Increased recurrence rates of hepatocellular carcinoma after DAA therapy in a hepatitis C-infected Egyptian cohort: A comparative analysis

In Egypt, hepatocellular carcinoma (HCC) is the most common form of cancer and direct-acting antivirals (DAA) are administered on a large scale to patients with chronic HCV infection to reduce the risk. In this unique setting, we aimed to determine the association of DAA exposure with early-phase HCC recurrence in patients with a history of HCV-related liver cancer. This was a prospective cohort study of an HCV-infected population from one Egyptian specialized HCC management centre starting from the time of successful HCC intervention. The incidence rates of HCC recurrence between DAA-exposed and nonexposed patients were compared, starting from date of HCC complete radiological response and censoring after 2 years. DAA exposure was treated as time varying. Two Poisson regressions models were used to control for potential differences in the exposed and nonexposed group; multivariable adjustment and balancing using inverse probability of treatment weighting (IPTW). We included 116 patients: 53 treated with DAAs and 63 not treated with DAAs. There was 37.7% and 25.4% recurrence in each group after a median of 16.0 and 23.0 months of follow-up, respectively. Poisson regression using IPTW demonstrated an association between DAAs and HCC recurrence with an incidence rate ratio of 3.83 (95% CI: 2.02-7.25), which was similar in the multivariable-adjusted model and various sensitivity analyses. These results add important evidence towards the possible role of DAAs in HCC recurrence and stress the need for further mechanistic studies and clinical trials to accurately confirm this role and to identify patient characteristics that may be associated with this event.

Pilot study investigating the feasibility of an ulcer-specific quality of life questionnaire

Objective: This study explores the feasibility and reliability of a modified ulcer-specific quality of life (QOL) questionnaire on patients suffering from venous leg ulcers.

Methods: A cross-sectional survey was conducted on a cohort of patients suffering from venous leg ulcers who had been registered at Rochdale Infirmary to participate in a clinical trial. A self-administered six-page questionnaire – Freiburger Lebensqualitäts Questionnaire Assessment (FLQA) – on the QOL along with a checklist was used to collect data from March 2002 to June 2003. The feasibility and reliability of the venous leg ulcer specific questionnaire, the patient-reported QOL and their perspective on compression therapy were chosen as the main outcomes of the study.

Results: A response rate of 94% was obtained, of which 56% were women and 44% were men with an average age of 63 years. Approximately 72% of respondents reported that the questionnaire was suitable to reflect their perspectives on QOL and compression therapy. The questionnaire took an average of 20 minutes to complete. The average QOL score was 45.27 in all the eight domains, where 0 reflected good QOL and 100 reflected poor QOL, indicating that the respondents' QOL had been adversely affected due to venous leg ulcers. Men had an average score of 52.0 in all the eight domains and women scored 39.0 in a 0–100 scale. Hence, comparatively, men had poorer QOL than women. Reliability was assessed using measures of internal consistency and test–retest analysis. Cronbach's alpha, α = 0.934 indicated that the survey items were highly inter-correlated. Test–retest analysis indicated that there was moderate-to-strong correlation in seven out of eight domains, which meant that the reproducibility of the FLQA questionnaire was consistent.

Conclusions: The pilot survey conducted on a representative sample of patients indicated that the questionnaire is suitable and has the potential to reflect the perspective on compression therapy and overall QOL of patients suffering from venous leg ulcers. The survey tool demonstrated the clinical and research utility as a QOL outcome measure for clinical trials evaluating wound care products on patients suffering from venous leg ulcers.