Outcome of liver cancer patients with SARS-CoV-2 infection: An International, Multicentre, Cohort Study

BACKGROUND & AIMS

Information about the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with liver cancer is lacking. This study characterizes the outcomes and mortality risk in this population.

METHODS

Multicentre retrospective, cross-sectional, international study of liver cancer patients with SARS-CoV-2 infection registered between February and December 2020. Clinical data at SARS-CoV-2 diagnosis and outcomes were registered.

RESULTS

Two hundred fifty patients from 38 centres were included, 218 with hepatocellular carcinoma (HCC) and 32 with intrahepatic cholangiocarcinoma (iCCA). The median age was 66.5 and 64.5 years, and 84.9% and 21.9% had cirrhosis in the HCC and iCCA cohorts respectively. Patients had advanced cancer stage at SARS-CoV-2 diagnosis in 39.0% of the HCC and 71.9% of the iCCA patients. After a median follow-up of 7.20 (IQR: 1.84-11.24) months, 100 (40%) patients have died, 48% of the deaths were SARS-CoV-2-related. Forty (18.4%) HCC patients died within 30-days. The death rate increase was significantly different according to the BCLC stage (6.10% [95% CI 2.24-12.74], 11.76% [95% CI 4.73-22.30], 20.69% [95% CI 11.35-31.96] and 34.52% [95% CI 17.03-52.78] for BCLC 0/A, B, C and D, respectively; p = .0017). The hazard ratio was 1.45 (95% CI 0.49-4.31; p = .5032) in BCLC-B versus 0/A, and 3.13 (95% CI 1.29-7.62; p = .0118) in BCLC-C versus 0/A in the competing risk Cox regression model. Nineteen out of 32 iCCA (59.4%) died, and 12 deaths were related to SARS-CoV-2 infection.

CONCLUSIONS

This is the largest cohort of liver cancer patients infected with SARS-CoV-2. It characterizes the 30-day mortality risk of SARS-CoV-2 infected patients with HCC during this period.

Assessing the impact of COVID-19 on liver cancer management (CERO-19)

Background & Aims

The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). Herein, we evaluated whether the schedule of LC screening or procedures has been interrupted or delayed because of the COVID-19 pandemic.

Methods

An international survey evaluated the impact of the COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international, and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave.

Results

Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia, and Africa (73.7%, 17.1%, 5.3%, 2.6%, and 1.3% per continent, respectively). Eighty-seven percent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening programme, 50% cancelled curative and/or palliative treatments for LC, and 41.7% modified the liver transplantation programme. Forty-five out of 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service before the COVID-19 pandemic (n = 19/37).

Conclusions

The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with liver cancer. Modifications in screening, diagnostic, and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision-making.

Lay summary

The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems globally. Herein, we assessed the impact of the first wave pandemic on patients with liver cancer and found that routine care for these patients has been majorly disrupted, which could have a significant impact on outcomes.

International and multicenter real-world study of sorafenib-treated patients with hepatocellular carcinoma under dialysis

BACKGROUND & AIMS

Information on safety and efficacy of systemic treatment in patients with hepatocellular carcinoma (HCC) under dialysis are limited due to patient exclusion from clinical trials. Thus, we aimed to evaluate the rate, prevalence, tolerability, and outcome of sorafenib in this population.

METHODS

We report a multicenter study comprising patients from Latin America and Europe. Patients treated with sorafenib were enrolled; demographics, dose modifications, adverse events (AEs), treatment duration, and outcome of patients undergoing dialysis were recorded.

RESULTS

As of March 2018, 6156 HCC patients were treated in 44 centres and 22 patients were concomitantly under dialysis (0.36%). The median age was 65.5 years, 40.9% had hepatitis C, 75% had Child-Pugh A, and 85% were Barcelona Clinic Liver Cancer-C. The median time to first dose modification, treatment duration and overall survival rate were 2.4 months (interquartile ranges [IQR], 0.8-3.8), 10.8 months (IQR, 4.5-16.9), and 17.5 months (95% CI, 7.2-24.5), respectively. Seventeen patients required at least 1 dose modification. The main causes of first dose modification were asthenia/worsening of Eastern Cooperative Oncology Group-Performance Status and diarrhoea. At the time of death or last follow-up, four patients were still on treatment and 18 had discontinued sorafenib: 14 were due to tumour progression, 2 were sorafenib-related, and 2 were non-sorafenib-related AE.

CONCLUSIONS

The outcomes observed in this cohort seem comparable to those in the non-dialysis population. Thus, to the best of our knowledge, this is the largest and most informative dataset regarding systemic treatment outcomes in HCC patients undergoing dialysis.

0272 Effects of Gestational Sleep Restriction on Maternal Behavior in Rodents: A Systematic Review and Meta-Analysis

Introduction

Sleep restriction during pregnancy is related with postpartum depression in clinical settings. Preclinical studies have been conducted in rodent models of maternal behavior, intending to evaluate the mechanisms behind this relationship, but have raised inconsistent data so far. Our aims were to perform a preclinical meta-analysis, evaluating the actual effects or prenatal sleep restriction on maternal behavior in rodents.

Methods

A bibliographic search was conducted in Pubmed, Scopus, Web of Science, Psychinfo and Lilacs. Search strategy encompassed three domains: sleep restriction during pregnancy (as intervention), maternal behavior (as outcome) and experimentation animals (as population). Studies were first selected based on titles and abstracts, followed by full text analysis and data extraction. Individual effect size for each articles was calculated using standardized mean difference and meta-analysis was conducted using a DerSimonian and Laird random effects model.

Results

144 articles were included in our initial data screening. Sample was reduced to six records after screening. A meta-analysis was performed, including data from two maternal behavior tests (pup retrieval test and ethogram-based analyses). A total of 115 animals were included. Meta-analysis showed that sleep restriction during pregnancy have no significant effects on maternal behavior.

Conclusion

Clinical studies and meta-analysis have shown that sleep restriction and disorders during pregnancy increase risk for postpartum depression. However, preclinical studies fail to corroborate these results, as sleep restriction during pregnancy does not reduce maternal behavior in rodents. The presence of negative effects in women and the maintenance of normal maternal behavior levels in rodents under comparable intervention demonstrate that other factors might mediate this relationship (among which, sociocultural factors might play a role). The maintenance of maternal behavior seems to be an adaptive behavior, assuring the suitability and survival of the litter, even in face of environmental stresses.

Support

AFIP, FAVC, CNPq, FAPESP

Peripheral insulin resistance during treatment of chronic hepatitis C with peguilated interferon plus ribavirin

Patients with hepatitis C virus (HCV) infection present higher risk of developing type-2 diabetes mellitus (DM). However, the mechanism of this association and the role of antiviral treatment are still unclear. The objective of this study was to investigate the relationship between the use of peguilated interferon and the development of insulin resistance (IR) in these patients.

METHODS

HOMA index was evaluated in 30 HCV-infected patients just before and during the first 6 months of treatment with peguilated interferon plus ribavirin. Anthropometrical parameters and glucose/cholesterol profile were also monitored.

RESULTS

No changes in HOMA after 6 months of treatment were observed. Glucose levels decreased but not significantly (P = 0.059). Patients with higher HOMA index after 6 months of treatment also presented higher aminotransferase levels (P = 0.03), higher fat index on computed tomography (P = 0.011), longer time of exposure to the virus (P = 0.021), and a positive smoking history when compared to non-insulin resistant patients (P = 0.045). There was no influence of fibrosis stage on liver biopsy in the insulin-resistance development.

CONCLUSIONS

No changes in the IR were observed after 6 months of treatment. Insulin resistance is related to the abdominal fat and anthropometrical parameters rather than to the antiviral treatment.

A versatile X-ray diffraction station at LNLS (Brazil)

Versatility was a major consideration in the project to provide an X-ray diffraction station at LNLS. At least two techniques are possible at the station: powder diffraction and multiple single-crystal diffraction. A two-crystal monochromator based on monolithic elastic translators, developed at LNLS, with sagittal focusing by the second crystal, allows 10 mrad of a >/=2 keV monochromatic beam to be used on the diffractometer. The station is equipped with a fast scintillation detector, imaging plates, a high-energy-resolution pin-diode detector, an ionization chamber and a high-angular-resolution soller slit. The data collection and control hardware and software were also developed at LNLS. The theta-2theta goniometry for powder diffraction on this 1 m-diameter diffractometer is based on commercial rotation tables. The multiple single-crystal goniometry is realized by an independent elastic axis driven by differential micrometers for both high- and low-resolution angular movements. At least four independent axes can be positioned as necessary on the diffractometer table. Powder diffractograms and double-crystal rocking curves collected with the synchrotron beam show the expected quality.