1
|
Graceffa P, Melatti P, Dioguardi A, Callari C, Cartabellotta F, Granata A. Hematic Peri-gastric Collection Post-LSG: What About Endoscopic Internal Drainage? Obes Surg 2024; 34:2001-2002. [PMID: 38499944 DOI: 10.1007/s11695-024-07166-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Pietro Graceffa
- Interventional Endoscopic Unit, Buccheri La Ferla Hospital, Postal Code: 90123, Palermo, Italy.
| | - Piera Melatti
- Interventional Endoscopic Unit, Buccheri La Ferla Hospital, Postal Code: 90123, Palermo, Italy
| | - Angelo Dioguardi
- Center of Excellence in Bariatric Surgery, Buccheri La Ferla Hospital, Postal Code: 90123, Palermo, Italy
| | - Cosimo Callari
- Center of Excellence in Bariatric Surgery, Buccheri La Ferla Hospital, Postal Code: 90123, Palermo, Italy
| | - Fabio Cartabellotta
- Department of Internal Medicine, Buccheri La Ferla Hospital, Postal Code: 90123, Palermo, Italy
| | - Antonino Granata
- Interventional Endoscopic Unit, Buccheri La Ferla Hospital, Postal Code: 90123, Palermo, Italy
| |
Collapse
|
2
|
Guggino R, Borsellino N, Spada M, Verderame F, Mezzatesta P, Marchesa P, Firenze A, Cartabellotta F, Fazio I, Pergolizzi S, Callari C, Gebbia V. Management of Patients with Gastric or Gastroesophageal Junction Cancer: From Theory to Integrated Clinical Path- ways Implementation in the Real World. Clin Ter 2022; 173:316-323. [PMID: 35857048 DOI: 10.7417/ct.2022.2440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Best care of esophagogastric junction and gastric cancer (EGC) requires a complex, timely interaction between members of a multi-disciplinary team (MDT). An integrated clinical pathway (ICP) is necessary to achieve this goal as well as the implementation of its use in daily practice. The objective of this study was to elaborate on an integrated clinical pathway for the multi-disciplinary management of ECG. Authors also put in act an implementation program to improve adherence to guidelines thought an ICP. METHOD This prospective work carried out by a multi-institutional MDT in Italy identified expert panel extracted relevant recommendations and/or statements from published papers and guidelines obtaining a set of crucial interventions employed the Estimate-Talk-Estimate method. A flow-chart diagram was elaborated to elicit the process at a glance. The primary outcome measure was the elaboration of an ICP with a high consensus rate also reported as a snapshot diagram and its implementation in daily clinical practice. An accredited certification body agency validated results, and an implementation process was started in several hospitals known to treat ECG. RESULTS A methodologist aggregated a multi-disciplinary panel of experts from different institutions. The panel elaborated a flow-chart diagram with crucial intervention highlight and connecting lines, as well as outcome measures. An accredited certification body agency validated the entire process, representing the basis for empowerment and implementation among patients and oncological professionals in various hospitals. CONCLUSION The multi-disciplinary and multi-institutional expert panel successfully elaborated on a validated ICP for all stages ECG. An in-hospital implementation program has been programmed.
Collapse
Affiliation(s)
- R Guggino
- Service of Clinical Nutrition, ASP Palermo, Italy
| | - N Borsellino
- Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo, Italy
- GSTU Foundation for Cancer Research, Palermo, Italy
| | - M Spada
- Medical Oncology Unit, Fondazione Istituto Giglio, Cefalù, Palermo, Italy
| | - F Verderame
- Medical Oncology Unit, Ospedale Cervello Villa Sofia, Palermo, Italy
| | - P Mezzatesta
- Surgical Oncology Unit, La Maddalena Clinic for Cancer, Palermo
| | - P Marchesa
- Surgical Oncology Unit, ARNAS, Palermo, Italy
| | - A Firenze
- Risk Management Unit, Policlinico Paolo Giaccone, University of Palermo, Italy
| | - F Cartabellotta
- Chief Department of Internal Medicine, Ospedale Buccheri La Ferla, Palermo, Italy
| | - I Fazio
- Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo, Italy
- Radiotherapy Unit, Casa di Cura Macchiarella, Palermo, Italy
| | - S Pergolizzi
- Radiotherapy Unit, Policlinico Barresi, Messina, Italy
| | - C Callari
- Surgical Unit, Ospedale Buccheri La Ferla, Palermo, Italy
| | - V Gebbia
- GSTU Foundation for Cancer Research, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties - Promise, University of Palermo, Italy
- Medical Oncology Unit, La Maddalena Clinic for Cancer, Palermo, Italy
| |
Collapse
|
3
|
Calvaruso V, Petta S, Cacciola I, Cabibbo G, Cartabellotta F, Distefano M, Scifo G, Di Rosolini MA, Russello M, Prestileo T, Madonia S, Malizia G, Montineri A, Digiacomo A, Licata A, Benanti F, Bertino G, Enea M, Battaglia S, Squadrito G, Raimondo G, Cammà C, Craxì A, Di Marco V. Liver and cardiovascular mortality after hepatitis C virus eradication by DAA: Data from RESIST-HCV cohort. J Viral Hepat 2021; 28:1190-1199. [PMID: 33896097 PMCID: PMC8359835 DOI: 10.1111/jvh.13523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 01/06/2023]
Abstract
Real-world evidence on the course of Hepatitis C Virus (HCV) chronic liver disease after Sustained Virologic Response (SVR) obtained with direct-acting antiviral drugs (DAAs) are still limited, and the effects on mortality remain unclear. We evaluated the post-treatment survival of 4307 patients in the RESIST-HCV cohort (mean age 66.3 ± 11.6 years, 56.9% males, 24.7% chronic hepatitis, 66.9% Child-Pugh A cirrhosis and 8.4% Child-Pugh B cirrhosis) treated with DAAs between March 2015 and December 2016 and followed for a median of 73 weeks (range 16-152). Proportional cause-specific hazard regression for competing risks was used to evaluate the survival and to assess the predictors of liver and cardiovascular death. Overall, 94.7% of patients achieved SVR while 5.3% were HCV RNA-positive at last follow-up. Sixty-three patients (1.4%) died during the observation period. SVR was associated with a decreased risk of liver mortality (hazard ratio,HR0.09, beta -2.37, p < .001). Also, platelet count (HR 0.99, beta-0.01, p = .007) and albumin value (HR 0.26, beta -1.36 p = .001) were associated with liver mortality by competing risk analysis. SVR was associated with a reduced risk of cardiovascular mortality regardless of presence of cirrhosis (HR 0.07, beta-2.67, p < .001). Presence of diabetes (HR 3.45, beta 1.24, p = .014) and chronic kidney disease class ≥3 (HR 3.60, beta 1.28, p = 0.016) were two factors independently associated with higher risk of cardiovascular mortality. Patients with SVR to a DAA therapy have a better liver and cardiovascular survival, and the effects of HCV eradication are most evident in patients with compensated liver disease.
Collapse
Affiliation(s)
- Vincenza Calvaruso
- Gastroenterology and Hepatology Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, PROMISE, University of Palermo, Palermo, Italy
| | - Salvatore Petta
- Gastroenterology and Hepatology Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, PROMISE, University of Palermo, Palermo, Italy
| | - Irene Cacciola
- UOC Epatologia Clinica e Biomolecolare, Messina, Italy.,AOUP G. Martino, Dipartimento di Medicina Interna e Sperimentale, University of Messina, Messina, Italy
| | - Giuseppe Cabibbo
- Gastroenterology and Hepatology Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, PROMISE, University of Palermo, Palermo, Italy
| | | | - Marco Distefano
- UOC Malattie Infettive, Ospedale Umberto I di Siracusa, ASP Siracusa, Siracusa, Italy
| | - Gaetano Scifo
- UOC Malattie Infettive, Ospedale Umberto I di Siracusa, ASP Siracusa, Siracusa, Italy
| | | | | | - Tullio Prestileo
- UOC Malattie Infettive, ARNAS Civico-Di Cristina-Benefratelli, Palermo, Italy
| | | | | | - Arturo Montineri
- UOC Malattie infettive, AO Universitaria V. Emanuele di Catania, Catania, Italy
| | | | - Anna Licata
- UOC Medicina Interna, AOUP Paolo Giaccone, Palermo, Italy
| | | | - Gaetano Bertino
- UOC Medicina Interna, AO Universitaria V. Emanuele di Catania, Catania, Italy
| | - Marco Enea
- Gastroenterology and Hepatology Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, PROMISE, University of Palermo, Palermo, Italy
| | - Salvatore Battaglia
- Gastroenterology and Hepatology Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, PROMISE, University of Palermo, Palermo, Italy
| | - Giovanni Squadrito
- UOC Epatologia Clinica e Biomolecolare, Messina, Italy.,AOUP G. Martino, Dipartimento di Medicina Interna e Sperimentale, University of Messina, Messina, Italy
| | - Giovanni Raimondo
- UOC Epatologia Clinica e Biomolecolare, Messina, Italy.,AOUP G. Martino, Dipartimento di Medicina Interna e Sperimentale, University of Messina, Messina, Italy
| | - Calogero Cammà
- Gastroenterology and Hepatology Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, PROMISE, University of Palermo, Palermo, Italy
| | - Antonio Craxì
- Gastroenterology and Hepatology Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, PROMISE, University of Palermo, Palermo, Italy
| | - Vito Di Marco
- Gastroenterology and Hepatology Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, PROMISE, University of Palermo, Palermo, Italy
| | | |
Collapse
|
4
|
Cabibbo G, Celsa C, Calvaruso V, Petta S, Cacciola I, Cannavò MR, Madonia S, Rossi M, Magro B, Rini F, Distefano M, Larocca L, Prestileo T, Malizia G, Bertino G, Benanti F, Licata A, Scalisi I, Mazzola G, Di Rosolini MA, Alaimo G, Averna A, Cartabellotta F, Alessi N, Guastella S, Russello M, Scifo G, Squadrito G, Raimondo G, Trevisani F, Craxì A, Di Marco V, Cammà C. Direct-acting antivirals after successful treatment of early hepatocellular carcinoma improve survival in HCV-cirrhotic patients. J Hepatol 2019; 71:265-273. [PMID: 30959157 DOI: 10.1016/j.jhep.2019.03.027] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/02/2019] [Accepted: 03/22/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS The effectiveness of direct-acting antivirals (DAAs) against hepatitis C virus (HCV), following successful treatment of early hepatocellular carcinoma (HCC), has been studied extensively. However, the benefit in terms of overall survival (OS) remains to be conclusively demonstrated. The aim of this study was to assess the impact of DAAs on OS, HCC recurrence, and hepatic decompensation. METHODS We prospectively enrolled 163 consecutive patients with HCV-related cirrhosis and a first diagnosis of early Barcelona Clinic Liver Cancer stage 0/A HCC, who had achieved a complete radiologic response after curative resection or ablation and were subsequently treated with DAAs. DAA-untreated patients from the ITA.LI.CA. cohort (n = 328) served as controls. After propensity score matching, outcomes of 102 DAA-treated (DAA group) and 102 DAA-untreated patients (No DAA group) were compared. RESULTS In the DAA group, 7/102 patients (6.9%) died, HCC recurred in 28/102 patients (27.5%) and hepatic decompensation occurred in 6/102 patients (5.9%), after a mean follow-up of 21.4 months. OS was significantly higher in the DAA group compared to the No DAA group (hazard ratio [HR] 0.39; 95% CI0.17-0.91; p = 0.03). HCC recurrence was not significantly different between the DAA and No DAA groups (HR0.70; 95% CI0.44-1.13; p = 0.15). A significant reduction in the rate of hepatic decompensation was observed in the DAA group compared with the No DAA group (HR0.32; 95% CI0.13-0.84; p = 0.02). In the DAA group, sustained virologic response was a significant predictor of OS (HR 0.02; 95% CI 0.00-0.19; p <0.001), HCC recurrence (HR 0.25; 95% CI 0.11-0.57; p <0.001) and hepatic decompensation (HR 0.12; 95% CI 0.02-0.38; p = 0.02). CONCLUSIONS In patients with HCV-related cirrhosis who had been successfully treated for early HCC, DAAs significantly improved OS compared with No DAA treatment. LAY SUMMARY We aimed to determine whether direct-acting antivirals (DAAs) significantly improve overall survival in patients with hepatitis C virus-related compensated cirrhosis and a first diagnosis of hepatocellular carcinoma (HCC) which has been successfully treated with curative resection or ablation. Using propensity-score matched patients, we found that DAAs improved overall survival and reduced the risk of hepatic decompensation. However, the risk of HCC recurrence was not significantly reduced.
Collapse
Affiliation(s)
- Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Italy
| | - Ciro Celsa
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Italy
| | - Vincenza Calvaruso
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Italy
| | - Salvatore Petta
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Italy
| | - Irene Cacciola
- UOC Epatologia Clinica e Biomolecolare; AOUP G. Martino, Dipartimento di Medicina Interna e Sperimentale, University of Messina, Italy
| | | | | | - Margherita Rossi
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Italy
| | - Bianca Magro
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Italy
| | - Francesca Rini
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Italy
| | | | - Licia Larocca
- UOC Malattie Infettive, AOUP G. Rodolico, Catania, Italy
| | - Tullio Prestileo
- UOC Malattie Infettive, ARNAS Civico-Di Cristina-Benefratelli, Palermo, Italy
| | | | | | | | - Anna Licata
- UOC Medicina Interna, AOUP Paolo Giaccone, Palermo, Italy
| | - Ignazio Scalisi
- UOC Medicina Interna, Ospedale di Mazzara del Vallo, ASP, Trapani, Italy
| | - Giovanni Mazzola
- UOC Malattie Infettive, Azienda Ospedaliera Universitaria Paolo Giaccone, Palermo, Italy
| | | | - Giuseppe Alaimo
- UOC Medicina Interna, Ospedale di Agrigento, ASP Agrigento, Italy
| | - Alfonso Averna
- UOC Malattie Infettive, Ospedale di Caltanissetta, ASP Caltanissetta, Italy
| | | | - Nicola Alessi
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Italy
| | - Salvatore Guastella
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Italy
| | | | - Gaetano Scifo
- UOC Malattie Infettive, Ospedale Umberto I, Siracusa, Italy
| | - Giovanni Squadrito
- UOC Epatologia Clinica e Biomolecolare; AOUP G. Martino, Dipartimento di Medicina Interna e Sperimentale, University of Messina, Italy
| | - Giovanni Raimondo
- UOC Epatologia Clinica e Biomolecolare; AOUP G. Martino, Dipartimento di Medicina Interna e Sperimentale, University of Messina, Italy
| | - Franco Trevisani
- Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - University of Bologna, Italy
| | - Antonio Craxì
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Italy
| | - Vito Di Marco
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Italy
| | - Calogero Cammà
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Italy.
| | | |
Collapse
|
5
|
Viganò M, Andreoni M, Perno CF, Craxì A, Aghemo A, Alberti A, Andreone P, Babudieri S, Bonora S, Brunetto MR, Bruno R, Bruno S, Calvaruso V, Caporaso N, Cartabellotta F, Ceccherini-Silberstein F, Cento V, Ciancio A, Colombatto P, Coppola N, Di Marco V, Di Perri G, Fagiuoli S, Gaeta GB, Gasbarrini A, Lampertico P, Pellicelli A, Prestileo T, Puoti M, Raimondo G, Rizzardini G, Taliani G, Zignego AL. Real life experiences in HCV management in 2018. Expert Rev Anti Infect Ther 2019; 17:117-128. [PMID: 30582384 DOI: 10.1080/14787210.2019.1563755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, with approximately 71 million chronically infected individuals worldwide. Treatment of chronic hepatitis C has considerably improved in the last few years thanks to the introduction of direct-acting antivirals able to achieve sustained virological response in more than 95% of patients. Successful anti-HCV treatment can halt liver disease progression and solve the HCV-related extra-hepatic manifestations, eventually reducing liver-related and overall mortality. Areas covered: With the aim to respond to unmet needs in patient's identification, universal access to antiviral therapy and treatment optimization in specific setting of HCV-infected patients, a group of Italian experts met in Stresa in May 2018. The summary of the considerations arising from this meeting and the final statements are reported in this paper. Expert commentary: All the advances on HCV cure may have a real clinical impact not only in individual patients but also at the social health level if they are applied to all infected patients, independently from the stage of liver disease. Further improvements are needed in order to attain HCV elimination, such as the development of an enhanced screening program working in parallel to the present treatment options.
Collapse
Affiliation(s)
- Mauro Viganò
- a Hepatology Unit, Ospedale San Giuseppe , University of Milan , Milan , Italy
| | - Massimo Andreoni
- b Department Medicine of Systems , University Tor Vergata , Rome , Italy
| | - Carlo Federico Perno
- c Department of Laboratory Medicine, Niguarda Hospital , University of Milan , Milan , Italy
| | - Antonio Craxì
- d Department of Gastroenterology, DiBiMIS , University of Palermo , Palermo , Italy
| | - Alessio Aghemo
- e UO Medicina Interna ed Epatologia , Humanitas University and Research Hospital , Milano , Italy
| | - Alfredo Alberti
- f Department of Molecular Medicine , University of Padua , Padua , Italy
| | - Pietro Andreone
- g Centro per lo Studio e Ricerche delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche , Università di Bologna , Bologna , Italy
| | - Sergio Babudieri
- h Infectious Diseases Department, AOU Sassari , University of Sassari , Sassari , Italy
| | - Stefano Bonora
- i Unit of Infectious Diseases, Department of Medical Sciences , University of Turin , Turin , Italy
| | - Maurizia Rossana Brunetto
- j Dipartimento di Medicina Clinica e Sperimentale Università di Pisa , UO Epatologia Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Raffaele Bruno
- k Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo , University of Pavia , Pavia , Italy
| | - Savino Bruno
- l Department of Internal Medicine , Humanitas University Medicine , Rozzano , Italy
| | - Vincenza Calvaruso
- d Department of Gastroenterology, DiBiMIS , University of Palermo , Palermo , Italy
| | - Nicola Caporaso
- m Department of Clinical Medicine and Surgery, Gastroenterology Unit , University of Naples "Federico II" , Naples , Italy
| | - Fabio Cartabellotta
- n Department of Internal Medicine , Buccheri La Ferla Hospital Fatebenefratelli , Palermo , Italy
| | | | - Valeria Cento
- c Department of Laboratory Medicine, Niguarda Hospital , University of Milan , Milan , Italy
| | - Alessia Ciancio
- p Dipartimento di Scienze Mediche , Università di Torino , Torino , Italy
| | - Piero Colombatto
- j Dipartimento di Medicina Clinica e Sperimentale Università di Pisa , UO Epatologia Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Nicola Coppola
- q Infectious Diseases Unit, AORN Caserta , University of Campania , Caserta , Italy
| | - Vito Di Marco
- d Department of Gastroenterology, DiBiMIS , University of Palermo , Palermo , Italy
| | - Giovanni Di Perri
- i Unit of Infectious Diseases, Department of Medical Sciences , University of Turin , Turin , Italy
| | - Stefano Fagiuoli
- r USC Gastroenterologia Epatologia e Trapiantologia, Dipartimento di Medicina Specialistica e dei Trapianti , ASST Papa Giovanni XXIII , Bergamo , Italy
| | | | - Antonio Gasbarrini
- t Fondazione Policlinico Gemelli IRCCS , Universita' Cattolica del Sacro Cuore , Roma , Italy
| | - Pietro Lampertico
- u Gastroenterology and Hepatology Division, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Università di Milano , Milano , Italy
| | - Adriano Pellicelli
- v UOC Malattie del Fegato Dipartimento Interaziendale Trapianti Azienda Ospedaliera San Camillo Forlanini , Rome , Italy
| | - Tullio Prestileo
- w Infectious Diseases Unit and Centre for Migration and Health ARNAS , Civico-Benfratelli Hospital , Palermo , Italy
| | - Massimo Puoti
- x SC Malattie Infettive, Department of Infectious Diseases , ASST Grande Ospedale Metropolitano Niguarda , Milano , Italy
| | - Giovanni Raimondo
- y Division of Clinical and Molecular Hepatology, Department of Internal Medicine , University Hospital of Messina , Messina , Italy
| | - Giuliano Rizzardini
- z Infectious Diseases Department ASST Fatebenefratelli Sacco, School of Clinical Medicine, Faculty of Health Science , University of the Witwatersrand , Johannesburg , South Africa
| | - Gloria Taliani
- aa Infectious Diseases Unit and School of Tropical Medicine , Sapienza of Rome University , Rome , Italy
| | - Anna Linda Zignego
- ab Department of Experimental and Clinical Medicine and Department of Oncology, Interdepartmental Hepatology Center MASVE , Azienda Ospedaliero-Universitaria Careggi (AOUC) , Florence , Italy
| |
Collapse
|
6
|
Calvaruso V, Cabibbo G, Cacciola I, Petta S, Madonia S, Bellia A, Tinè F, Distefano M, Licata A, Giannitrapani L, Prestileo T, Mazzola G, Di Rosolini MA, Larocca L, Bertino G, Digiacomo A, Benanti F, Guarneri L, Averna A, Iacobello C, Magro A, Scalisi I, Cartabellotta F, Savalli F, Barbara M, Davì A, Russello M, Scifo G, Squadrito G, Cammà C, Raimondo G, Craxì A, Di Marco V. Incidence of Hepatocellular Carcinoma in Patients With HCV-Associated Cirrhosis Treated With Direct-Acting Antiviral Agents. Gastroenterology 2018; 155:411-421.e4. [PMID: 29655836 DOI: 10.1053/j.gastro.2018.04.008] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/13/2018] [Accepted: 04/08/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Studies have produced conflicting results of the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis C virus-associated cirrhosis treated with direct-acting antivirals (DAAs). Data from clinics are needed to accurately assess the occurrence rate of HCC in patients with cirrhosis in the real world. METHODS We collected data from a large prospective study of 2,249 consecutive patients (mean age = 65.4 years, 56.9% male) with hepatitis C virus-associated cirrhosis (90.5% with Child-Pugh class A and 9.5% with Child-Pugh class B) treated with DAAs from March 2015 through July 2016 at 22 academic and community liver centers in Sicily, Italy. HCC occurrence was evaluated by Kaplan-Meier curves. Cox regression analysis was used to identify variables associated with HCC development. RESULTS A sustained virologic response (SVR) was achieved by 2,140 patients (total = 95.2%; 95.9% with Child Pugh class A and 88.3% with Child Pugh class B; P < .001). Seventy-eight patients (3.5%) developed HCC during a mean follow-up of 14 months (range = 6-24 months). At 1 year after exposure to DAAs, HCC developed in 2.1% of patients with Child-Pugh class A with an SVR and 6.6% of patients with no SVR and in 7.8% of patients with Child-Pugh class B with an SVR and 12.4% of patients with no SVR (P < .001 by log-rank test). Albumin level below 3.5 g/dL (hazard ratio = 1.77, 95% confidence interval = 1.12-2.82, P = .015), platelet count below 120 × 109/L (hazard ratio = 3.89, 95% confidence interval = 2.11-7.15, P < .001), and absence of an SVR (hazard ratio = 3.40, 95% confidence interval = 1.89-6.12, P < .001) were independently associated increased risk for HCC. The mean interval from exposure to DAAs to an HCC diagnosis was 9.8 months (range = 2-22 months) and did not differ significantly between patients with (n = 64, 9.2 months) and without (n = 14, 12.0 months) an SVR (P = .11). A larger proportion of patients with an SVR had a single HCC lesion (78% vs 50% without an SVR; P = .009) or an HCC lesion smaller than 3 cm (58% vs 28% without an SVR; P = .07). CONCLUSIONS In an analysis of data from a large prospective study of patients with hepatitis C virus-associated compensated or decompensated cirrhosis, we found that the SVR to DAA treatment decreased the incidence of HCC over a mean follow-up of 14 months.
Collapse
Affiliation(s)
- Vincenza Calvaruso
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy
| | - Giuseppe Cabibbo
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy
| | - Irene Cacciola
- UOC Epatologia Clinica e Biomolecolare and AOUP G Martino, Dipartimento di Medicina Interna e Sperimentale, University of Messina, Messina, Italy
| | - Salvatore Petta
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy
| | | | | | - Fabio Tinè
- UOC Gastroenterologia, AO Villa Sofia-Cervello, Palermo, Italy
| | - Marco Distefano
- UOC Malattie Infettive, Ospedale Vittorio Emanuele di Siracusa, ASP Siracusa, Siracusa, Italy
| | - Anna Licata
- UOC Medicina Interna, AOUP Paolo Giaccone, Palermo, Italy
| | | | - Tullio Prestileo
- UOC Malattie Infettive, ARNAS Civico-Di Cristina-Benefratelli, Palermo, Italy
| | - Giovanni Mazzola
- UOC Malattie Infettive, Azienda Ospedaliera Universitaria Paolo Giaccone, Palermo, Italy
| | | | - Licia Larocca
- UOC Malattie infettive, AOUP G Rodolico, Catania, Italy
| | | | | | | | - Luigi Guarneri
- UOC Malattie Infettive, Ospedale di Enna, ASP Enna, Enna, Italy
| | - Alfonso Averna
- UOC Malattie Infettive, Ospedale di Caltanissetta, ASP Caltanissetta, Caltanissetta, Italy
| | | | - Antonio Magro
- UOC Medicina Interna, Ospedale di Agrigento, ASP Agrigento, Agrigento, Italy
| | - Ignazio Scalisi
- UOC Medicina Interna, Ospedale di Mazzara del Vallo, ASP, Trapani, Italy
| | | | - Francesca Savalli
- UOC Malattie Infettive, Ospedale di Trapani, ASP Trapani, Trapani, Italy
| | - Marco Barbara
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy
| | - Antonio Davì
- UOC Malattie Infettive, Ospedale di Modica, ASP Ragusa, Ragusa, Italy
| | | | - Gaetano Scifo
- UOC Malattie Infettive, Ospedale Vittorio Emanuele di Siracusa, ASP Siracusa, Siracusa, Italy
| | - Giovanni Squadrito
- UOC Epatologia Clinica e Biomolecolare and AOUP G Martino, Dipartimento di Medicina Interna e Sperimentale, University of Messina, Messina, Italy
| | - Calogero Cammà
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy
| | - Giovanni Raimondo
- UOC Epatologia Clinica e Biomolecolare and AOUP G Martino, Dipartimento di Medicina Interna e Sperimentale, University of Messina, Messina, Italy
| | - Antonio Craxì
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy.
| | | |
Collapse
|
7
|
Cabibbo G, Petta S, Calvaruso V, Cacciola I, Cannavò MR, Madonia S, Distefano M, Larocca L, Prestileo T, Tinè F, Bertino G, Giannitrapani L, Benanti F, Licata A, Scalisi I, Mazzola G, Cartabellotta F, Alessi N, Barbàra M, Russello M, Scifo G, Squadrito G, Raimondo G, Craxì A, Di Marco V, Cammà C. Is early recurrence of hepatocellular carcinoma in HCV cirrhotic patients affected by treatment with direct-acting antivirals? A prospective multicentre study. Aliment Pharmacol Ther 2017; 46:688-695. [PMID: 28791711 DOI: 10.1111/apt.14256] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 05/16/2017] [Accepted: 07/17/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on HCV-related hepatocellular carcinoma (HCC) early recurrence in patients whose HCC was previously cured, and subsequently treated by direct-acting antivirals (DAAs), are equivocal. AIM To assess the risk of HCC early recurrence after DAAs exposure in a large prospective cohort of HCV-cirrhotic patients with previous successfully treated HCC, also looking for risk factors for cancer early recurrence. METHODS We enrolled 143 consecutive patients with complete response after curative treatment of HCC, subsequently treated with DAAs and monitored by the web-based RESIST-HCV database. Clinical, biological, and virological data were collected. The primary endpoint was the probability of HCC early recurrence from DAA starting by Kaplan-Meier method. RESULTS Eighty-six per cent of patients were in Child-Pugh class A and 76% of patients were BCLC A. Almost all patients (96%) achieved sustained virological response. Twenty-four HCC recurrences were observed, with nodular or infiltrative pattern in 83% and 17% of patients, respectively. The 6-, 12- and 18-month HCC recurrence rates were 12%, 26.6% and 29.1%, respectively. Main tumour size and history of prior HCC recurrence were independent risk factors for HCC recurrence by Cox multivariate model. CONCLUSIONS Probability of HCC early recurrence in patients who had HCC previously cured remains high, despite HCV eradication by DAAs. Risk was comparable but not higher to that reported in literature in DAA-untreated patients. Previous HCC recurrence and tumour size can be used to stratify the risk of HCC early recurrence. Further studies are needed to assess impact of DAAs on late recurrence and mortality.
Collapse
|
8
|
Cartabellotta F, Di Marco V. The HCV Sicily Network: a web-based model for the management of HCV chronic liver diseases. Eur Rev Med Pharmacol Sci 2016; 20:11-16. [PMID: 28083864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Epidemiological studies report that in Sicily reside about 30,000 citizens with a diagnosis of chronic hepatitis due to HCV. The availability of direct antiviral action (DAA) is a real therapeutic breakthrough, but the high cost of the therapeutic regimes limits their use and forced the National Health System to establish clinical priority for the treatment. MATERIALS AND METHODS The HCV Sicily Network is a web-based model of best medical practice, which was designed to improve the management and the treatment of HCV chronic hepatitis and cirrhosis. The network includes 41 centers and 84 gastroenterologists or infectivologists connected by a web platform that recorder the diagnosis and the clinic priority for the therapy. RESULTS From March 2015 to September 2016, 9,965 patients (57% male, mean age 61 years, 34% with age over 70 years) have been recorded in the web platform, 3,319 patients completed the treatment, and 1,754 completed the 12 weeks of follow-up. The Sustained Virological Response (SVR) was achieved in 1,541 patients (87.8%), while 136 patients (7.7%) 77 patients (4.5%) experienced a virological relapse during the 12 weeks of follow-up. CONCLUSIONS The HCV Sicily Network is an excellent system for the Regional Department of Health that can have a real estimation of patients that received an efficacy, but high-cost therapy.
Collapse
Affiliation(s)
- F Cartabellotta
- Unit of Internal Medicine, Buccheri La Ferla Hospital, Palermo, Italy.
| | | |
Collapse
|
9
|
Carroccio A, Iacono G, Cottone M, Di Prima L, Cartabellotta F, Cavataio F, Scalici C, Montalto G, Di Fede G, Rini G, Notarbartolo A, Averna MR. Diagnostic accuracy of fecal calprotectin assay in distinguishing organic causes of chronic diarrhea from irritable bowel syndrome: a prospective study in adults and children. Clin Chem 2003; 49:861-7. [PMID: 12765980 DOI: 10.1373/49.6.861] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fecal calprotectin (FC) has been proposed as a marker of inflammatory bowel disease (IBD), but few studies have evaluated its usefulness in patients with chronic diarrhea of various causes. We evaluated the diagnostic accuracy of a FC assay in identifying "organic" causes of chronic diarrhea in consecutive adults and children. METHODS We consecutively enrolled 70 adult patients (30 males, 40 females; median age, 35 years) and 50 children (20 males, 30 females; median age, 3.5 years) with chronic diarrhea of unknown origin. All patients underwent a complete work-up to identify the causes of chronic diarrhea. FC was measured by ELISA. RESULTS In adult patients, FC showed 64% sensitivity and 80% specificity with 70% positive and 74% negative predictive values for organic causes. False-positive results (8 of 40 cases) were associated with the use of aspirin (3 cases) or nonsteroidal antiinflammatory drugs (1 case) and with the presence of concomitant liver cirrhosis (3 cases). False-negative results mainly included patients suffering from celiac disease (5 cases). Patients with IBD (9 cases) were identified with 100% sensitivity and 95% specificity. In pediatric patients, sensitivity was 70%, specificity was 93%, and positive and negative predictive values were 96% and 56%. False-negative results (11 of 35 cases) were associated mainly with celiac disease (6 cases) or intestinal giardiasis (2 cases). CONCLUSIONS FC assay is an accurate marker of IBD in both children and adult patients. In adults, false negatives occur (e.g., in celiac disease) and false-positive results are seen in cirrhosis or users of nonsteroidal antiinflammatory drugs. Diagnostic accuracy is higher in children.
Collapse
|
10
|
Tripi S, Di Gaetano G, Soresi M, Cartabellotta F, Vassallo R, Carroccio A, Anastasi G, Montalto G. Interferon-?? Alone versus Interferon-?? plus Ribavirin in Patients with Chronic Hepatitis C Not Responding to Previous Interferon-?? Treatment. BioDrugs 2000; 13:299-304. [DOI: 10.2165/00063030-200013040-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
|