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Mgaieth S, Kemp W, Gow P, Fink M, Lubel J, Nicoll A, Gazzola A, Hong T, Ryan M, Knight V, Dev AT, Sood S, Bell S, Paul E, Roberts SK. Impact of viral hepatitis aetiology on survival outcomes in hepatocellular carcinoma: A large multicentre cohort study. J Viral Hepat 2017; 24:982-989. [PMID: 28414893 DOI: 10.1111/jvh.12717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 10/15/2016] [Accepted: 02/27/2017] [Indexed: 12/15/2022]
Abstract
While HBV and HCV are risk factors for HCC, uncertainty exists as to whether these viral infections have prognostic significance in HCC. Thus, we compared the overall survival of patients with HBV, HCV and nonviral HCC, and evaluated whether the presence of HBV and HCV predicts patient outcomes. We conducted a multicentre study of HCC cases diagnosed at six Melbourne tertiary hospitals between Jan 2000-Dec 2014. Patient demographics, liver disease and tumour characteristics and patient outcomes were obtained from hospital databases, computer records and the Victorian Death Registry. Survival outcomes were compared between HBV, HCV and nonviral hepatitis cases and predictors of survival determined using Cox proportional hazards regression. There were 1436 new HCC cases identified including 776 due to viral hepatitis (HBV 235, HCV 511, HBV-HCV 30) and 660 from nonviral causes. The median survival of HBV, HCV and nonviral HCC patients was 59.1, 28.4 and 20.9 months, respectively (P<.0001). On multivariate analysis, independent risk factors for survival included HCC aetiology, gender, BCLC stage, serum AFP, total number and size of lesions, and serum creatinine and albumin. After adjusting for these and method of detection, HBV remained an independent predictor of improved overall survival when compared to both nonviral (HR 0.60%, 95% CI 0.35-0.98; P=.03) and HCV-related HCC (HR 0.51%, 95% CI 0.30-0.85; P=.01). In this large multicentre study, HBV is independently associated with improved overall survival compared with HCV and nonviral-related HCC. Further studies are needed to determine the underlying factor(s) responsible.
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Affiliation(s)
- S Mgaieth
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
| | - W Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
| | - P Gow
- Department of Gastroenterology, Austin Hospital, Heidelberg, Vic., Australia
| | - M Fink
- Department of Surgery, Austin Hospital, Heidelberg, Vic., Australia
| | - J Lubel
- Department of Gastroenterology, Box Hill Hospital, Box Hill, Vic., Australia
| | - A Nicoll
- Department of Gastroenterology, Box Hill Hospital, Box Hill, Vic., Australia.,Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - A Gazzola
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
| | - T Hong
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Vic., Australia
| | - M Ryan
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Vic., Australia
| | - V Knight
- Department of Gastroenterology, Monash Medical Centre, Clayton, Vic., Australia
| | - A T Dev
- Department of Gastroenterology, Monash Medical Centre, Clayton, Vic., Australia
| | - S Sood
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - S Bell
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Vic., Australia
| | - E Paul
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - S K Roberts
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
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Lubel J, Chivers S, Taylor D, Capuano B. Testing of direct acting antiviral agents purchased overseas: a necessary precaution to protect patients? Intern Med J 2017; 46:1111-3. [PMID: 27633473 DOI: 10.1111/imj.13182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 03/06/2016] [Accepted: 04/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- J Lubel
- Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - S Chivers
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - D Taylor
- Department of Research and Ethics, Eastern Health, Melbourne, Victoria, Australia
| | - B Capuano
- Department of Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Melbourne, Victoria, Australia
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Philpott H, Lubel J, Nandurkar S. Letter: colestyramine for chronic unexplained diarrhoea - promising but much to learn? Aliment Pharmacol Ther 2015; 42:388. [PMID: 26147113 DOI: 10.1111/apt.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- H Philpott
- Department of Gastroenterology, Eastern Health, Melbourne, Vic., Australia.
| | - J Lubel
- Department of Gastroenterology, Eastern Health, Melbourne, Vic., Australia
| | - S Nandurkar
- Department of Gastroenterology, Eastern Health, Melbourne, Vic., Australia
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Abstract
Drug-induced gastrointestinal disorders can mimic conditions, such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) and, hence, recognition can prevent unnecessary investigations and treatment. While the knowledge and awareness relating to the adverse gastrointestinal effects of some medications, such as non-steroidal anti-inflammatory drugs are well established, other commonly prescribed drugs, such as antipsychotics, antidepressants and metformin are less well understood and warrant further study. This review attempts to integrate recent information regarding adverse drug reactions and place this in a useful clinical context.
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Affiliation(s)
- H L Philpott
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia Box Hill Hospital, Melbourne, Australia The Alfred Hospital, Melbourne, Australia
| | - S Nandurkar
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia Box Hill Hospital, Melbourne, Australia
| | - J Lubel
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia Box Hill Hospital, Melbourne, Australia
| | - P R Gibson
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia Box Hill Hospital, Melbourne, Australia The Alfred Hospital, Melbourne, Australia
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Abstract
Drug-induced gastrointestinal disorders can mimic conditions, such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) and, hence, recognition can prevent unnecessary investigations and treatment. While the knowledge and awareness relating to the adverse gastrointestinal effects of some medications, such as non-steroidal anti-inflammatory drugs are well established, other commonly prescribed drugs, such as antipsychotics, antidepressants and metformin are less well understood and warrant further study. This review attempts to integrate recent information regarding adverse drug reactions and place this in a useful clinical context.
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Affiliation(s)
- H L Philpott
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia,Box Hill Hospital, Melbourne, Australia,The Alfred Hospital, Melbourne, Australia
| | - S Nandurkar
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia,Box Hill Hospital, Melbourne, Australia
| | - J Lubel
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia,Box Hill Hospital, Melbourne, Australia
| | - P R Gibson
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia,Box Hill Hospital, Melbourne, Australia,The Alfred Hospital, Melbourne, Australia
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