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Riechelmann RP, Leite LS, Bariani GM, Glasberg J, Rivelli TG, da Fonseca LG, Nebuloni DR, Braghiroli MI, Queiroz MA, Isejima AM, Kappeler C, Kikuchi L, Hoff PM. Regorafenib in Patients with Antiangiogenic-Naïve and Chemotherapy-Refractory Advanced Colorectal Cancer: Results from a Phase IIb Trial. Oncologist 2019; 24:1180-1187. [PMID: 31175167 DOI: 10.1634/theoncologist.2019-0067] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/11/2019] [Accepted: 04/25/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Regorafenib is a multikinase inhibitor with antiangiogenic effects that improves overall survival (OS) in metastatic colorectal cancer (mCRC) after failure of standard therapies. We investigated the efficacy and safety of regorafenib in antiangiogenic therapy-naïve chemotherapy-refractory advanced colorectal cancer. PATIENTS AND METHODS This single-center, single-arm, phase IIb study (NCT02465502) enrolled adults with mCRC whose disease had progressed on, or who were intolerant to, standard therapy, but who were antiangiogenic therapy-naïve. Patients received regorafenib 160 mg once daily for 3 weeks per 4-week cycle. The primary endpoint was progression-free survival (PFS) rate at week 8. RESULTS Of 59 treated patients, almost half had received at least four prior lines of therapy. Patients received a median of 86% of the planned dose. The week 8 PFS rate was 53% (95% confidence interval [CI], 39.1-64.3); median PFS was 3.5 months (95% CI, 1.8-3.6). Median OS was 7.4 months (95% CI, 5.3-8.9). Tumor response (RECIST version 1.1) was 2%, and metabolic response rate (criteria from the European Organisation for Research and Treatment of Cancer) was 41%. The most frequently reported regorafenib-related grade ≥3 adverse events were hypertension (36%), hand-foot skin reaction (HFSR, 25%), and hypophosphatemia (24%). There were no regorafenib-related deaths. An exploratory analysis showed that patients with grade ≥2 HFSR had longer OS (10.2 months) with regorafenib treatment versus those with grades 0-1 (5.4 months). CONCLUSION These findings support the antitumor activity of regorafenib in antiangiogenic-naïve patients with chemotherapy-refractory mCRC. IMPLICATIONS FOR PRACTICE The multikinase inhibitor regorafenib improved overall survival in the phase III CORRECT and CONCUR trials in heavily pretreated patients with treatment-refractory metastatic colorectal cancer (mCRC). Exploratory subgroup analysis from CONCUR suggested that regorafenib treatment prior to targeted therapy (including bevacizumab) may improve outcomes. In this single-center, single-arm phase IIb study, regorafenib demonstrated antitumor activity in 59 antiangiogenic-naïve patients with chemotherapy-refractory mCRC. Further studies should assess the efficacy of regorafenib in this patient population, as well as explore the reasons behind improved outcomes among patients who had a metabolic response and those who developed hand-foot skin reaction.
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Affiliation(s)
- Rachel P Riechelmann
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
- Department of Clinical Oncology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Luiz S Leite
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Giovanni M Bariani
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Joao Glasberg
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Thomas G Rivelli
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | - Daniela R Nebuloni
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Maria I Braghiroli
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Marcelo A Queiroz
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
- Division of Nuclear Medicine and Molecular Imaging, University of São Paulo, São Paulo, Brazil
| | - Alice M Isejima
- Medical Affairs Study Support, SBU Oncology, Bayer S.A., São Paulo, Brazil
| | - Christian Kappeler
- Clinical Statistics, Global Clinical Oncology, Bayer AG, Berlin, Germany
| | - Luciana Kikuchi
- Medical and Data Management, SBU Oncology, Bayer S.A., São Paulo, Brazil
| | - Paulo M Hoff
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Pinato DJ, Allara E, Chen TY, Trevisani F, Minguez B, Zoli M, Harris M, Dalla Pria A, Merchante N, Platt H, Jain M, Caturelli E, Kikuchi L, Pineda J, Nelson M, Farinati F, Rapaccini GL, Aytaman A, Yin M, Tan CK, Bower M, Giannini EG, Bräu N. Influence of HIV Infection on the Natural History of Hepatocellular Carcinoma: Results From a Global Multicohort Study. J Clin Oncol 2018; 37:296-304. [PMID: 30562130 DOI: 10.1200/jco.18.00885] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Conflicting evidence indicates that HIV seropositivity may influence the outcome of patients with hepatocellular carcinoma (HCC), a leading cause of mortality in people with HIV. We aimed to verify whether HIV affected the overall survival (OS) of patients with HCC, independent of treatment and geographic origin. PATIENTS AND METHODS We designed an international multicohort study of patients with HCC accrued from four continents who did not receive any anticancer treatment. We estimated the effect of HIV seropositivity on patients' OS while accounting for common prognostic factors and demographic characteristics in uni- and multivariable models. RESULTS A total of 1,588 patients were recruited, 132 of whom were HIV positive. Most patients clustered within Barcelona Clinic Liver Cancer (BCLC) C or D criteria (n = 1,168 [74%]) and Child-Turcotte-Pugh (CTP) class B (median score, 7; interquartile range [IQR], 3). At HCC diagnosis, the majority of patients who were HIV-positive (n = 65 [64%]) had been on antiretrovirals for a median duration of 8.3 years (IQR, 8.59 years) and had median CD4+ cell counts of 256 (IQR, 284) with undetectable HIV RNA (n = 68 [52%]). OS decreased significantly throughout BCLC stages 0 to D (16, 12, 7.5, 3.1, and 3 months, respectively; P < .001). Median OS of patients who were HIV-positive was one half that of their HIV-uninfected counterparts (2.2 months [bootstrap 95% CI, 1.2 to 3.1 months] v 4.1 months [95% CI, 3.6 to 4.4 months]). In adjusted analyses, HIV seropositivity increased the hazard of death by 24% ( P = .0333) independent of BCLC ( P < .0001), CTP ( P < .0001), α-fetoprotein ( P < .0001), geographical origin ( P < .0001), and male sex ( P = .0016). Predictors of worse OS in patients who were HIV-positive included CTP ( P = .0071) and α-fetoprotein ( P < .0001). CONCLUSION Despite adequate antiretroviral treatment, HIV seropositivity is associated with decreased survival in HCC, independent of stage, anticancer treatment, and geographical origin. Mechanistic studies investigating the immunobiology of HIV-associated HCC are urgently required.
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Affiliation(s)
| | - Elias Allara
- 1 Imperial College London, London, United Kingdom.,2 University of Cambridge, Cambridge, United Kingdom
| | - Ting-Yi Chen
- 3 VA Central Texas Health Care System, Austin, TX
| | | | - Beatriz Minguez
- 5 Hospital Universitario Vall d'Hebron, Vall d'Hebron Institut of Research, CIBERehd, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | | | - Alessia Dalla Pria
- 7 Chelsea and Westminster Hospital and Imperial College London, London, United Kingdom
| | | | | | - Mamta Jain
- 10 University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | - Mark Nelson
- 7 Chelsea and Westminster Hospital and Imperial College London, London, United Kingdom
| | | | | | - Ayse Aytaman
- 15 VA New York Harbor Healthcare System, Brooklyn, NY
| | | | | | - Mark Bower
- 7 Chelsea and Westminster Hospital and Imperial College London, London, United Kingdom
| | | | - Norbert Bräu
- 19 James J. Peters Veterans Affairs Medical Center, Bronx, NY.,20 Icahn School Medicine at Mount Sinai, New York, NY
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Debes JD, Chan AJ, Balderramo D, Kikuchi L, Gonzalez Ballerga E, Prieto JE, Tapias M, Idrovo V, Davalos MB, Cairo F, Barreyro FJ, Paredes S, Hernandez N, Avendaño K, Diaz Ferrer J, Yang JD, Carrera E, Garcia JA, Mattos AZ, Hirsch BS, Gonçalves PT, Carrilho FJ, Roberts LR. Hepatocellular carcinoma in South America: Evaluation of risk factors, demographics and therapy. Liver Int 2018. [PMID: 28640517 DOI: 10.1111/liv.13502] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death worldwide. Most studies addressing the epidemiology of HCC originate from developed countries. This study reports the preliminary findings of a multinational approach to characterize HCC in South America. METHODS We evaluated 1336 HCC patients seen at 14 centres in six South American countries using a retrospective study design with participating centres completing a template chart of patient characteristics. The diagnosis of HCC was made radiographically or histologically for all cases according to institutional standards. Methodology of surveillance for each centre was following AASLD or EASL recommendations. RESULTS Sixty-eight percent of individuals were male with a median age of 64 years at time of diagnosis. The most common risk factor for HCC was hepatitis C infection (HCV, 48%), followed by alcoholic cirrhosis (22%), Hepatitis B infection (HBV, 14%) and NAFLD (9%). We found that among individuals with HBV-related HCC, 38% were diagnosed before age 50. The most commonly provided therapy was transarterial chemoembolization (35% of HCCs) with few individuals being considered for liver transplant (<20%). Only 47% of HCCs were diagnosed during surveillance, and there was no difference in age of diagnosis between those diagnosed incidentally vs by surveillance. Nonetheless, being diagnosed during surveillance was associated with improved overall survival (P = .01). CONCLUSIONS Our study represents the largest cohort to date reporting characteristics and outcomes of HCC across South America. We found an important number of HCCs diagnosed outside of surveillance programmes, with associated increased mortality in those patients.
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Affiliation(s)
- Jose D Debes
- Department of Medicine, University of Minnesota, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Aaron J Chan
- Department of Medicine, University of Minnesota, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Domingo Balderramo
- Departamento de Gastroenterologia, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Luciana Kikuchi
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Jhon E Prieto
- Department of Gastroenterology, Organización Sanitas Colombia, Centro de enfermedades hepáticas y digestivas (CEHYD), Bogota, Colombia
| | - Monica Tapias
- Department of Gastroenterology, Hospital Universitario Fundación Santa Fe y Organizacion Sánitas, Bogotá, Colombia
| | - Victor Idrovo
- Department of Gastroenterology, Hospital Universitario Fundación Santa Fe y Organizacion Sánitas, Bogotá, Colombia
| | - Milagros B Davalos
- Department of Gastroenterology, Hospital Nacional Edgardo Rebagliati Martins, HNERM, Lima, Peru
| | - Fernando Cairo
- Departamento de Gastroenterologia, Hospital El Cruce, Buenos Aires, Argentina
| | - Fernando J Barreyro
- Consejo Nacional de Investigaciones Científicas y Técnicas, Posadas, Argentina
| | - Sebastian Paredes
- Departamento de Gastroenterologia y Hepatologia, Hospital Presidente Peron, Formosa, Argentina
| | - Nelia Hernandez
- Departamento de Gastroenterologia y Hepatologia, Hospital de Clinicas (UdelaR), Montevideo, Uruguay
| | - Karla Avendaño
- Departamento de Gastroenterologia y Hepatologia, Hospital de Clinicas (UdelaR), Montevideo, Uruguay
| | - Javier Diaz Ferrer
- Department of Gastroenterology, Hospital Nacional Edgardo Rebagliati Martins, HNERM, Lima, Peru
| | - Ju Dong Yang
- Department of Gastroenterology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Enrique Carrera
- Departamento de Gastroenterologia y Hepatologia, Hospital Eugenio Espejo, Quito, Ecuador
| | | | - Angelo Z Mattos
- Department of Gastroenterology, Hospital Nossa Senhora da Conceição-HNSC, Porto Alegre, Brazil
| | - Bruno S Hirsch
- Department of Gastroenterology, Hospital Nossa Senhora da Conceição-HNSC, Porto Alegre, Brazil
| | - Pablo T Gonçalves
- Department of Gastroenterology, Hospital Nossa Senhora da Conceição-HNSC, Porto Alegre, Brazil
| | - Flair J Carrilho
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Lewis R Roberts
- Department of Gastroenterology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Pinato DJ, Sharma R, Citti C, Platt H, Ventura-Cots M, Allara E, Chen TY, Dalla Pria A, Jain M, Mínguez B, Kikuchi L, Kaufman West E, Merli M, Kaplan DE, Hasson H, Marks K, Nelson M, Núñez M, Aytaman A, Bower M, Bräu N. The albumin-bilirubin grade uncovers the prognostic relationship between hepatic reserve and immune dysfunction in HIV-associated hepatocellular carcinoma. Aliment Pharmacol Ther 2018; 47:95-103. [PMID: 29034998 DOI: 10.1111/apt.14356] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 08/03/2017] [Revised: 08/19/2017] [Accepted: 09/11/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a leading cause of liver-related mortality in people living with HIV, where co-infection with hepatotropic viruses accelerates the course of chronic liver disease. AIM To evaluate whether the albumin-bilirubin (ALBI) grade, a more accurate marker of liver dysfunction in HCC, might identify patients with progressive liver dysfunction in the context of HIV/hepatitis co-infection. METHODS Using uni- and multi-variable analyses, we studied the albumin-bilirubin grade as a predictor of overall survival (OS) in a large, multi-center cohort of patients with HIV-associated HCC recruited from 44 centres in 9 countries within the Liver Cancer in HIV study group. Patients who underwent liver transplantation were excluded. RESULTS A total of 387 patients, predominantly HCV co-infected (78%) with balanced representation of all Barcelona Clinic Liver Cancer (BCLC) stages (A = 33%, B = 18%, C = 37%, D = 12%) were recruited. At HCC diagnosis, 84% had been on anti-retrovirals for a median duration of 8.8 years. The albumin-bilirubin grade identified significant differences in median survival of 97 months for grade 1 (95% CI 13-180 months), 17 months for grade 2 (95% CI 11-22 months) and 6 months for grade 3 (95% CI 4-9 months, P < .001). A more advanced albumin-bilirubin grade correlated with lower CD4 counts (464/373/288 cells/mm3 for grades 1/2/3) and higher HIV viraemia (3.337/8.701/61.845 copies/mL for grades 1/2/3, P < .001). CONCLUSIONS In this large, multi-center retrospective study, the albumin-bilirubin grade highlights the interplay between liver reserve and immune dysfunction as prognostic determinants in HIV-associated HCC.
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Chan AJ, Balderramo D, Kikuchi L, Ballerga EG, Prieto JE, Tapias M, Idrovo V, Davalos MB, Cairo F, Barreyro FJ, Paredes S, Hernandez N, Avendaño K, Ferrer JD, Yang JD, Carrera E, Mattos AZ, Hirsch BS, Gonçalves PT, Carrilho FJ, Roberts LR, Debes JD. Early Age Hepatocellular Carcinoma Associated With Hepatitis B Infection in South America. Clin Gastroenterol Hepatol 2017; 15:1631-1632. [PMID: 28532694 DOI: 10.1016/j.cgh.2017.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/30/2017] [Accepted: 05/13/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Aaron J Chan
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Domingo Balderramo
- Departamento de Gastroenterologia, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Luciana Kikuchi
- University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Jhon E Prieto
- Organización Sanitas Colombia, Centro de Enfermedades Hepáticas y Digestivas, Bogota, Colombia
| | - Monica Tapias
- Hospital Universitario Fundación Santa Fe y Organizacion Sánitas, Bogotá, Colombia
| | - Victor Idrovo
- Hospital Universitario Fundación Santa Fe y Organizacion Sánitas, Bogotá, Colombia
| | | | - Fernando Cairo
- Unidad de Hepatologia, Hospital El Cruce, Buenos Aires, Argentina
| | - Fernando J Barreyro
- Consejo Nacional de Investigaciones Científicas y Técnicas, Posadas, Argentina
| | - Sebastian Paredes
- Departmento de Gatroenterologia, Hospital Presidente Peron, Formosa, Argentina
| | - Nelia Hernandez
- Hospital de Clinicas (Universidad de la Republica), Montevideo, Uruguay
| | - Karla Avendaño
- Hospital de Clinicas (Universidad de la Republica), Montevideo, Uruguay
| | | | - Ju Dong Yang
- Department of Gastroenterology, Hospital Nossa Senhora da Conceição-Hospital Nossa Senhora da Conceição (HNSC), Porto Alegre, Brazil
| | - Enrique Carrera
- Department of Gastroenterology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Angelo Z Mattos
- Department of Gastroenterology, Hospital Nossa Senhora da Conceição-HNSC, Porto Alegre, Brazil
| | - Bruno S Hirsch
- Department of Gastroenterology, Hospital Nossa Senhora da Conceição-HNSC, Porto Alegre, Brazil
| | - Pablo T Gonçalves
- Department of Gastroenterology, Hospital Nossa Senhora da Conceição-HNSC, Porto Alegre, Brazil
| | | | - Lewis R Roberts
- Department of Gastroenterology, Hospital Nossa Senhora da Conceição-Hospital Nossa Senhora da Conceição (HNSC), Porto Alegre, Brazil
| | - Jose D Debes
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
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Kikuchi L, Chagas AL, Alencar RS, Tani C, Diniz MA, D’Albuquerque LA, Carrilho FJ. Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage. Clinics (Sao Paulo) 2017; 72:454-460. [PMID: 28954003 PMCID: PMC5577619 DOI: 10.6061/clinics/2017(08)01] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/24/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES: This study sought to assess the adherence of newly diagnosed hepatocellular carcinoma patients to the Barcelona Clinic Liver Cancer system treatment guidelines and to examine the impact of adherence on the survival of patients in different stages of the disease. METHODS: This study included all patients referred for the treatment of hepatocellular carcinoma between 2010 and 2012. Patients (n=364) were classified according to the Barcelona Clinic Liver Cancer guidelines. Deviations from the recommended guidelines were discussed, and treatment was determined by a multidisciplinary team. The overall survival curves were estimated with the Kaplan-Meier method and were compared using the log-rank test. RESULTS: The overall rate of adherence to the guidelines was 52%. The rate of adherence of patients in each scoring group varied as follows: stage 0, 33%; stage A, 45%; stage B, 78%; stage C, 35%; and stage D, 67%. In stage 0/A, adherent patients had a significantly better overall survival than non-adherent patients (hazard ratio=0.19, 95% confidence interval (CI): 0.09-0.42; p<0.001). Among the stage D patients, the overall survival rate was worse in adherent patients than in non-adherent patients (hazard ratio=4.0, 95% CI: 1.67-9.88; p<0.001), whereas no differences were observed in patients in stages B or C. CONCLUSIONS: The rate of adherence to the Barcelona Clinic Liver Cancer staging system in clinical practice varies according to clinical disease stage. Adherence to the recommended guidelines positively impacts survival, especially in patients with early-stage disease.
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Affiliation(s)
- Luciana Kikuchi
- São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Aline Lopes Chagas
- São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Regiane S.S.M. Alencar
- São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Claudia Tani
- São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcio A. Diniz
- São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz A.C. D’Albuquerque
- São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Flair José Carrilho
- São Paulo Clínicas Liver Cancer Group, Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,Universidade de Sao Paulo, Sao Paulo, SP, BR
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7
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Branco F, Alencar RSM, Volt F, Sartori G, Dode A, Kikuchi L, Tani CM, Chagas AL, Pfiffer T, Hoff P, Carrilho FJ, Mattos AA. The Impact of Early Dermatologic Events in the Survival of Patients with Hepatocellular Carcinoma Treated with Sorafenib. Ann Hepatol 2017; 16:263-268. [PMID: 28233750 DOI: 10.5604/16652681.1231585] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The presence of dermatologic reaction as an adverse event to sorafenib treatment in patients with unresectable hepatocellular carcinoma has been indicated as a prognostic factor for survival in a recent prospective analysis. To date, this is the only clinical predictor of treatment response, which can be evaluated earlier in the treatment and, therefore, contribute to a better and more individualized patient management. MATERIAL AND METHODS This retrospective study included 127 patients treated with sorafenib under real-life practice conditions in two hepatology reference centers in Brazil. Demographic data, disease/medical history and time of sorafenib administration as well as adverse events related to the medication were recorded in a database. RESULTS Cirrhosis was present in 94% of patients, 85.6% were Child-Pugh A, 80.3%BCLC-C, 81% had vascular invasion and/or extrahepatic spread and 95% had a performance status 0 to 1.The median duration of treatment was 10.1 months (range: 0.1-47 months).The most common adverse event within the first 60 days of treatment were diarrhea (62.2%) and dermatological reaction (42%).The median overall survival for the cohort was 20 months, and it was higher for patients who developed dermatological reactions within the first 60 days compared to those who did not present this adverse event. CONCLUSION This retrospective analysis showed the use of sorafenib in patients selected according to BCLC staging, and it is the first external validation of early dermatologic adverse events as a predictor of overall survival in patients with advanced hepatocellular carcinoma.
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Affiliation(s)
- Fernanda Branco
- Irmandade Santa Casa de Misericórdia de Porto Alegre Hospital, Department of Hepatology, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Regiane S M Alencar
- São Paulo Clínicas Liver Cancer Group, São Paulo, Cancer Institute of São Paulo and Clínicas Hospital School of Medicine University of São Paulo, Brazil
| | - Fernanda Volt
- Irmandade Santa Casa de Misericórdia de Porto Alegre Hospital, Department of Hepatology, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Giovana Sartori
- Irmandade Santa Casa de Misericórdia de Porto Alegre Hospital, Department of Hepatology, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Andressa Dode
- Irmandade Santa Casa de Misericórdia de Porto Alegre Hospital, Department of Hepatology, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Luciana Kikuchi
- São Paulo Clínicas Liver Cancer Group, São Paulo, Cancer Institute of São Paulo and Clínicas Hospital School of Medicine University of São Paulo, Brazil
| | - Claudia M Tani
- São Paulo Clínicas Liver Cancer Group, São Paulo, Cancer Institute of São Paulo and Clínicas Hospital School of Medicine University of São Paulo, Brazil
| | - Aline L Chagas
- São Paulo Clínicas Liver Cancer Group, São Paulo, Cancer Institute of São Paulo and Clínicas Hospital School of Medicine University of São Paulo, Brazil
| | - Tulio Pfiffer
- Oncology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Paulo Hoff
- Oncology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flair J Carrilho
- São Paulo Clínicas Liver Cancer Group, São Paulo, Cancer Institute of São Paulo and Clínicas Hospital School of Medicine University of São Paulo, Brazil
| | - Angelo A Mattos
- Irmandade Santa Casa de Misericórdia de Porto Alegre Hospital, Department of Hepatology, Federal University of Health Sciences of Porto Alegre, Brazil
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8
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Carrilho FJ, Mattos AAD, Vianey AF, Vezozzo DCP, Marinho F, Souto FJ, Cotrim HP, Coelho HSM, Silva I, Garcia JHP, Kikuchi L, Lofego P, Andraus W, Strauss E, Silva G, Altikes I, Medeiros JE, Bittencourt PL, Parise ER. Brazilian society of hepatology recommendations for the diagnosis and treatment of hepatocellular carcinoma. Arq Gastroenterol 2016; 52 Suppl 1:2-14. [PMID: 26959803 DOI: 10.1590/s0004-28032015000500001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma is a malignancy of global importance and is associated with a high rate of mortality. Recent advances in the diagnosis and treatment of this disease make it imperative to update the recommendations on the management of the disease. In order to draw evidence-based recommendations concering the diagnosis and management of hepatocellular carcinoma, the Brazilian Society of Hepatology has sponsored a single-topic meeting in João Pessoa (PB). All the invited pannelists were asked to make a systematic review of the literature and to present topics related to the risk factors for its development, methods of screening, radiological diagnosis, staging systems, curative and palliative treatments and hepatocellular carcinoma in noncirrhotic liver. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of those recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present paper is the final version of the reviewed manuscript containing the recommendations of the Brazilian Society of Hepatology.
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Affiliation(s)
| | | | | | | | - Fábio Marinho
- Hospital Português de Beneficiência, Recife, PE, Brazil
| | | | | | | | - Ivonete Silva
- Faculdade de Medicina, Universidade Federal de São Paulo, SP, Brazil
| | | | - Luciana Kikuchi
- Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Patricia Lofego
- Faculdade de Medicina, Universidade Federal do Espírito Santo, ES, Brazil
| | | | - Edna Strauss
- Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | | | | | | | | | - Edison R Parise
- Faculdade de Medicina, Universidade Federal de São Paulo, SP, Brazil
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9
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Moreira JP, Malta FDM, Diniz MA, Kikuchi L, Chagas AL, Lima LDSB, Gomes-Gouvêa MS, de Castro VFD, Santana RAF, Sumita NM, Paranagua Vezozzo DC, Carrilho FJ, Pinho JRR. Interferon lambda and hepatitis C virus core protein polymorphisms associated with liver cancer. Virology 2016; 493:136-41. [PMID: 27035616 DOI: 10.1016/j.virol.2016.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/06/2016] [Accepted: 03/09/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is often persistent and gradually advances from chronic hepatitis to liver cirrhosis and hepatocellular carcinoma (HCC). Worldwide, hepatocellular carcinoma is the fifth most common neoplasm. METHOD OF STUDY the Interferon lambda (IFNL) polymorphisms genotypes (rs8099917, rs12979860 and rs12980275) and the presence of mutations in HCV core protein were analyzed in 59 patients with HCC, and also in 50 cirrhotic patients (without HCC). RESULTS the rs12980275-AG genotype was associated with HCC on age-adjusted analysis (OR 2.42, 95% CI 1.03-5.69, P=0.043). Core substitutions R70Q and L91M were mainly found in genotype 1b isolates. Furthermore, a borderline level of statistical significance association was found among the presence of amino acid Glutamine (Q) in the position 70 and IFNL3 genotype AG (P=0.054). CONCLUSIONS the screening of these polymorphisms and functional studies would be useful in clinical practice for identifying groups at high risk of HCC development.
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Affiliation(s)
- João Paulo Moreira
- Laboratory of Tropical Gastroenterology and Hepatology "João Alves de Queiroz and Castorina Bittencourt Alves", LIM-07, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil; Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Fernanda de Mello Malta
- Laboratory of Tropical Gastroenterology and Hepatology "João Alves de Queiroz and Castorina Bittencourt Alves", LIM-07, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil; Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo, Brazil.
| | - Márcio Augusto Diniz
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo, Brazil; Samuel Oschin Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Luciana Kikuchi
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Aline Lopes Chagas
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Livia de Souza Botelho Lima
- Laboratory of Tropical Gastroenterology and Hepatology "João Alves de Queiroz and Castorina Bittencourt Alves", LIM-07, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil; Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Michele Soares Gomes-Gouvêa
- Laboratory of Tropical Gastroenterology and Hepatology "João Alves de Queiroz and Castorina Bittencourt Alves", LIM-07, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil; Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo, Brazil
| | | | | | - Nairo Massakazu Sumita
- Central Laboratory Division of Hospital das Clínicas, University of São Paulo, School of Medicine, São Paulo, Brazil
| | | | - Flair José Carrilho
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - João Renato Rebello Pinho
- Laboratory of Tropical Gastroenterology and Hepatology "João Alves de Queiroz and Castorina Bittencourt Alves", LIM-07, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil; Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil
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10
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Alencar RSSM, Kikuchi L, Tani CM, Chagas AL, Camargo CC, Pfiffer TEF, Hoff PMG, Carrilho FJ. Better Management of Adverse Events Favors Sorafenib Treatment of HCC Patients and Impact on Survival. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jct.2016.74029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Toda KS, Kikuchi L, Chagas AL, Tanigawa RY, Paranaguá-Vezozzo DC, Pfiffer T, Rocha MDS, Alves VAF, Carrilho FJ. Hepatocellular Carcinoma Related to Schistosoma mansoni Infection: Case Series and Literature Review. J Clin Transl Hepatol 2015; 3:260-4. [PMID: 26807381 PMCID: PMC4721893 DOI: 10.14218/jcth.2015.00027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 07/31/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIMS Schistosomiasis is a major chronic disease of humans in endemic regions, and infected individuals may develop a spectrum of pathology, including hepatic fibrosis, hepatosplenomegaly, and portal hypertension. Hepatocellular carcinoma (HCC) is considered the fifth most common cancer in the world, and there is limited and controversial evidence suggesting that Schistosoma mansoni infection may be a possible risk factor for HCC. The aim of this study was to report a case series of patients with HCC and S. mansoni infection and to conduct a literature review on the topic. METHODS From January 2002 to January 2015, an institutional database was screened retrospectively to identify patients with HCC and S. mansoni infection at a single center in the Department of Gastroenterology of University of São Paulo School of Medicine and Hospital das Clínicas, Brazil. RESULTS Seven cases were included. The mean age of patients was 62.1±10.3 years; six (85.7%) were male and one (14.3%) was female. All cases had positive epidemiology, coming from endemic areas of S. mansoni infection in Brazil, and four (57.1%) had previous complications (upper gastrointestinal bleeding) related to portal hypertension or surgery intervention (splenectomy) performed more than 10 years before the HCC diagnosis. Nontumoral portal vein thrombosis was identified in five (71.4%) patients. All patients had negative serology for HCV, and four (57.1%) had positivity of HBVcore antibodies without evidence of viral replication. According to BCLC staging, one (14.3%) patient was BCLC A and received TACE instead of RFA because HCC size was >30 mm; three (42.8%) BCLC B patients received sorafenib instead of local regional treatment due to the presence of nontumoral TPV. During follow-up, all patients developed tumoral progression and died. CONCLUSIONS It remains unclear if S. mansoni infection alone has carcinogenic potential. The available literature indicates that S. Mansoni, in the presence of HBV and HCV infections, likely acts as a cofactor for the hepatic lesion and potentiates injury.
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Affiliation(s)
- Karla Sawada Toda
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Gastroenterology University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luciana Kikuchi
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Gastroenterology University of São Paulo School of Medicine, São Paulo, Brazil
| | - Aline Lopes Chagas
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Gastroenterology University of São Paulo School of Medicine, São Paulo, Brazil
| | - Ryan Yukimatsu Tanigawa
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Pathology University of São Paulo School of Medicine, São Paulo, Brazil
| | - Denise Cerqueira Paranaguá-Vezozzo
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Gastroenterology University of São Paulo School of Medicine, São Paulo, Brazil
| | - Túlio Pfiffer
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Oncology University of São Paulo School of Medicine, São Paulo, Brazil
| | - Manoel de Souza Rocha
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Radiology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Venâncio Avancini Ferreira Alves
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Departments of Pathology University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flair José Carrilho
- São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil
- Correspondence to: Flair José Carrilho, Department of Gastroenterology, University of São Paulo School of Medicine, Av Dr Enéas de Carvalho Aguiar, 255, São Paulo, SP 05403-000, Brazil. Tel: +55-11-2661-7830, Fax: +55-11-2661-7830, E-mail:
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12
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Passos-Castilho AM, Carvalho VM, Cardozo KHM, Kikuchi L, Chagas AL, Gomes-Gouvêa MS, Malta F, de Seixas-Santos Nastri AC, Pinho JRR, Carrilho FJ, Granato CFH. Serum lipidomic profiling as a useful tool for screening potential biomarkers of hepatitis B-related hepatocellular carcinoma by ultraperformance liquid chromatography-mass spectrometry. BMC Cancer 2015; 15:985. [PMID: 26680993 PMCID: PMC4683945 DOI: 10.1186/s12885-015-1995-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 12/10/2015] [Indexed: 01/24/2023] Open
Abstract
Background Chronic hepatitis B (CHB) virus infection is a major cause of hepatocellular carcinoma (HCC), as late diagnosis is the main factor for the poor survival of patients. There is an urgent need for accurate biomarkers for early diagnosis of HCC. The aim of the study was to explore the serum lipidome profiles of hepatitis B-related HCC to identify potential diagnostic biomarkers. Methods An ultraperformance liquid chromatography mass spectrometry (UPLC-MS) lipidomic method was used to characterize serum profiles from HCC (n = 32), liver cirrhosis (LC) (n = 30), CHB (n = 25), and healthy subjects (n = 34). Patients were diagnosed by clinical laboratory and imaging evidence and all presented with CHB while healthy controls had normal liver function and no infectious diseases. Results The UPLC-MS-based serum lipidomic profile provided more accurate diagnosis for LC patients than conventional alpha-fetoprotein (AFP) detection. HCC patients were discriminated from LC with 78 % sensitivity and 64 % specificity. In comparison, AFP showed sensitivity and specificity of 38 % and 93 %, respectively. HCC was differentiated from CHB with 100 % sensitivity and specificity using the UPLC-MS approach. Identified lipids comprised glycerophosphocolines, glycerophosphoserines and glycerophosphoinositols. Conclusions UPLC-MS lipid profiling proved to be an efficient and convenient tool for diagnosis and screening of HCC in a high-risk population. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1995-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ana Maria Passos-Castilho
- Division of Infectious Diseases, Federal University of Sao Paulo, 781 Pedro de Toledo Street, 15th floor, Sao Paulo, SP, 04039032, Brazil.
| | | | | | - Luciana Kikuchi
- Department of Gastroenterology, Sao Paulo Clinicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Sao Paulo, SP, Brazil.
| | - Aline Lopes Chagas
- Department of Gastroenterology, Sao Paulo Clinicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Sao Paulo, SP, Brazil.
| | - Michele Soares Gomes-Gouvêa
- Department of Gastroenterology, Sao Paulo Clinicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Sao Paulo, SP, Brazil.
| | - Fernanda Malta
- Department of Gastroenterology, Sao Paulo Clinicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Sao Paulo, SP, Brazil.
| | | | - João Renato Rebello Pinho
- Department of Gastroenterology, Sao Paulo Clinicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Sao Paulo, SP, Brazil.
| | - Flair José Carrilho
- Department of Gastroenterology, Sao Paulo Clinicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Sao Paulo, SP, Brazil.
| | - Celso Francisco Hernandes Granato
- Division of Infectious Diseases, Federal University of Sao Paulo, 781 Pedro de Toledo Street, 15th floor, Sao Paulo, SP, 04039032, Brazil. .,Fleury Group, Sao Paulo, SP, Brazil.
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13
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Chagas AL, Kikuchi L, Herman P, Alencar RSSM, Tani CM, Diniz MA, Pugliese V, Rocha MDS, D'Albuquerque LAC, Carrilho FJ, Alves VAF. Clinical and pathological evaluation of fibrolamellar hepatocellular carcinoma: a single center study of 21 cases. Clinics (Sao Paulo) 2015; 70:207-13. [PMID: 26017653 PMCID: PMC4449480 DOI: 10.6061/clinics/2015(03)10] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/05/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Fibrolamellar hepatocellular carcinoma is a rare primary malignant liver tumor that differs from conventional hepatocellular carcinoma in several aspects. The aim of this study was to describe the clinical, surgical and histopathological features of fibrolamellar hepatocellular carcinoma and to analyze the factors associated with survival. METHODS We identified 21 patients with histopathologically diagnosed fibrolamellar hepatocellular carcinoma over a 22-year period. Clinical information was collected from medical records and biopsies, and surgical specimens were reviewed. RESULTS The median age at diagnosis was 20 years. Most patients were female (67%) and did not have associated chronic liver disease. Most patients had a single nodule, and the median tumor size was 120 mm. Vascular invasion was present in 31% of patients, and extra-hepatic metastases were present in 53%. Fourteen patients underwent surgery as the first-line therapy, three received chemotherapy, and four received palliative care. Eighteen patients had "pure fibrolamellar hepatocellular carcinoma," whereas three had a distinct area of conventional hepatocellular carcinoma and were classified as having "mixed fibrolamellar hepatocellular carcinoma." The median overall survival was 36 months. The presence of "mixed fibrolamellar hepatocellular carcinoma" and macrovascular invasion were predictors of poor survival. Vascular invasion was associated with an increased risk of recurrence in patients who underwent surgery. CONCLUSION Fibrolamellar hepatocellular carcinoma was more common in young female patients without chronic liver disease. Surgery was the first therapeutic option to achieve disease control, even in advanced cases. Vascular invasion was a risk factor for tumor recurrence. The presence of macrovascular invasion and areas of conventional hepatocellular carcinoma were directly related to poor survival.
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Affiliation(s)
| | | | - Paulo Herman
- São Paulo Clínicas Liver Cancer Group, São Paulo, Brazil
| | | | - Claudia M Tani
- São Paulo Clínicas Liver Cancer Group, São Paulo, Brazil
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14
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Kikuchi L, Menezes M, Chagas AL, Tani CM, Alencar RSSM, Diniz MA, Alves VAF, D’Albuquerque LAC, Carrilho FJ. Percutaneous radiofrequency ablation for early hepatocellular carcinoma: Risk factors for survival. World J Gastroenterol 2014; 20:1585-1593. [PMID: 24587635 PMCID: PMC3925868 DOI: 10.3748/wjg.v20.i6.1585] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/12/2013] [Accepted: 11/29/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate outcomes of radiofrequency ablation (RFA) therapy for early hepatocellular carcinoma (HCC) and identify survival- and recurrence-related factors.
METHODS: Consecutive patients diagnosed with early HCC by computed tomography (CT) or magnetic resonance imaging (MRI) (single nodule of ≤ 5 cm, or multi- (up to 3) nodules of ≤ 3 cm each) and who underwent RFA treatment with curative intent between January 2010 and August 2011 at the Instituto do Câncer do Estado de São Paulo, Brazil were enrolled in the study. RFA of the liver tumors (with 1.0 cm ablative margin) was carried out under CT-fluoro scan and ultrasonic image guidance of the percutaneous ablation probes. Procedure-related complications were recorded. At 1-mo post-RFA and 3-mo intervals thereafter, CT and MRI were performed to assess outcomes of complete response (absence of enhancing tissue at the tumor site) or incomplete response (enhancing tissue remaining at the tumor site). Overall survival and disease-free survival rates were estimated by the Kaplan-Meier method and compared by the log rank test or simple Cox regression. The effect of risk factors on survival was assessed by the Cox proportional hazard model.
RESULTS: A total of 38 RFA sessions were performed during the study period on 34 patients (age in years: mean, 63 and range, 49-84). The mean follow-up time was 22 mo (range, 1-33). The study population showed predominance of male sex (76%), less severe liver disease (Child-Pugh A, n = 26; Child-Pugh B, n = 8), and single tumor (65%). The maximum tumor diameters ranged from 10 to 50 mm (median, 26 mm). The initial (immediately post-procedure) rate of RFA-induced complete tumor necrosis was 90%. The probability of achieving complete response was significantly greater in patients with a single nodule (vs patients with multi-nodules, P = 0.04). Two patients experienced major complications, including acute pulmonary edema (resolved with intervention) and intestinal perforation (led to death). The 1- and 2-year overall survival rates were 82% and 71%, respectively. Sex, tumor size, initial response, and recurrence status influenced survival, but did not reach the threshold of statistical significance. Child-Pugh class and the model for end-stage liver disease score were identified as predictors of survival by simple Cox regression, but only Child-Pugh class showed a statistically significant association to survival in multiple Cox regression analysis (HR = 15; 95%CI: 3-76 mo; P = 0.001). The 1- and 2-year cumulative disease-free survival rates were 65% and 36%, respectively.
CONCLUSION: RFA is an effective therapy for local tumor control of early HCC, and patients with preserved liver function are the best candidates.
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15
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Kikuchi L, Chagas AL, Alencar RS, Paranaguá-Vezozzo DC, Carrilho FJ. Clinical and epidemiological aspects of hepatocellular carcinoma in Brazil. Antivir Ther 2013; 18:445-9. [PMID: 23793796 DOI: 10.3851/imp2602] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2012] [Indexed: 10/26/2022]
Abstract
The global hepatocellular carcinoma (HCC) incidence is widely variable, depending on geographic region and the prevalence of major risk factors. In Brazil, two large multicentre retrospective studies were performed to investigate clinical and epidemiological aspects of HCC. In the first study, performed in 1997, HCC was found in cirrhotic livers in 71% of cases. Chronic alcoholism was present in 36% of cases, chronic hepatitis B in 35% and hepatitis C in 25%. In a 2010 survey, cirrhosis was present in 98% of cases and HCV was the main aetiology (54%). Differences in HBV prevalence were found among regions. Selection of HCC treatment depends on tumour burden, liver function and performance status. Liver transplantation (LT) is the best available curative treatment for HCC in its early stage and with compromised liver function. After modifications in priority policy, the number of patients with early HCC submitted for LT has increased in the past 5 years in Brazil. Chemoembolization is the most common initial HCC therapy in early and intermediate stages of HCC in Brazil.
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Affiliation(s)
- Luciana Kikuchi
- São Paulo Clínicas Liver Cancer Group, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
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16
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Silva MF, Sapisochin G, Strasser SI, Hewa-Geeganage S, Chen J, Wigg AJ, Jones R, Saraiva R, Kikuchi L, Carrilho F, Fontes PRO, Charco R. Liver resection and transplantation offer similar 5-year survival for Child-Pugh-Turcotte A HCC-patients with a single nodule up to 5 cm: a multicenter, exploratory analysis. Eur J Surg Oncol 2013; 39:386-95. [PMID: 23375469 DOI: 10.1016/j.ejso.2012.12.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 11/15/2012] [Accepted: 12/07/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIM The current guideline of the American Association for the Study of Liver Diseases recommends liver resection for Child-Pugh-Turcotte A patients with a single hepatocellular carcinoma, total serum bilirubin ≤ 1 mg/dL and absence of significant portal hypertension. This subset of patients would have a long-term survival comparable to transplantation. The main aim of this study is to evaluate the survival rates in patients with a single nodule ≤ 5 cm following resection. METHODS Medical records of 105 Child-Pugh-Turcotte A patients who underwent liver resection between 1997 and 2009 were analyzed in 3 countries. RESULTS One, 3-, and 5-year survival rate was 97%, 83%, and 66%, respectively, and no variable that can be assessed prior to liver resection predicted survival probabilities. CONCLUSIONS Liver resection offers 5-year survival similar to transplantation for Child-Pugh-Turcotte A patients with hepatocellular carcinoma and a single nodule up to 5 cm, independently of any patient baseline characteristics.
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Affiliation(s)
- M F Silva
- Department of Gastroenterology, Flinders University, Adelaide, Australia.
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Carrilho FJ, Kikuchi L, Branco F, Goncalves CS, Mattos AAD. Clinical and epidemiological aspects of hepatocellular carcinoma in Brazil. Clinics (Sao Paulo) 2010; 65:1285-90. [PMID: 21340216 PMCID: PMC3020338 DOI: 10.1590/s1807-59322010001200010] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 09/14/2010] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES We performed a national survey to update hepatocellular carcinoma (HCC) epidemiology in Brazil and determined the clinical and epidemiological profiles of patients with HCC in different Brazilian regions. METHODS Data from 29 centers included 1,405 patients diagnosed with HCC from 2004 to 2009. RESULTS The median age was 59 (1-92 years old; 78% male). At diagnosis, females were older than males (median age: 62 vs. 59 years old respectively; p<0.0001). Ninety-eight percent of the patients had cirrhosis (1279/1308). Hepatitis C virus was the main etiology (54%), followed by hepatitis B virus (16%) and alcohol (14%). In Southeastern and Southern Brazil, hepatitis C virus accounted for over 55% of cases. In the Northeast and North, hepatitis C virus accounted for less than 50%, and hepatitis B virus accounted for 22-25% of cases; hepatitis B was more prevalent in the Northern than in the Southern regions. Some 43%, 35%, and 22% of patients were in early, intermediate, and advanced stages respectively. Initial therapies for HCC included chemoembolization or embolization (36%), percutaneous ablation (13%), liver resection (7%), and sorafenib (1%). Liver transplantation was performed in 242 patients (19%), but it was the initial therapy for only 56 patients (4%). CONCLUSION The epidemiology, classification, and therapy selection for HCC varied among Brazilian regions. Hepatitis C infection was the most common etiology of liver cirrhosis; chemoembolization was the most common therapy employed. Liver cirrhosis was the main risk factor for HCC development in Brazil.
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Affiliation(s)
- Flair Jose Carrilho
- Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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