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Hsieh MC, Ratnapradipa KL, Rozek L, Wen S, Chiu YW, Peters ES. Temporal trends and patterns for early- and late-onset adult liver cancer incidence vary by race/ethnicity, subsite, and histologic type in the United States from 2000 to 2019. Cancer Causes Control 2025; 36:551-560. [PMID: 39786651 PMCID: PMC11982089 DOI: 10.1007/s10552-024-01955-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 12/20/2024] [Indexed: 01/12/2025]
Abstract
PURPOSE To examine incidence trends and patterns for early- and late-onset liver cancer. METHODS Liver and intrahepatic bile duct (IBD) cancers diagnosed between 2000 and 2019 were acquired from 22 SEER registries. Variables included early-onset (20-49) vs. late-onset (50+), anatomic subsite, histologic type (hepatocellular carcinoma [HCC] and IBD cholangiocarcinoma [ICC]), sex, and race/ethnicity. Age-standardized incidence rates were calculated using SEER*Stat. Jointpoint regression analysis was employed to estimate the annual percent change (APC) and the average APC (AAPC) with pairwise comparisons for trend by sex and by race/ethnicity stratified by age and subsite. RESULTS Liver cancer incidence decreased among early-onset (AAPC [95% CI] - 2.39 [- 2.74, - 2.07]) but increased among late-onset patients (2.85 [2.71, 3.01]), primarily driven by HCC (3.60 [3.50, 3.71]). IBD incidence increased for both ages with ICC incidence annually increasing 7.92% (6.84, 9.26) for early-onset and 6.32% (5.46, 8.86) for late-onset patients. Early-onset liver cancer displayed comparable trends across racial/ethnic groups; however, late-onset liver cancer showed more variation, particularly among American Indian/Alaska Native/Asian Pacific Islander (AI/AN/API) populations, which experienced a significant decrease in incidence, thereby narrowing the gap with other racial/ethnic groups. For IBD, an identical pattern of early-onset IBD among non-Hispanic Blacks (NHBs) compared to Hispanics was showed with coincidence test p = 0.1522, and a parallel pattern was observed among late-onset patients for both sexes (p = 0.5087). CONCLUSION Late-onset HCC continues to rise, except for NHB and AI/AN/API, where incidence rates have started to decrease over the past 4-5 years. Early and late-onset ICC incidence continues to increase across all racial/ethnic groups.
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Affiliation(s)
- Mei-Chin Hsieh
- Epidemiology and Population Health Program, School of Public Health, Louisiana State University Health Sciences Center, 2020 Gravier St., 3Rd Floor, , New Orleans, LA, 70112, USA.
- Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA.
| | - Kendra L Ratnapradipa
- Epidemiology Department, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Laura Rozek
- Oncology Academic Department, Georgetown University Medical Center, Washington, DC, 20057, USA
- Cancer Prevention and Control Program for Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, 20057, USA
| | - Shengdi Wen
- Epidemiology and Population Health Program, School of Public Health, Louisiana State University Health Sciences Center, 2020 Gravier St., 3Rd Floor, , New Orleans, LA, 70112, USA
| | - Yu-Wen Chiu
- Epidemiology and Population Health Program, School of Public Health, Louisiana State University Health Sciences Center, 2020 Gravier St., 3Rd Floor, , New Orleans, LA, 70112, USA
| | - Edward S Peters
- Epidemiology Department, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198, USA
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Altaf A, Kiran A, Sarwar M, Maqbool T, Sharif S, Iqbal H, Farooq S, Ali Q, Han S, Ahmad A. Therapeutic potential of Bacopa monnieri extracts against hepatocellular carcinoma through in-vitro and computational studies. PLoS One 2025; 20:e0321445. [PMID: 40294146 PMCID: PMC12036942 DOI: 10.1371/journal.pone.0321445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Accepted: 03/06/2025] [Indexed: 04/30/2025] Open
Abstract
BACKGROUND Among various cancers, primary liver cancer is the seventh most diagnosed malignancy and is the second most prevalent contributor to cancer-causing deaths. During conventional treatment, the recurrence of disease, low drug inefficacy, and severe side effects are the main limitations. Recently, natural anticancer medicines from the Middle East, Korea, China, Europe, North America, and India have attracted a lot of interest due to their low side effects and better remedial properties. The current study investigated the antioxidative and anticancer effects of ethanolic (BME) and n-hexane (BMH) extracts of B. monnieri (L.) Wettst. METHODS In the current study, phytochemical profiling was done using gas chromatography-mass spectrometry (GC-MS) analysis. The antioxidant potential was measured using DPPH, nitric oxide, superoxide anion, and hydrogen peroxide assays, while the cell viability and apoptotic effect were measured by MTT, crystal violet, and annexin V/PI protocols, respectively. RESULTS Higher concentrations of total phenolic contents (274.92±3.52 mgGAE/g), total flavonoid contents (141.99±4.14 mgQE/g) and tannins (55.49±4.63 mgTAE/g) were observed in BME extract with strong antioxidant potential than BMH extract. Also, BME extract showed higher cytotoxicity with less IC50 value (24.70 μg/mL) and a lower percentage of cell viability, while the same extract exhibited 58.65% apoptosis against HepG2 cells in comparison to cisplatin and BMH extract. Furthermore, Spiro[(tricyclo[6.2.2.0(2,7)]dodeca-5,9-diene)-4,1'-cyclobutane]-11,2'-dione from BME extract showed the lead docking score of -8.8, -8.1 and -7.8 kcal/mol against TGF-βR1, TNF-α, and iNOS, respectively. CONCLUSION In conclusion, the ethanolic extract of B. monnieri has a significant potential for becoming a potent anticancer drug that effectively treats liver damage, including HCC.
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Affiliation(s)
- Awais Altaf
- Institute of Molecular Biology and Biotechnology, The University of Lahore, Lahore, Pakistan
- Faculty of Health Sciences, Equator University of Science and Technology, Masaka, Uganda,
| | - Asia Kiran
- Institute of Molecular Biology and Biotechnology, The University of Lahore, Lahore, Pakistan
| | - Muhammad Sarwar
- Institute of Molecular Biology and Biotechnology, The University of Lahore, Lahore, Pakistan
| | - Tahir Maqbool
- Institute of Molecular Biology and Biotechnology, The University of Lahore, Lahore, Pakistan
| | - Sumaira Sharif
- Institute of Molecular Biology and Biotechnology, The University of Lahore, Lahore, Pakistan
| | - Hana’a Iqbal
- National Institute of Virology, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Saba Farooq
- National Institute of Virology, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Qurban Ali
- Department of Plant Breeding and Genetics, University of the Punjab, Lahore, Pakistan
| | - Shiming Han
- School of Biological Sciences and Technology, Liupanshui Normal University, Liupanshui, China
| | - Ajaz Ahmad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Wong LL, Hromalik LR, Hernandez BY, Acoba JD, Kwee SA. The Changing Pathogenesis of Liver Cancer in Hawaii over Three Decades. Cancer Epidemiol Biomarkers Prev 2025; 34:527-533. [PMID: 39869025 PMCID: PMC11968224 DOI: 10.1158/1055-9965.epi-24-1399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 11/13/2024] [Accepted: 01/21/2025] [Indexed: 01/28/2025] Open
Abstract
BACKGROUND Worldwide trends support the increasing contribution of hepatic steatosis to the incidence of hepatocellular carcinoma (HCC). This study investigates if similar changes are seen in Hawaii, where the incidence of HCC is higher than in most of the United States. METHODS This is a retrospective study of 1,651 patients diagnosed with HCC (1991-2023) that includes 60% to 70% of HCC cases in Hawaii. We evaluated changes in patient demographics, risk factors, and disease etiology over the past three decades. RESULTS From 1991 to 2023, there were significant increases in the proportion of HCC cases attributable to metabolic dysfunction-associated steatotic liver disease (MASLD), coinciding with an increase in the prevalence of metabolic risk factors including obesity, diabetes, hyperlipidemia, and hypertension. Cases with a history of smoking also increased through 2020. Conversely, HCC cases presenting with cirrhosis alone decreased. Hepatitis C virus (HCV)-associated cases increased through 2015 and then tapered, whereas Hepatitis B virus (HBV)-associated cases decreased through 2020. There was no significant change in the proportion of alcohol-associated cases. CONCLUSIONS Although HBV continues to be a major contributor to HCC in Hawaii, HCV-related HCC cases have tapered, whereas metabolic risk factors for HCC and cases attributable to MASLD have increased over time, paralleling overall trends observed in the United States. Efforts are needed to manage these metabolic factors to address the burden of HCC. IMPACT Although Hawaii continues to have a large burden of viral hepatitis-related HCC, metabolic factors and MASLD have affected the pathogenesis of liver cancer in Hawaii over the past three decades.
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Affiliation(s)
- Linda L. Wong
- Department of Surgery, University of Hawaii, John A. Burns School of Medicine
- University of Hawaii, Cancer Center
| | - Larry R. Hromalik
- Department of Surgery, University of Hawaii, John A. Burns School of Medicine
| | | | - Jared D. Acoba
- University of Hawaii, Cancer Center
- Department of Medicine, University of Hawaii, John A Burns School of Medicine
| | - Sandi A. Kwee
- University of Hawaii, Cancer Center
- PET Imaging, Queens Medical Center
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Cannet F, Sequera C, Veloso PM, El Kaoutari A, Methia M, Richelme S, Kaya M, Cherni A, Dupont M, Borg JP, Morel C, Boursier Y, Maina F. Tracing specificity of immune landscape remodeling associated with distinct anticancer treatments. iScience 2025; 28:112071. [PMID: 40124507 PMCID: PMC11930375 DOI: 10.1016/j.isci.2025.112071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 07/18/2024] [Accepted: 02/10/2025] [Indexed: 03/25/2025] Open
Abstract
Immune cells within the tumor microenvironment impact cancer progression, resistance, response to treatments. Despite remarkable outcomes for some cancer patients, immunotherapies remain unsatisfactory for others. Here, we designed an experimental setting using the Alb-R26 Met "inside-out" mouse model, faithfully recapitulating molecular features of liver cancer patients, to explore the effects of distinct anticancer targeted therapies on the tumor immune landscape. Using two treatments in clinical trials for different cancer types, Decitabine and MEK+BCL-XL blockage, we show their capability to trigger tumor regression in Alb-R26 Met mice and to superimpose distinct profiles of immune cell types and immune-checkpoints, impacting immunotherapy response. A machine learning approach processing tumor imaging and immune profile data identified a putative signature predicting tumor treatment response in mice and patients. Outcomes exemplify how the tumor immune microenvironment is differentially reshaped by distinct anticancer agents and highlight the importance of measuring its modulation during treatment to optimize oncotherapy and immunotherapy combinations.
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Affiliation(s)
- Floriane Cannet
- Aix Marseille Univ, CNRS/IN2P3, CPPM, 13009 Marseille, France
- Aix Marseille Univ, CNRS, Inserm, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille (CRCM), 13009 Marseille, France
- Aix Marseille Univ, CNRS, Developmental Biology Institute of Marseille (IBDM), Turing Center for Living Systems, 13009 Marseille, France
| | - Célia Sequera
- Aix Marseille Univ, CNRS, Inserm, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille (CRCM), 13009 Marseille, France
- Aix Marseille Univ, CNRS, Developmental Biology Institute of Marseille (IBDM), Turing Center for Living Systems, 13009 Marseille, France
| | - Paula Michea Veloso
- Aix Marseille Univ, CNRS, Inserm, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille (CRCM), 13009 Marseille, France
| | - Abdessamad El Kaoutari
- Aix Marseille Univ, CNRS, Inserm, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille (CRCM), 13009 Marseille, France
| | - Melissa Methia
- Aix Marseille Univ, CNRS, Inserm, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille (CRCM), 13009 Marseille, France
| | - Sylvie Richelme
- Aix Marseille Univ, CNRS, Developmental Biology Institute of Marseille (IBDM), Turing Center for Living Systems, 13009 Marseille, France
| | - Muge Kaya
- Aix Marseille Univ, CNRS, Inserm, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille (CRCM), 13009 Marseille, France
| | - Afef Cherni
- Aix Marseille Univ, CNRS/IN2P3, CPPM, 13009 Marseille, France
| | - Mathieu Dupont
- Aix Marseille Univ, CNRS/IN2P3, CPPM, 13009 Marseille, France
| | - Jean-Paul Borg
- Aix Marseille Univ, CNRS, Inserm, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille (CRCM), 13009 Marseille, France
- Institut Universitaire de France, Paris, France
| | - Christian Morel
- Aix Marseille Univ, CNRS/IN2P3, CPPM, 13009 Marseille, France
| | | | - Flavio Maina
- Aix Marseille Univ, CNRS, Inserm, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille (CRCM), 13009 Marseille, France
- Aix Marseille Univ, CNRS, Developmental Biology Institute of Marseille (IBDM), Turing Center for Living Systems, 13009 Marseille, France
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Pinheiro PS, Zhang J, Setiawan VW, Cranford HM, Wong RJ, Liu L. Liver Cancer Etiology in Asian Subgroups and American Indian, Black, Latino, and White Populations. JAMA Netw Open 2025; 8:e252208. [PMID: 40146106 PMCID: PMC11950898 DOI: 10.1001/jamanetworkopen.2025.2208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Accepted: 01/27/2025] [Indexed: 03/28/2025] Open
Abstract
Importance Hepatocellular carcinoma (HCC) is a major public health issue in the US, linked to hepatitis C virus (HCV), hepatitis B virus (HBV), alcohol-related liver disease (ALD), and metabolic dysfunction-associated steatotic liver disease (MASLD). Monitoring HCC high-risk populations and trends across increasingly diverse groups is crucial for targeted prevention and intervention strategies. Objective To evaluate incidence patterns and temporal trends in HCC incidence by etiology across sex, race and ethnicity, and detailed Asian subgroups in California, highlighting emerging metabolic risks and declining viral influences, to guide targeted prevention strategies. Design, Setting, and Participants This population-based, retrospective cohort study used data from the California Cancer Registry linked to statewide hospital diagnostic records for etiology classification. All HCC cases diagnosed between 2010 and 2018 in California were included. Data were analyzed from March 28 to November 3, 2024. Exposure Etiology of HCC, categorized as HCV, HBV, ALD, MASLD, or other causes. Main Outcomes and Measures Age-adjusted incidence rates (AAIRs) of HCC, stratified by sex, race and ethnicity, and etiology. Trends were analyzed using Joinpoint regression. Results From 2010 to 2018, 31 671 patients (23 558 [74.4%] male; median [IQR] age, 64 [15] years) were newly diagnosed with HCC in California, with 14 664 (46.3%) due to HCV, 7457 (23.5%) due to MASLD, 3941 (12.4%) due to ALD, and 3271 (10.3%) due to HBV. By 2017 to 2018, MASLD accounted for 27.4% of HCCs, surpassing HCV among women. HCV-related HCC rates per 100 000 population were highest among American Indian (men: 12.8; women: 3.6), Black (men: 10.8; women: 3.0), and US-born Latino (men: 15.7; women: 3.5) populations and specific Asian groups (particularly Cambodian [men: 15.5; women: 6.3] and Vietnamese [men: 13.7; women: 4.8]). Rates of MASLD-related HCC per 100 000 population were highest among American Indian (men: 4.2; women: 2.7), Asian and Pacific Islander (men: 3.9; women: 1.8), and Latino (men: 4.4; women: 2.9) populations. Rates of HBV-related HCC per 100 000 population remained high throughout the study period in some Asian and Pacific Islander subgroups (Cambodian [men: 18.3; women: 3.4], Chinese [men: 10.1; women: 2.6], Korean [men: 11.5; women: 2.8], Laotian [men: 25.0; women: 5.4], and Vietnamese [men: 16.6; women: 3.5]), but not all subgroups, and HBV-related HCC declined overall. During 2014 to 2018, the overall HCC incidence changed annually by -3.1% (95% CI -4.8% to -1.4%) in men and -3.2% (95% CI, -10.9% to -0.9%) in women, largely due to declines in HCV-related HCC. However, MASLD- and ALD-related HCC rates increased throughout 2010 to 2018 (MASLD: 1.9% [95% CI, 0.8% to 3.0%]; ALD: 1.9% [95% CI, 0.6% to 3.1%]). Conclusions and Relevance This retrospective cohort study found that etiology of HCC was associated with detailed racial and ethnic groups, with notable variation across disaggregated Asian groups. Rates of MASLD-related and ALD-related HCC were increasing, posing new challenges for prevention. American Indian, Asian and Pacific Islander, and Latino populations were disproportionately affected by HCC, beyond viral causes. Targeted public health interventions addressing alcohol, viral, and metabolic risk factors are needed.
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Affiliation(s)
- Paulo S. Pinheiro
- Division of Epidemiology & Population Health Sciences, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
| | - Juanjuan Zhang
- Los Angeles Cancer Surveillance Program, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Veronica Wendy Setiawan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Hannah M. Cranford
- Division of Epidemiology & Population Health Sciences, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California
- Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Lihua Liu
- Los Angeles Cancer Surveillance Program, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
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Quinn PL, Tounkara F, Rodríguez MG, Chahal K, Saiyed S, Gutta G, Hannon C, Sarna A, Kim A, Cloyd JM, Molina Y, Kitajewski J, Ejaz A. Access to care and the Hispanic paradox among Hispanic patients with hepatocellular carcinoma. Clin Res Hepatol Gastroenterol 2025; 49:102519. [PMID: 39722361 PMCID: PMC11898000 DOI: 10.1016/j.clinre.2024.102519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 11/18/2024] [Accepted: 12/11/2024] [Indexed: 12/28/2024]
Abstract
PURPOSE Despite the disproportionate impact of hepatocellular carcinoma (HCC) on Hispanic patients, reported outcomes are limited, particularly among subpopulations. Our study aimed to evaluate outcomes in access to care and survival among racial and ethnic Hispanic subpopulations. METHODS The National Cancer Database was utilized to identify patients diagnosed with HCC between 2004 and 2020. The independent variables of interest were racial/ethnic groups, with the Hispanic population disaggregated by race and Hispanic heritage. The primary outcomes were the presentation of early versus late-stage HCC, undergoing a curative-intent procedure, time to treatment, and overall survival. Logistic regression was performed with adjustments made for demographic, clinical, and socioeconomic variables. RESULTS Among 211,988 patients with HCC identified, 12.3 % (n = 26,085) were classified as Hispanic. In comparison with NHW patients, South/Central American patients had the lowest odds of early-stage presentation (OR=0.91; p = 0.1), Cuban patients had the lowest odds of undergoing a curative-intent procedure (OR=0.72; p = 0.04), and Mexican patients had the highest odds of delayed treatment (OR=1.45; p < 0.001). Hispanics had a longer median survival at 19 months than NHW patients (15 months, p < 0.001), with Hispanic Black (HR 0.59, p < 0.001) and Dominican (HR 0.56, p < 0.001) patients having the lowest mortality risk among Hispanic subpopulations. DISCUSSION Despite decreased resection rates and increased likelihood of delayed treatment, Hispanics had improved survival across its subpopulations in comparison to NHW patients, further highlighting the Hispanic paradox.
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Affiliation(s)
- Patrick L Quinn
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Fode Tounkara
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Kunika Chahal
- SUNY Downstate Health Services University, Brooklyn, NY, USA
| | | | - Goutam Gutta
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Connor Hannon
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Angela Sarna
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alex Kim
- UT Southwestern Medical Center, Dallas, TX, USA
| | - Jordan M Cloyd
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Aslam Ejaz
- University of Illinois Chicago, Chicago, IL, USA.
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Hwang SY, Danpanichkul P, Agopian V, Mehta N, Parikh ND, Abou-Alfa GK, Singal AG, Yang JD. Hepatocellular carcinoma: updates on epidemiology, surveillance, diagnosis and treatment. Clin Mol Hepatol 2025; 31:S228-S254. [PMID: 39722614 PMCID: PMC11925437 DOI: 10.3350/cmh.2024.0824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Revised: 11/08/2024] [Accepted: 12/20/2024] [Indexed: 12/28/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is a major global burden, ranking as the third leading cause of cancer-related mortality. HCC due to chronic hepatitis B virus (HBV) or C virus (HCV) infection has decreased due to universal vaccination for HBV and effective antiviral therapy for both HBV and HCV, but HCC related to metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease is increasing. Biannual liver ultrasonography and serum α-fetoprotein are the primary surveillance tools for early HCC detection among high-risk patients (e.g., cirrhosis, chronic HBV). Alternative surveillance tools such as blood-based biomarker panels and abbreviated magnetic resonance imaging (MRI) are being investigated. Multiphasic computed tomography or MRI is the standard for HCC diagnosis, but histological confirmation should be considered, especially when inconclusive findings are seen on cross-sectional imaging. Staging and treatment decisions are complex and should be made in multidisciplinary settings, incorporating multiple factors including tumor burden, degree of liver dysfunction, patient performance status, available expertise, and patient preferences. Early-stage HCC is best treated with curative options such as resection, ablation, or transplantation. For intermediate-stage disease, locoregional therapies are primarily recommended although systemic therapies may be preferred for patients with large intrahepatic tumor burden. In advanced-stage disease, immune checkpoint inhibitor-based therapy is the preferred treatment regimen. In this review article, we discuss the recent global epidemiology, risk factors, and HCC care continuum encompassing surveillance, diagnosis, staging, and treatments.
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Affiliation(s)
- Soo Young Hwang
- Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, Maryland, USA
| | - Pojsakorn Danpanichkul
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Vatche Agopian
- Dumont-UCLA Transplant and Liver Cancer Centers, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Neil Mehta
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, California, USA
| | - Neehar D. Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ghassan K. Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
- Department of Medicine, Weill Medical College at Cornell University, New York, USA
- Trinity College Dublin, Dublin, Ireland
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ju Dong Yang
- Karsh Division of Gastroenterology and Hepatology, Comprehensive Transplant Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Zorina ES, Naryzhny SN. Biomarkers of hepatocellular carcinoma: status and prospects. BIOMEDITSINSKAIA KHIMIIA 2025; 71:7-18. [PMID: 40045719 DOI: 10.18097/pbmcr1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2025]
Abstract
Hepatocellular carcinoma (HCC) also known as hepatocellular cancer is one of the most common and aggressive types of primary malignant liver neoplasms. This type of cancer accounts for up to 90% of all primary liver tumors and is the third leading cause of cancer death worldwide. Despite the advances in modern medicine, diagnostics and treatment of HCC remain challenging, especially in the later stages, when the patient's prognosis significantly worsens and treatment options are very limited. More than half a century has passed since Yu.S. Tatarinov discovered embryo-specific α-globulin in the blood of people with primary liver cancer in 1963, which was later called alpha-fetoprotein (AFP), but unfortunately, the number of specific and sensitive biomarkers for HCC remains very limited. In this regard, many scientific papers are devoted to the search and study of potential HCC biomarkers, which are essential for early diagnostics, prognosis, and development of new therapeutic strategies. Proteomic studies represent one of the promising approaches to investigate both molecular mechanisms of HCC occurrence and HCC biomarkers. Identification of specific protein profiles characteristic of tumor cells can contribute to the identification of new biomarkers that can be used not only for early detection of the disease, but also for monitoring its progression, assessing the response to therapy and predicting the clinical outcome. This review discusses current achievements in the search for potential biomarkers of HCC, as well as the prospects for their clinical use.
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Affiliation(s)
- E S Zorina
- Institute of Biomedical Chemistry, Moscow, Russia
| | - S N Naryzhny
- Petersburg Institute of Nuclear Physics B.P. Konstantinova National Research Center "Kurchatov Institute", Gatchina, Leningrad Region, Russia
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Bennett FJ, Keilson JM, Turgeon MK, Oppat KM, Warren EAK, Shah SA, Agopian VG, Magliocca JF, Cameron A, Orloff SL, Kubal CA, Cannon RM, Akoad ME, Emamaullee J, Aucejo F, Vagefi PA, Nguyen MH, Dhanireddy K, Kazimi MM, Sonnenday CJ, Foley DP, Abdouljoud M, Sudan DL, Humar A, Doyle MBM, Chapman WC, Maithel SK. Racial Disparities in Liver Transplant for Hepatitis C-Associated Hepatocellular Carcinoma. Ann Surg Oncol 2025; 32:426-437. [PMID: 39414703 PMCID: PMC11931600 DOI: 10.1245/s10434-024-16317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 09/19/2024] [Indexed: 10/18/2024]
Abstract
BACKGROUND In the United States, hepatitis C virus-associated hepatocellular carcinoma incidence and mortality are highest among minorities. Socioeconomic constraints play a major role in inequitable treatment. We evaluated the association between race/ethnicity and outcomes in a population that overcame treatment barriers. METHODS We report a retrospective cohort study of 666 patients across 20 institutions in the United States Hepatocellular Carcinoma Liver Transplantation Consortium from 2015 to 2019 with hepatitis C virus-associated hepatocellular carcinoma who completed direct-acting antiviral therapy and underwent liver transplantation. Patients were excluded if they had a prior liver transplantation, hepatocellular carcinoma recurrence, no prior liver-directed therapy, or if race/ethnicity data were unavailable. Patients were stratified by race/ethnicity. Primary outcomes were recurrence-free survival and overall survival, and secondary outcome was major postoperative complication. RESULTS Race/ethnicity was not associated with differences in 5-year recurrence-free survival (White 90%, Black 88%, Hispanic 92%, Other 87%; p = 0.85), overall survival (White 85%, Black 84%, Hispanic 84%, Other 93%; p = 0.70), or major postoperative complication. CONCLUSIONS Race/ethnicity was not associated with worse oncologic or postoperative outcomes among those who completed direct-acting antiviral therapy and underwent liver transplantation, suggesting that overcoming socioeconomic constraints equalizes outcomes across racial/ethnic groups. Eliminating barriers that prohibit care access among minorities must be a priority.
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Affiliation(s)
- Frances J Bennett
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jessica M Keilson
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Michael K Turgeon
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Kailey M Oppat
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Emilie A K Warren
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Shimul A Shah
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vatche G Agopian
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph F Magliocca
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Andrew Cameron
- Department of Surgery, Johns Hopkins, Baltimore, MD, USA
| | - Susan L Orloff
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | | | - Robert M Cannon
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mohamed E Akoad
- Department of Surgery, Lahey Hospital and Medical Center, Boston, MA, USA
| | - Juliet Emamaullee
- Department of Surgery, Keck Hospital of University of Southern California, Los Angeles, CA, USA
| | | | - Parsia A Vagefi
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mindie H Nguyen
- Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA
| | | | - Marwan M Kazimi
- Department of Surgery, Piedmont Healthcare, Atlanta, GA, USA
| | | | - David P Foley
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Debra L Sudan
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Abhinav Humar
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M B Majella Doyle
- Department of Surgery, Washington University School of Medicine at St. Louis, St. Louis, MO, USA
| | - William C Chapman
- Department of Surgery, Washington University School of Medicine at St. Louis, St. Louis, MO, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
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10
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Yoon JY, Shah SC, Lin JJ, Kim MK, Itzkowitz SH, Wang CP. Shattering the monolith: burden of gastrointestinal cancer in Asian Americans, Native Hawaiians, and Pacific Islanders in the United States. LANCET REGIONAL HEALTH. AMERICAS 2025; 41:100954. [PMID: 39650260 PMCID: PMC11625213 DOI: 10.1016/j.lana.2024.100954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 11/04/2024] [Accepted: 11/11/2024] [Indexed: 12/11/2024]
Abstract
Asian Americans remain the fastest-growing racial group in the United States, and are anticipated to double over the next few decades. Asian Americans are the only major racial-ethnic group for whom cancer remains the leading cause of death, and multiple gastrointestinal cancers rank among the top five incident and fatal cancers. Most research to date presents Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) in aggregate, overlooking their vast heterogeneity and hindering efforts to identify and address health disparities within AANHPI origin groups. Here, we present gastrointestinal cancer incidence and mortality in AANHPI, including disaggregated rates where feasible, and highlight gaps in current screening practices. We conclude with actionable suggestions to shift away from using broad racial categories to evaluate cancer disparities, towards high-quality, disaggregated data to better isolate and address factors driving the clear differential cancer risks among AANHPI.
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Affiliation(s)
- Ji Yoon Yoon
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shailja C. Shah
- GI Section, VA San Diego Healthcare System, San Diego, CA, USA
- Division of Gastroenterology, University of California San Diego, San Diego, CA, USA
| | - Jenny J. Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Kang Kim
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Steven H. Itzkowitz
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina P. Wang
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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11
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He Y, Pinheiro PS, Tripathi O, Nguyen H, Srinivasan M, Palaniappan LP, Thompson CA. Cancer Mortality among Hispanic Groups in the United States by Birthplace (2003-2017). Cancer Epidemiol Biomarkers Prev 2024; 33:1598-1609. [PMID: 39361352 PMCID: PMC11611630 DOI: 10.1158/1055-9965.epi-24-0792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 08/28/2024] [Accepted: 10/01/2024] [Indexed: 11/14/2024] Open
Abstract
BACKGROUND The Hispanic population is the second largest racial/ethnic group in the United States, consisting of multiple distinct ethnicities. Ethnicity-specific variations in cancer mortality may be attributed to countries of birth, so we aimed to understand differences in cancer mortality among disaggregated Hispanics by nativity (native- or foreign-born vs. US-born) over 15 years. METHODS A total of 228,197 Hispanic decedents (Mexican, Puerto Rican, Cuban, and Central or South American) with cancer-related deaths from US death certificates (2003-2017) were analyzed. Seven cancers that contribute significantly to Hispanic male (lung and bronchus, colon and rectum, liver, prostate, and pancreas cancers) and female (lung and bronchus, liver, pancreas, colon and rectum, female breast, and ovary cancers) mortality were selected for analysis. 5-year age-adjusted mortality rates [(95% confidence interval); per 100,000] and standardized mortality ratios (95% confidence interval) using foreign-born as the reference group were calculated. Joinpoint regression analysis was used to model cancer-related mortality trends. RESULTS Puerto Rico-born Puerto Ricans, Cuba-born Cubans, and US-born Mexicans had some of the highest cancer death rates among all the Hispanic groups. In general, foreign-born Hispanics had higher cancer mortality rates than US-born Hispanics, except Mexicans. Overall, US-born and non-US-born (i.e., native- or foreign-born) Hispanic groups experienced decreasing rates of cancer deaths over the years. CONCLUSIONS We noted vast heterogeneity in mortality rates by nativity across Hispanic groups, a fast-growing diverse US population. IMPACT Understanding disaggregated patterns and trends in cancer burden can motivate deeper discussion around community health resources, which may improve the health of Hispanics across the United States.
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Affiliation(s)
- Yuelin He
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Asian Health Research and Education, Stanford University School of Medicine; Stanford, CA
| | - Paulo S. Pinheiro
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, United States
| | - Osika Tripathi
- Center for Asian Health Research and Education, Stanford University School of Medicine; Stanford, CA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; La Jolla, CA
- San Diego State University School of Public Health; San Diego, CA
| | - Helen Nguyen
- San Diego State University School of Public Health; San Diego, CA
| | - Malathi Srinivasan
- Center for Asian Health Research and Education, Stanford University School of Medicine; Stanford, CA
| | - Latha P. Palaniappan
- Center for Asian Health Research and Education, Stanford University School of Medicine; Stanford, CA
| | - Caroline A. Thompson
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Asian Health Research and Education, Stanford University School of Medicine; Stanford, CA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC
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12
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Ly KN, Barker LK, Kilmer G, Shing JZ, Jiles RB, Teshale E. Disparities in hepatitis C among people aged 12-59 with no history of injection drug use, United States, January 2013-March 2020. Liver Int 2024; 44:3250-3259. [PMID: 39324414 PMCID: PMC11927374 DOI: 10.1111/liv.16108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 08/21/2024] [Accepted: 09/11/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND AND AIMS In the United States, hepatitis C virus (HCV) infection occurs primarily through injection drug use (IDU), but transmission also occurs through other ways. This study examined HCV prevalence and disparities among US residents aged 12-59 years with no IDU history. METHODS We analysed 2013-March 2020 National Health and Nutrition Examination Survey data to calculate the HCV prevalence among people with no drug use history and only a non-IDU history, collectively referred to as no IDU history. These estimates were compared to those with an IDU history and stratified by sociodemographic and hepatitis A and hepatitis B serologic characteristics. RESULTS The current HCV infection prevalence among people aged 12-59 was .7% overall, and specifically 17.2% among people with an IDU history, .9% among people with a non-IDU history and .2% among people with no drug use history. These rates represented 1.4 million people with current HCV infection, of whom, 730 000 had an IDU history, 262 000 had a non-IDU history and 309 000 had no drug use history. Among people with no drug use history, current HCV infection prevalence was higher for people born during 1954-1965 versus after 1965, had completed high school or less versus at least some college and had past/present hepatitis B versus vaccinated for hepatitis B. CONCLUSION While the HCV infection burden was highest among people with an IDU history, we found a sizeable burden among people without such a history. These findings support policies and practices aimed at addressing disparities among people needing treatment.
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Affiliation(s)
- Kathleen N Ly
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laurie K Barker
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Greta Kilmer
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jaimie Z Shing
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ruth B Jiles
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eyasu Teshale
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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13
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Jasim SA, Salahdin OD, Malathi H, Sharma N, Rab SO, Aminov Z, Pramanik A, Mohammed IH, Jawad MA, Gabel BC. Targeting Hepatic Cancer Stem Cells (CSCs) and Related Drug Resistance by Small Interfering RNA (siRNA). Cell Biochem Biophys 2024; 82:3031-3051. [PMID: 39060914 DOI: 10.1007/s12013-024-01423-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
Tumor recurrence after curative therapy and hepatocellular carcinoma (HCC) cells' resistance to conventional therapies is the reasons for the worse clinical results of HCC patients. A tiny population of cancer cells with a strong potential for self-renewal, differentiation, and tumorigenesis has been identified as cancer stem cells (CSCs). The discovery of CSC surface markers and the separation of CSC subpopulations from HCC cells have been made possible by recent developments in the study of hepatic (liver) CSCs. Hepatic CSC surface markers include epithelial cell adhesion molecules (EpCAM), CD133, CD90, CD13, CD44, OV-6, ALDH, and K19. CSCs have a significant influence on the development of cancer, invasiveness, self-renewal, metastasis, and drug resistance in HCC, and thus provide a therapeutic chance to treat HCC and avoid its recurrence. Therefore, it is essential to develop treatment approaches that specifically and effectively target hepatic stem cells. Given this, one potential treatment approach is to use particular small interfering RNA (siRNA) to target CSC, disrupting their behavior and microenvironment as well as changing their epigenetic state. The characteristics of CSCs in HCC are outlined in this study, along with new treatment approaches based on siRNA that may be used to target hepatic CSCs and overcome HCC resistance to traditional therapies.
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Affiliation(s)
| | | | - H Malathi
- Department of Biotechnology and Genetics, School of Sciences, JAIN (Deemed to be University, Bangalore, Karnataka, India
| | - Neha Sharma
- Chandigarh Pharmacy College, Chandigarh group of Colleges, Jhanjeri, 140307, Mohali, Punjab, India
| | - Safia Obaidur Rab
- Department of Clinical Laboratory Sciences, College of Applied Medical Science, King Khalid University, Abha, Saudi Arabia
| | - Zafar Aminov
- Department of Public Health and Healthcare management, Samarkand State Medical University, 18 Amir Temur Street, Samarkand, Uzbekistan
| | - Atreyi Pramanik
- School of Applied and Life Sciences, Division of Research and Innovation, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Israa Hussein Mohammed
- College of nursing, National University of Science and Technology, Nasiriyah, Dhi Qar, Iraq
| | - Mohammed Abed Jawad
- Department of Medical Laboratories Technology, Al-Nisour University College, Baghdad, Iraq
| | - Benien C Gabel
- Medical laboratory technique college, the Islamic University, Najaf, Iraq
- Medical laboratory technique college, the Islamic University of Al Diwaniyah, Al Diwaniyah, Iraq
- Medical laboratory technique college, the Islamic University of Babylon, Babylon, Iraq
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14
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Garcia CJC, Grisetti L, Tiribelli C, Pascut D. The ncRNA-AURKA Interaction in Hepatocellular Carcinoma: Insights into Oncogenic Pathways, Therapeutic Opportunities, and Future Challenges. Life (Basel) 2024; 14:1430. [PMID: 39598228 PMCID: PMC11595987 DOI: 10.3390/life14111430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 10/15/2024] [Accepted: 11/03/2024] [Indexed: 11/29/2024] Open
Abstract
Hepatocellular carcinoma (HCC) represents a major public health concern and ranks among the leading cancer-related mortalities globally. Due to the frequent late-stage diagnosis of HCC, therapeutic options remain limited. Emerging evidence highlights the critical role of non-coding RNAs (ncRNAs) in the regulation of Aurora kinase A (AURKA), one of the key hub genes involved in several key cancer pathways. Indeed, the dysregulated interaction between ncRNAs and AURKA contributes to tumor development, progression, and therapeutic resistance. This review delves into the interplay between ncRNAs and AURKA and their role in hepatocarcinogenesis. Recent findings underscore the involvement of the ncRNAs and AURKA axis in tumor development and progression. Furthermore, this review also discusses the clinical significance of targeting ncRNA-AURKA axes, offering new perspectives that could lead to innovative therapeutic strategies aimed at improving outcomes for HCC patients.
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Affiliation(s)
- Clarissa Joy C. Garcia
- Liver Cancer Unit, Fondazione Italiana Fegato—ONLUS, 34149 Trieste, Italy
- Department of Life Sciences, Università degli Studi di Trieste, 34127 Trieste, Italy
| | - Luca Grisetti
- National Institute of Gastroenterology—IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy
| | - Claudio Tiribelli
- Liver Cancer Unit, Fondazione Italiana Fegato—ONLUS, 34149 Trieste, Italy
| | - Devis Pascut
- Liver Cancer Unit, Fondazione Italiana Fegato—ONLUS, 34149 Trieste, Italy
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15
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Kaplan DE, Tan R, Xiang C, Mu F, Hernandez S, Ogale S, Li J, Lin Y, Shi L, Singal AG. Overall Survival in Real-World Patients with Unresectable Hepatocellular Carcinoma Receiving Atezolizumab Plus Bevacizumab Versus Sorafenib or Lenvatinib as First-Line Therapy: Findings from the National Veterans Health Administration Database. Cancers (Basel) 2024; 16:3508. [PMID: 39456602 PMCID: PMC11506031 DOI: 10.3390/cancers16203508] [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: 08/28/2024] [Revised: 09/27/2024] [Accepted: 10/10/2024] [Indexed: 10/28/2024] Open
Abstract
Background/Objectives: This study evaluated comparative overall survival (OS) of United States veterans with unresectable hepatocellular carcinoma (uHCC) receiving first-line (1L) atezolizumab plus bevacizumab vs. sorafenib or lenvatinib, overall and across racial and ethnic groups. Methods: In this retrospective study, patients with uHCC who initiated atezolizumab plus bevacizumab (post-2020) or sorafenib or lenvatinib (post-2018) were identified from the Veterans Health Administration National Corporate Data Warehouse (1 January 2017-31 December 2022). Patient characteristics were evaluated in the year prior to 1L treatment initiation. Kaplan-Meier and multivariable Cox regression methods were used to compare OS starting from treatment between cohorts, both overall and by race and ethnicity. Results: Among the 1874 patients included, 405 (21.6%) received 1L atezolizumab plus bevacizumab, 1016 (54.2%) received sorafenib, and 453 (24.2%) received lenvatinib, with a median follow-up time of 8.5, 7.6, and 8.2 months, respectively. Overall, patients receiving atezolizumab plus bevacizumab had longer unadjusted median OS (12.8 [95% CI: 10.6, 17.1] months) than patients receiving sorafenib (8.0 [7.1, 8.6] months) or lenvatinib (9.5 [7.8, 11.4] months; both log-rank p < 0.001). After adjustment, atezolizumab plus bevacizumab was associated with a reduced risk of death by 30% vs. sorafenib (adjusted HR: 0.70 [95% CI: 0.60, 0.82]) and by 26% vs. lenvatinib (0.74 [0.62, 0.88]; both p < 0.001). OS trends in the White, Black, and Hispanic patient cohorts were consistent with that of the overall population. Conclusions: Atezolizumab plus bevacizumab was associated with improved survival outcomes compared with sorafenib and lenvatinib in patients with uHCC, both overall and across racial and ethnic subgroups.
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Affiliation(s)
- David E. Kaplan
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Gastroenterology Section, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - Ruoding Tan
- Genentech, South San Francisco, CA 94080, USA; (R.T.); (S.H.); (S.O.)
| | - Cheryl Xiang
- Analysis Group Inc., Boston, MA 02199, USA; (C.X.); (F.M.); (J.L.)
| | - Fan Mu
- Analysis Group Inc., Boston, MA 02199, USA; (C.X.); (F.M.); (J.L.)
| | - Sairy Hernandez
- Genentech, South San Francisco, CA 94080, USA; (R.T.); (S.H.); (S.O.)
| | - Sarika Ogale
- Genentech, South San Francisco, CA 94080, USA; (R.T.); (S.H.); (S.O.)
| | - Jiayang Li
- Analysis Group Inc., Boston, MA 02199, USA; (C.X.); (F.M.); (J.L.)
| | - Yilu Lin
- Department of Health Policy and Management, Tulane University, New Orleans, LA 70118, USA; (Y.L.); (L.S.)
- New Orleans VA Medical Center, New Orleans, LA 70119, USA
| | - Lizheng Shi
- Department of Health Policy and Management, Tulane University, New Orleans, LA 70118, USA; (Y.L.); (L.S.)
- New Orleans VA Medical Center, New Orleans, LA 70119, USA
| | - Amit G. Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
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16
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Han JW, Sohn W, Choi GH, Jang JW, Seo GH, Kim BH, Choi JY. Evolving trends in treatment patterns for hepatocellular carcinoma in Korea from 2008 to 2022: a nationwide population-based study. JOURNAL OF LIVER CANCER 2024; 24:274-285. [PMID: 39187270 PMCID: PMC11449573 DOI: 10.17998/jlc.2024.08.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUNDS/AIMS The treatment landscape for hepatocellular carcinoma (HCC) has significantly evolved over the past decade. We aimed to analyze trends in treatment patterns for HCC using a nationwide claims database from the Korean Health Insurance Review and Assessment Service. METHODS This retrospective population-based cohort study analyzed 171,002 newly diagnosed HCC patients between 2008 and 2022. Etiologies and treatment modalities were categorized based on the ICD-10 codes and insurance data. RESULTS The annual incidence decreased from 11,814 in 2008 to 10,443 in 2022. However, patients aged ≥70 increased noticeably, with those aged ≥80 rising from 3.8% in 2008 to 13.1% in 2022. From 2008 to 2022, the predominant cause of hepatitis B virus decreased from 68.9% to 59.7%, whereas nonalcoholic fatty liver disease increased from 8.9% to 15.8%. The initial treatment trends shifted: surgical resection and systemic therapy increased from 12.2% to 21.3% and from 0.2% to 9.6%, whereas transarterial therapy decreased from 49.9% to 36.6%. Best supportive care decreased from 31.7% to 21.3%. In the subgroup analysis, laparoscopic resection rate increased from 10.6% to 60.6% among the surgical resections. Sorafenib initially accounted for 100%, lenvatinib peaked at 36.5% in 2021, and atezolizumab-bevacizumab became the most widely used (63.1%) by 2022 among the systemic therapies. CONCLUSIONS This study demonstrates the temporal changes in the treatment patterns of Korean HCC patients. Surgical resection, particularly laparoscopic liver resection, and systemic therapy has increased significantly. These changes may have been influenced by reimbursement policies and advances in clinical research.
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Affiliation(s)
- Ji Won Han
- The Korean Liver Cancer Association, Seoul, Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Catholic University of Korea Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Sohn
- The Korean Liver Cancer Association, Seoul, Korea
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gwang Hyeon Choi
- The Korean Liver Cancer Association, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jeong Won Jang
- The Korean Liver Cancer Association, Seoul, Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Catholic University of Korea Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gi Hyeon Seo
- The Korean Liver Cancer Association, Seoul, Korea
- Health Insurance Review and Assessment Service, Seoul, Korea
| | - Bo Hyun Kim
- The Korean Liver Cancer Association, Seoul, Korea
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Jong Young Choi
- The Korean Liver Cancer Association, Seoul, Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Catholic University of Korea Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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17
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Yu M, Liu L, Gibson J(T, Campbell D, Liu Q, Scoppa S, Feuer EJ, Pinheiro PS. Assessing racial, ethnic, and nativity disparities in US cancer mortality using a new integrated platform. J Natl Cancer Inst 2024; 116:1145-1157. [PMID: 38426333 PMCID: PMC11223878 DOI: 10.1093/jnci/djae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/02/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Foreign-born populations in the United States have markedly increased, yet cancer trends remain unexplored. Survey-based Population-Adjusted Rate Calculator (SPARC) is a new tool for evaluating nativity differences in cancer mortality. METHODS Using SPARC, we calculated 3-year (2016-2018) age-adjusted mortality rates and rate ratios for common cancers by sex, age group, race and ethnicity, and nativity. Trends by nativity were examined for the first time for 2006-2018. Traditional cancer statistics draw populations from decennial censuses. However, nativity-stratified populations are from the American Community Surveys, thus involve sampling errors. To rectify this, SPARC employed bias-corrected estimators. Death counts came from the National Vital Statistics System. RESULTS Age-adjusted mortality rates were higher among US-born populations across nearly all cancer types, with the largest US-born, foreign-born difference observed in lung cancer among Black women (rate ratio = 3.67, 95% confidence interval [CI] = 3.37 to 4.00). The well-documented White-Black differences in breast cancer mortality existed mainly among US-born women. For all cancers combined, descending trends were more accelerated for US-born compared with foreign-born individuals in all race and ethnicity groups with changes ranging from -2.6% per year in US-born Black men to stable (statistically nonsignificant) among foreign-born Black women. Pancreas and liver cancers were exceptions with increasing, stable, or decreasing trends depending on nativity and race and ethnicity. Notably, foreign-born Black men and foreign-born Hispanic men did not show a favorable decline in colorectal cancer mortality. CONCLUSIONS Although all groups show beneficial cancer mortality trends, those with higher rates in 2006 have experienced sharper declines. Persistent disparities between US-born and foreign-born individuals, especially among Black people, necessitate further investigation.
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Affiliation(s)
- Mandi Yu
- Surveillance Research Program, Division of Cancer Control and Population Sciences, Bethesda, MD, USA
| | - Lihua Liu
- Los Angeles Cancer Surveillance Program, University of Southern California, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Dave Campbell
- Information Management Services, Inc, Calverton, MD, USA
| | - Qinran Liu
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steve Scoppa
- Information Management Services, Inc, Calverton, MD, USA
| | - Eric J Feuer
- Surveillance Research Program, Division of Cancer Control and Population Sciences, Bethesda, MD, USA
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18
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Arefan D, D'Ardenne NM, Iranpour N, Catania R, Yousef J, Chupetlovska K, Moghe A, Sholosh B, Thangasamy S, Borhani AA, Singhi AD, Monga SP, Furlan A, Wu S. Quantitative radiomics and qualitative LI-RADS imaging descriptors for non-invasive assessment of β-catenin mutation status in hepatocellular carcinoma. Abdom Radiol (NY) 2024; 49:2220-2230. [PMID: 38782785 DOI: 10.1007/s00261-024-04344-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Gain-of-function mutations in CTNNB1, gene encoding for β-catenin, are observed in 25-30% of hepatocellular carcinomas (HCCs). Recent studies have shown β-catenin activation to have distinct roles in HCC susceptibility to mTOR inhibitors and resistance to immunotherapy. Our goal was to develop and test a computational imaging-based model to non-invasively assess β-catenin activation in HCC, since liver biopsies are often not done due to risk of complications. METHODS This IRB-approved retrospective study included 134 subjects with pathologically proven HCC and available β-catenin activation status, who also had either CT or MR imaging of the liver performed within 1 year of histological assessment. For qualitative descriptors, experienced radiologists assessed the presence of imaging features listed in LI-RADS v2018. For quantitative analysis, a single biopsy proven tumor underwent a 3D segmentation and radiomics features were extracted. We developed prediction models to assess the β-catenin activation in HCC using both qualitative and quantitative descriptors. RESULTS There were 41 cases (31%) with β-catenin mutation and 93 cases (69%) without. The model's AUC was 0.70 (95% CI 0.60, 0.79) using radiomics features and 0.64 (0.52, 0.74; p = 0.468) using qualitative descriptors. However, when combined, the AUC increased to 0.88 (0.80, 0.92; p = 0.009). Among the LI-RADS descriptors, the presence of a nodule-in-nodule showed a significant association with β-catenin mutations (p = 0.015). Additionally, 88 radiomics features exhibited a significant association (p < 0.05) with β-catenin mutations. CONCLUSION Combination of LI-RADS descriptors and CT/MRI-derived radiomics determine β-catenin activation status in HCC with high confidence, making precision medicine a possibility.
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Affiliation(s)
- Dooman Arefan
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 200, Pittsburgh, PA, 15213, USA
- Pittsburgh Liver Research Center, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nicholas M D'Ardenne
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 200, Pittsburgh, PA, 15213, USA
| | - Negaur Iranpour
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Roberta Catania
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - Jacob Yousef
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 200, Pittsburgh, PA, 15213, USA
| | - Kalina Chupetlovska
- Diagnostic Imaging Department, University Hospital "Saint Ivan Rilski", Sofia, Bulgaria
| | - Akshata Moghe
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Biatta Sholosh
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 200, Pittsburgh, PA, 15213, USA
| | - Senthur Thangasamy
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 200, Pittsburgh, PA, 15213, USA
| | - Amir A Borhani
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 800, Chicago, IL, 60611, USA
| | - Aatur D Singhi
- Pittsburgh Liver Research Center, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pathology, University of Pittsburgh Medical Center, S405A-BST, 200 Lothrop Street, Pittsburgh, PA, 15261, USA
| | - Satdarshan P Monga
- Pittsburgh Liver Research Center, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pathology, University of Pittsburgh Medical Center, S405A-BST, 200 Lothrop Street, Pittsburgh, PA, 15261, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 200, Pittsburgh, PA, 15213, USA
- Pittsburgh Liver Research Center, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shandong Wu
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 200, Pittsburgh, PA, 15213, USA.
- Pittsburgh Liver Research Center, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Mignozzi S, Santucci C, Medina HN, Negri E, La Vecchia C, Pinheiro PS. Cancer mortality in Germany-born Americans and Germans. Cancer Epidemiol 2024; 88:102519. [PMID: 38183748 DOI: 10.1016/j.canep.2023.102519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Comparing cancer mortality and associated risk factors among immigrant populations in a host country to those in their country of origin reveals disparities in cancer risk, access to care, diagnosis, and disease management. This study compares cancer mortality between the German resident population and Germany-born individuals who migrated to the US. METHODS Cancer mortality data from 2008-2018 were derived for Germans from the World Health Organization database and for Germany-born Americans resident in four states (California, Florida, Massachusetts, and New York) from respective Departments of Vital Statistics. We calculated age-standardized mortality rates (ASMRs) using the European standard population and standardized mortality ratios (SMR) compared to the German resident population along with 95% confidence intervals (CIs). RESULTS Germany-born American males had lower ASMRs (253.8 per 100,000) than German resident population (325.6 per 100,000). The difference in females was modest, with ASMRs of 200.7 and 203.7 per 100,000, respectively. For all cancers, Germany-born American males had an SMR of 0.72 (95% CI: 0.70-0.74) and females 0.98 (95% CI: 0.95-1.00). Male SMRs among Germany-born Americans were significantly below one for oral cavity, stomach, colorectal, liver, lung, prostate, and kidney cancer. Among females, SMRs were below one for oral cavity, stomach, colorectal, gallbladder, breast, cervix uteri, and kidney cancer. For both sexes, SMRs were over one for bladder cancer (1.14 for males, 1.21 for females). Mortality was higher for lung cancer (SMR: 1.68), non-Hodgkin's lymphoma (1.18) and uterine cancer (1.22) among Germany-born American females compared to the German resident population. CONCLUSION Germany-born American males but not females showed lower cancer mortality than German resident population. Disparities may stem from variations in risk factors (e.g., smoking and alcohol use) as well as differences in screening practices and participation, cancer treatment, besides some residual potential "healthy immigrant effect".
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Affiliation(s)
- Silvia Mignozzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudia Santucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Heidy N Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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20
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Maguire FB, Hofer BM, Parikh-Patel A, Keegan THM. An Examination of Liver Cancer Incidence in California. JOURNAL OF REGISTRY MANAGEMENT 2024; 51:136-145. [PMID: 40109759 PMCID: PMC11917983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/22/2025]
Abstract
Background and Objective Liver cancer is composed of 2 main types, hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA). After years of increasing HCC incidence rates in the United States, declines have been noted in recent years, but CCA incidence rates have continued increasing. Given these variable trends; documented disparities by sex, age, and race/ethnicity; and shifting risk factors from viral infection (hepatitis B and C) to metabolic causes (obesity, diabetes, nonalcoholic fatty liver disease), we sought to assess the incidence rate trends for HCC and CCA in California to inform whether California trends are similar to those observed in the United States as a whole, whether these trends have continued in the most recent years for which data is available, and to identify at-risk groups that may benefit from targeted intervention. Methods Using SEER*Stat software, we calculated age-adjusted incidence rates (AAIR) by sex, age group, and race/ethnicity for patients aged ≥40 years diagnosed with HCC and CCA from 2010 to 2021 identified in the California Cancer Registry. We assessed the annual percent change (APC) over this period for each subgroup using Joinpoint software. Results For HCC, the AAIR significantly decreased for men (-2.68%) and women (-2.23%) since 2014. Significant decreases were observed for men among all racial/ethnic groups, but among women, decreases were only seen in Black and Asian/Pacific Islander patients. Decreases in AAIR were greatest among those aged 40 to 64 years (men, -7.01%; women, -7.79%) and increases were observed for men aged ≥75 years since 2010 (1.15%). For CCA, the AAIR significantly increased for men aged ≥75 years (2.8%) and for women in all age groups. Only White men had decreasing AAIRs. Conclusion HCC AAIR trends have declined in California, but not for all groups. Older men and Hispanic and White women did not experience the same reductions in HCC AAIR observed in other groups. CCA AAIR trends have increased among nearly all groups for women. Future research should focus on evaluating risk factors by liver cancer sub-type, and regular screening of individuals with risk factors should be considered.
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Affiliation(s)
- Frances B. Maguire
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Brenda M. Hofer
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Arti Parikh-Patel
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Theresa H. M. Keegan
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento, California
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California
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