tong
- Department
of Infectious Diseases, Zhejiang Provincial
People’s Hospital, People’s Hospital of Hangzhou Medical
College, No. 158 Shangtang Road, Hangzhou, Zhejiang 310014, China
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Winters AC, Viramontes M, Buch A, Najarian L, Yum J, Yang L, Saab S. Older Patients With Hepatocellular Carcinoma Are Less Knowledgeable About Survivorship Issues: Outcomes from a Survey-based Study. J Clin Gastroenterol 2021; 55:88-92. [PMID: 33060439 DOI: 10.1097/mcg.0000000000001442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS As the incidence and survival for hepatocellular carcinoma increase, the number of patients having been treated for liver cancer would be expected to increase as well. Little is known about the experience of the survivors of hepatocellular carcinoma. METHODS The authors conducted a 3-tool survey of hepatocellular carcinoma survivors at a large, academic, and tertiary referral medical center to assess potential areas of disparities in the survivorship experience. The instruments aimed to assess knowledge of survivorship issues (Perceived Efficacy in Patient-Physician Interactions Questionnaire-1), preparedness for the survivorship experience (Perceived Efficacy in Patient-Physician Interactions Questionnaire-2), and self-efficacy in procuring medical information while navigating the patient-provider relationship (Perceived Efficacy in Patient-Physician Interactions Questionnaire). The authors compared mean test scores for each instrument, with higher scores indicating a more positive response, by patient characteristics and used s linear regression model to examine associations between sociodemographics and survey scores. RESULTS In total, 110 patients took at least 1 survey. In the multiple linear regression model, the authors found that for every increase in patient age by 10 years, knowledge of survivorship issues decreased by a total score of 1.3 (P=0.02). In this model, the authors found no significant differences between male and female respondents, English and non-English speakers, and liver transplant recipients and nonliver transplant recipients. Survivors who had completed a 4-year college degree had significantly higher knowledge of survivorship issues than those who did not use χ testing, but this finding did not maintain significance in the multiple linear regression model. CONCLUSIONS In a population of 110 ethnically diverse hepatocellular carcinoma survivors, the authors found older patients had gaps in knowledge of survivorship issues. Particular attention should be paid to older populations during liver cancer treatment.
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Affiliation(s)
| | - Matthew Viramontes
- Surgery, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA
| | - Adam Buch
- Surgery, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA
| | - Lisa Najarian
- Surgery, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA
| | - Jung Yum
- Surgery, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA
| | | | - Sammy Saab
- Departments of Medicine
- Surgery, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA
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Winters AC, Bedier F, Saab S. Management of Side Effects of Systemic Therapies for Hepatocellular Carcinoma: Guide for the Hepatologist. Clin Liver Dis 2020; 24:755-769. [PMID: 33012457 DOI: 10.1016/j.cld.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Historically, systemic treatment of advanced hepatocellular carcinoma was limited to the tyrosine kinase inhibitor sorafenib. With the recent approval of several new agents the armamentarium of treatment options available to providers and patients has expanded. Although these promising advances offer hope for patients with advanced hepatocellular carcinoma, they also present new and challenging adverse effects that threaten to limit their efficacy. Immunotherapy with checkpoint inhibitors introduce immune-related adverse events, which may affect a wide array of organ systems. With prompt recognition, however, common side effects of systemic therapies for hepatocellular carcinoma are predictable, manageable, and many improve with appropriate intervention.
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Affiliation(s)
- Adam C Winters
- Pfleger Liver Institute, 200 Medical Plaza Driveway, Suite 214, Los Angeles, CA 90095, USA
| | - Fatima Bedier
- Pfleger Liver Institute, 200 Medical Plaza Driveway, Suite 214, Los Angeles, CA 90095, USA
| | - Sammy Saab
- Pfleger Liver Institute, 200 Medical Plaza Driveway, Suite 214, Los Angeles, CA 90095, USA.
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6
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Winters AC, Sung JC, Wyatt B, Berera D, Schiano TD, Schwartz ME, Perumalswami PV, Branch AD. At diagnosis of hepatocellular carcinoma, African Americans with hepatitis C have better liver function than other patients. Clin Liver Dis (Hoboken) 2018; 12:109-112. [PMID: 30416720 PMCID: PMC6220896 DOI: 10.1002/cld.745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Adam C. Winters
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
| | - Julie C. Sung
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
| | - Brooke Wyatt
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
| | - Deeva Berera
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
| | - Thomas D. Schiano
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
| | - Myron E. Schwartz
- Department of Surgery, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
| | - Ponni V. Perumalswami
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
| | - Andrea D. Branch
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai Medical CenterNew YorkNY
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7
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Chang KV, Chen JD, Wu WT, Huang KC, Hsu CT, Han DS. Association between Loss of Skeletal Muscle Mass and Mortality and Tumor Recurrence in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Liver Cancer 2018; 7:90-103. [PMID: 29662836 PMCID: PMC5892377 DOI: 10.1159/000484950] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) has multiple prognostic factors, and there is an increase in knowledge about the body composition and physical status of patients with HCC. The present meta-analysis aimed to explore whether loss of skeletal muscle mass is associated with mortality and tumor recurrence in patients with HCC. METHOD A systematic search was conducted for published literature using PubMed, Embase, and Scopus. We included cohort or case-control studies investigating patients with HCC. The primary and secondary outcomes were the associations of loss of skeletal muscle mass with overall survival and tumor recurrence, respectively, expressed by a summary hazard ratio (HR) and 95% confidence interval (CI). RESULT A total of 13 studies comprising 3,111 patients were included. The summary HRs calculated by either univariate or multivariate analysis both suggested a significant association between sarcopenia and all-cause mortality (crude HR = 2.04, 95% CI: 1.74-2.38; adjusted HR = 1.95, 95% CI: 1.60-2.37). Similarly, loss of skeletal muscle mass was associated with tumor recurrence (crude HR = 1.85, 95% CI: 1.44-2.37; adjusted HR = 1.76, 95% CI: 1.27-2.45). The stratified analysis showed that treatment types and inclusion of body mass index or body weight in the Cox regression model did not modify both clinical outcomes. With an increase in cut-off values of muscle mass on computed tomography images (especially for male patients), there was an insignificant trend of stronger associations between loss of skeletal muscle mass and all-cause mortality. CONCLUSION Loss of skeletal muscle mass is associated with increased all-cause mortality and tumor recurrence in patients with HCC. Further prospective studies incorporating measurements of muscle strength and physical function are warranted to see whether inclusion of both parameters better predicts the outcome than use of muscle mass only.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan, ROC,Community and Geriatric Medicine Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan, ROC,Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Bei-Hu Branch, Taipei, Taiwan, ROC
| | - Jin-De Chen
- Community and Geriatric Medicine Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan, ROC,Department of Gastroenterology, National Taiwan University HospitalBei-Hu Branch, Taiwan, ROC
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan, ROC
| | - Kuo-Chin Huang
- Community and Geriatric Medicine Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan, ROC,Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | - Chia-Tzu Hsu
- Community and Geriatric Medicine Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan, ROC
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan, ROC,Community and Geriatric Medicine Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan, ROC,Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Bei-Hu Branch, Taipei, Taiwan, ROC,Health Science and Wellness Center, National Taiwan University, Taipei, Taiwan, ROC,*Der-Sheng Han, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, No. 87, NeiJiang Rd., WanHwa District, Taipei 108, Taiwan (ROC), E-Mail
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8
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Jones PD, Diaz C, Wang D, Gonzalez-Diaz J, Martin P, Kobetz E. The Impact of Race on Survival After Hepatocellular Carcinoma in a Diverse American Population. Dig Dis Sci 2018; 63:515-528. [PMID: 29275448 DOI: 10.1007/s10620-017-4869-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 11/23/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Hepatocellular carcinoma (HCC) incidence is increasing at differential rates depending on race. We aimed to identify associations between race and survival after HCC diagnosis in a diverse American population. METHODS Using the cancer registry from Sylvester Comprehensive Cancer Center, University of Miami and Jackson Memorial Hospitals, we performed retrospective analysis of 999 patients diagnosed with HCC between 9/24/2004 and 12/19/2014. We identified clinical characteristics by reviewing available electronic medical records. The association between race and survival was analyzed using Cox proportional hazards regression. RESULTS Median survival in days was 425 in Blacks, 904.5 in non-Hispanic Whites, 652 in Hispanics, 570 in Asians, and 928 in others, p < 0.01. Blacks and Asians presented at more advanced stages with larger tumors. Although Whites had increased severity of liver disease at diagnosis compared to other races, they had 36% reduced rate of death compared to Blacks, [hazard ratio (HR) 0.64, 95% confidence interval (CI) 0.51-0.8, p < 0.01]. After adjusting for significant covariates, Whites had 22% (HR 0.78, 95% CI 0.61-0.99, p 0.04) reduced risk of death, compared to Blacks. Transplant significantly reduced rate of death; however, only 13.3% of Blacks had liver transplant, compared to 40.1% of Whites, p < 0.01. CONCLUSIONS In this diverse sample of patients, survival among Blacks is the shortest after HCC diagnosis. Survival differences reflect a more advanced tumor stage at presentation rather than severity of underlying liver disease precluding treatment. Improving survival in minority populations, in whom HCC incidence is rapidly increasing, requires identification and modification of factors contributing to late-stage presentation.
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Affiliation(s)
- Patricia D Jones
- Division of Hepatology, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA.
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
| | - Carlos Diaz
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Danlu Wang
- Department of Medicine, University of Miami Miller School of Medicine/JFK Medical Center Palm Beach Regional GME Consortium, Miami, FL, 33136, USA
| | - Joselin Gonzalez-Diaz
- Division of Hepatology, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Paul Martin
- Division of Hepatology, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Erin Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
- Division of Computational Medicine and Population Health, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
- Jay Weiss Institute for Health Equity, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
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Waziry R, Grebely J, Amin J, Alavi M, Hajarizadeh B, George J, Matthews GV, Law M, Dore GJ. Survival following hospitalization with hepatocellular carcinoma among people notified with hepatitis B or C virus in Australia (2000-2014). Hepatol Commun 2017; 1:736-747. [PMID: 29404490 PMCID: PMC5678911 DOI: 10.1002/hep4.1073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/27/2017] [Accepted: 06/29/2017] [Indexed: 12/23/2022] Open
Abstract
We assessed trends in HCC survival in patients with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection in New South Wales, Australia. Data on HBV (n = 54,399) and HCV (n = 96,908) notifications (1993‐2012) were linked to a hospitalization database (July 2000‐June 2014), the New South Wales Cancer Registry, and the New South Wales Death Registry. A total of 725 (1.3%) first HBV‐hepatocellular carcinoma (HCC) and 1,309 (1.4%) first HCV‐HCC hospitalizations were included. Death occurred in 60.4% of HBV‐HCC and 69.6% of HCV‐HCC patients. Median survival following first HBV‐HCC hospitalization improved from 0.6 years (95% confidence interval [CI] 0.39‐1.28) in 2000‐2004 to 2.8 years (1.54‐5.54) in 2010‐2014. Median survival following first HCV‐HCC hospitalization was 0.8 years (0.45‐1.33) in 2000‐2004 and 0.9 (0.67‐1.18) in 2010‐2014. One‐year HBV‐HCC survival in 2010‐2014 compared to 2000‐2004 improved for those with (94% versus 81%) and without (42% versus 33%) potentially curative procedures (liver resection, liver transplantation, and radiofrequency ablation). Factors associated with improved survival following HBV‐HCC were later study period (hazard ratio [HR] = 0.74; 95% CI, 0.57‐0.97) and potentially curative procedures (liver resection, liver transplantation, and radiofrequency ablation) (HR = 0.23; 95% CI, 0.17‐0.29), while male gender (HR = 1.37; 95% CI, 1.03‐1.82), human immunodeficiency virus coinfection (HR = 3.06; 95% CI, 1.36‐6.88), and Charlson Comorbidity Index ≥3 (HR = 1.81; 95% CI, 1.35‐2.40) were associated with reduced survival. Factors associated with improved survival following HCC‐HCV were Asia‐Pacific country of birth (HR = 0.68; 95% CI, 0.55‐0.84) and potentially curative procedures (HR = 0.21; 95% CI, 0.17‐0.25), while age (HR = 1.01; 95% CI, 1.01‐1.02), rural place of residence (HR = 1.46; 95% CI, 1.22‐1.74), and human immunodeficiency virus coinfection (HR = 2.71; 95% CI, 1.19‐6.15) were associated with reduced survival. Conclusion: All‐cause survival following HBV‐HCC has improved considerably, suggesting an impact of more effective antiviral therapy and earlier HCC diagnosis; in contrast, all‐cause survival for HCV‐HCC is unchanged. (Hepatology Communications 2017;1:736–747)
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Affiliation(s)
- Reem Waziry
- The Kirby Institute UNSW Sydney Sydney Australia
| | | | - Janaki Amin
- Faculty of Medicine and Health Sciences Macquarie University Sydney Australia
| | - Maryam Alavi
- The Kirby Institute UNSW Sydney Sydney Australia
| | | | - Jacob George
- Storr Liver Unit Westmead Millennium Institute and Westmead Hospital, University of Sydney Sydney Australia
| | | | - Matthew Law
- The Kirby Institute UNSW Sydney Sydney Australia
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10
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Zhang C, Li C, Chen X, Zhou Y, Yin B, Ni R, Zhang Y, Liu J. Overexpression of dishevelled 2 is involved in tumor metastasis and is associated with poor prognosis in hepatocellular carcinoma. Clin Transl Oncol 2017; 19:1507-1517. [PMID: 28589433 DOI: 10.1007/s12094-017-1697-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/29/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Although hepatocellular carcinoma (HCC) is one of the most common malignant tumors, its molecular mechanism is still unknown. Dishevelled 2 (Dvl2) is one of the downstream targets of non-canonical Wnt signaling, which has been demonstrated to be of great importance in the progression of cancers. Nevertheless, the expression mechanisms and physiological significance of Dvl2 in HCC remain unclear. METHODS Western blotting and immunohistochemistry were used to measure Dvl2 protein expression in HCC and adjacent normal tissues of 101 patients. Wound healing and transwell assays were used to determine cell migration and invasion. RESULTS Dvl2 expression was upregulated in HCC tissues compared to the adjacent normal tissues. Moreover, its expression level was significantly correlated with histological grade (P = 0.042), metastasis (P = 0.005) and vein invasion (P = 0.009) in patients with HCC. Wound healing and transwell assays showed that knockdown of Dvl2 reduced cell migration and invasion in HepG2 cells. Finally, we confirmed that Dvl2 could regulate the migration and invasion of HCC cells by interacting with P62 in non-canonical Wnt signaling. CONCLUSIONS Our data showed that Dvl2 was overexpressed in HCC tissues and was also correlated with poor prognosis, suggesting that Dvl2 is a novel therapeutic target for HCC.
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Affiliation(s)
- C Zhang
- Grade 14, Clinical Medicine, Medical College, Nantong University, Nantong, 226001, Jiangsu, People's Republic of China
| | - C Li
- Department of Hepatic Oncology, Affiliated Cancer Hospital of Nantong University, 30# Tong Yang Road, Nantong, 226361, Jiangsu, People's Republic of China
| | - X Chen
- Department of Hepatic Oncology, Affiliated Cancer Hospital of Nantong University, 30# Tong Yang Road, Nantong, 226361, Jiangsu, People's Republic of China
| | - Y Zhou
- Department of Hepatic Oncology, Affiliated Cancer Hospital of Nantong University, 30# Tong Yang Road, Nantong, 226361, Jiangsu, People's Republic of China
| | - B Yin
- Grade 14, Clinical Medicine, Medical College, Nantong University, Nantong, 226001, Jiangsu, People's Republic of China
| | - R Ni
- Department of Gastroenterology, Affiliated Hospital of Nantong University, 20# Xisi Road, Nantong, 226001, Jiangsu, People's Republic of China
| | - Y Zhang
- Department of Hepatic Oncology, Affiliated Cancer Hospital of Nantong University, 30# Tong Yang Road, Nantong, 226361, Jiangsu, People's Republic of China.
| | - J Liu
- Department of Gastroenterology, Affiliated Hospital of Nantong University, 20# Xisi Road, Nantong, 226001, Jiangsu, People's Republic of China.
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11
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Chen JG, Zhu J, Zhang YH, Zhang YX, Yao DF, Chen YS, Lu JH, Ding LL, Chen HZ, Zhu CY, Yang LP, Zhu YR, Qiang FL. Cancer survival in Qidong between 1972 and 2011: A population-based analysis. Mol Clin Oncol 2017; 6:944-954. [PMID: 28588795 PMCID: PMC5451853 DOI: 10.3892/mco.2017.1234] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 03/07/2017] [Indexed: 01/07/2023] Open
Abstract
Population-based cancer survival is an improved index for evaluating the overall efficiency of cancer health services in a given region. The current study analysed the observed survival and relative survival of leading cancer sites from a population-based cancer registry between 1972 and 2011 in Qidong, China. A total of 92,780 incident cases with cancer were registered and followed-up for survival status. The main sites of the cancer types, based on the rank order of incidence, were the liver, stomach, lung, colon and rectum, oesophagus, breast, pancreas, leukaemia, brain and central nervous system (B and CNS), bladder, blood [non-Hodgkin's lymphoma (NHL)] and cervix. For all malignancies combined, the 5-year observed survival was 13.18% and the relative survival was 15.80%. Females had higher observed survival and relative survival (19.32 and 22.71%, respectively) compared with males (9.63 and 11.68%, respectively). The cancer sites with the highest five-year relative survival rates were the female breast, bladder, cervix and colon and rectum; followed by NHL, stomach, B and CNS cancer and leukaemia. The poorest survival rates were cancers of oesophagus, lung, pancreas and liver. Higher survival rates were observed in younger patients compared with older patients. Cancers of the oesophagus, female breast and bladder were associated with higher survival in middle-aged groups. Improved survival rates in the most recent two 5-year calendar periods were identified for stomach, lung, colon and rectum, oesophagus, female breast and bladder cancer, as well as leukaemia and NHL. The observations of the current study provide the opportunity for evaluation of the survival outcomes of frequent cancer sites that reflects the changes and improvement in a rural area in China.
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Affiliation(s)
- Jian-Guo Chen
- Qidong Cancer Registry, Qidong Liver Cancer Institute, Qidong, Jiangsu 226200, P.R. China
- Nantong University Tumour Hospital/Institute, Nantong, Jiangsu 226361, P.R. China
| | - Jian Zhu
- Qidong Cancer Registry, Qidong Liver Cancer Institute, Qidong, Jiangsu 226200, P.R. China
| | - Yong-Hui Zhang
- Qidong Cancer Registry, Qidong Liver Cancer Institute, Qidong, Jiangsu 226200, P.R. China
| | - Yi-Xin Zhang
- Nantong University Tumour Hospital/Institute, Nantong, Jiangsu 226361, P.R. China
| | - Deng-Fu Yao
- Affiliated Hospital of Nantong University, Nantong, Jiangsu 226000, P.R. China
| | - Yong-Sheng Chen
- Qidong Cancer Registry, Qidong Liver Cancer Institute, Qidong, Jiangsu 226200, P.R. China
| | - Jian-Hua Lu
- Qidong Cancer Registry, Qidong Liver Cancer Institute, Qidong, Jiangsu 226200, P.R. China
| | - Lu-Lu Ding
- Qidong Cancer Registry, Qidong Liver Cancer Institute, Qidong, Jiangsu 226200, P.R. China
| | - Hai-Zhen Chen
- Nantong University Tumour Hospital/Institute, Nantong, Jiangsu 226361, P.R. China
| | - Chao-Yong Zhu
- Nantong University Tumour Hospital/Institute, Nantong, Jiangsu 226361, P.R. China
| | - Li-Ping Yang
- Nantong University Tumour Hospital/Institute, Nantong, Jiangsu 226361, P.R. China
| | - Yuan-Rong Zhu
- Qidong Cancer Registry, Qidong Liver Cancer Institute, Qidong, Jiangsu 226200, P.R. China
| | - Fu-Lin Qiang
- Nantong University Tumour Hospital/Institute, Nantong, Jiangsu 226361, P.R. China
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12
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Babaei V, Ghorbani M, Mohseni N, Afraid H, Saghaei Y, Teimourian S. Clinical correlations between chronic hepatitis C infection and decreasing bone mass density after treatment with interferon-alpha. Asian Pac J Trop Biomed 2017. [DOI: 10.1016/j.apjtb.2016.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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13
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Correction: Trends in relative survival in patients with a diagnosis of hepatocellular carcinoma in Ontario: a population-based retrospective cohort study. CMAJ Open 2015; 3:E359. [PMID: 27022599 PMCID: PMC4701649 DOI: 10.9778/cmajo.20150109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
[This corrects the article on p. E208 in vol. 3.].
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14
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Thein HH, Campitelli MA, Yeung LT, Zaheen A, Yoshida EM, Earle CC. Improved Survival in Patients with Viral Hepatitis-Induced Hepatocellular Carcinoma Undergoing Recommended Abdominal Ultrasound Surveillance in Ontario: A Population-Based Retrospective Cohort Study. PLoS One 2015; 10:e0138907. [PMID: 26398404 PMCID: PMC4580446 DOI: 10.1371/journal.pone.0138907] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/06/2015] [Indexed: 02/07/2023] Open
Abstract
The optimal schedule for ultrasonographic surveillance of patients with viral hepatitis for the detection of hepatocellular carcinoma (HCC) remains unclear owing to a lack of reliable studies. We examined the timing of ultrasonography in patients with viral hepatitis-induced HCC and its impact on survival and mortality risk while determining predictors of receiving surveillance before HCC diagnosis. A population-based retrospective cohort analysis of patients with viral hepatitis-induced HCC in Ontario between 2000 and 2010 was performed using data from the Ontario Cancer Registry linked health administrative data. HCC surveillance for 2 years preceding diagnosis was assigned as: i) ≥ 2 abdominal ultrasound screens annually; ii) 1 screen annually; iii) inconsistent screening; and iv) no screening. Survival rates were estimated using the Kaplan-Meier method and parametric models to correct for lead-time bias. Associations between HCC surveillance and the risk of mortality after diagnosis were examined using proportional-hazards regression adjusting for confounding factors. Overall, 1,483 patients with viral hepatitis-induced HCC were identified during the study period; 20.2% received ≥ 1 ultrasound screen annually (routine surveillance) for the 2 years preceding diagnosis. The 5-year survival of those receiving routine surveillance was 31.93% (95% CI: 25.77-38.24%) and 31.84% (95% CI: 25.69-38.14%) when corrected for lead-time bias (HCC sojourn time 70 days and 140 days, respectively). This is contrasted with 20.67% (95% CI: 16.86-24.74%) 5-year survival in those who did not undergo screening. In the fully adjusted model, compared to unscreened patients, routine surveillance was associated with a lower mortality risk and a hazard ratio of 0.76 (95% CI: 0.64-0.91) and 0.81 (95% CI: 0.68-0.97), corrected for the respective lead-time bias. Our findings suggest that routine ultrasonography in patients with viral hepatitis is associated with improved survival and reduced mortality risk in a population-based setting. The data emphasizes the importance of surveillance for timely intervention in HCC-diagnosed patients.
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MESH Headings
- Aged
- Aged, 80 and over
- Carcinoma, Hepatocellular/diagnostic imaging
- Carcinoma, Hepatocellular/mortality
- Carcinoma, Hepatocellular/virology
- Early Detection of Cancer
- Epidemiological Monitoring
- Female
- Hepatitis B, Chronic/complications
- Hepatitis B, Chronic/diagnostic imaging
- Hepatitis B, Chronic/mortality
- Hepatitis C, Chronic/complications
- Hepatitis C, Chronic/diagnostic imaging
- Hepatitis C, Chronic/mortality
- Humans
- Kaplan-Meier Estimate
- Liver Neoplasms/diagnostic imaging
- Liver Neoplasms/mortality
- Liver Neoplasms/virology
- Male
- Middle Aged
- Multivariate Analysis
- Ontario
- Proportional Hazards Models
- Retrospective Studies
- Ultrasonography
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Affiliation(s)
- Hla-Hla Thein
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research/Cancer Care Ontario, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- * E-mail:
| | | | - Latifa T. Yeung
- Rouge Valley Health System, Scarborough, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ahmad Zaheen
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eric M. Yoshida
- University of British Columbia, Division of Gastroenterology, Vancouver, British Columbia, Canada
| | - Craig C. Earle
- Ontario Institute for Cancer Research/Cancer Care Ontario, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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