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Loon E, Narvaez-Barbecho C, Ortiz JP, Balderramo D, Carrera E, Diaz-Ferrer J, Arrese M, Mattos AZ, Boonstra A, Debes JD. Impact of self-reported ancestry on the epidemiology of hepatocellular carcinoma. J Gastroenterol Hepatol 2024. [PMID: 38615198 DOI: 10.1111/jgh.16578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Affiliation(s)
- E Loon
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - C Narvaez-Barbecho
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - J P Ortiz
- Gastroenterología y Hepatología, Centro de Enfermedades Hepáticas y Digestivas, Bogotá, Colombia
| | - D Balderramo
- Department of Gastroenterology, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - E Carrera
- Department of Gastroenterology and Hepatology, Hospital Eugenio Espejo, Quito, Ecuador
| | - J Diaz-Ferrer
- Department of Gastroenterology, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - M Arrese
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - A Z Mattos
- Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - A Boonstra
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J D Debes
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
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Fu S, Karim D, Prieto J, Balderramo D, Ferrer JD, Mattos AZ, Arrese M, Carrera E, Oliveira J, Debes JD, Boonstra A. Assessment of TLL1 variant and risk of hepatocellular carcinoma in Latin Americans and Europeans. Ann Hepatol 2024; 29:101181. [PMID: 37981236 DOI: 10.1016/j.aohep.2023.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/11/2023] [Accepted: 11/06/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES Tolloid like protein 1 (TLL1) rs17047200 has been reported to be associated with HCC development and liver fibrosis. However, to our knowledge, no studies have been performed on Latin Americans and comparative differences between TLL1 rs17047200 in HCC patients from Latin America and Europe are undefined. MATERIALS AND METHODS Cross-sectional analysis was performed on Latin American and European individuals. We analyzed TLL1 rs17047200 on DNA from 1194 individuals, including 420 patients with HCC (86.0 % cirrhotics) and 774 without HCC (65.9 % cirrhotics). RESULTS TLL1 rs17047200 genotype AT/TT was not associated with HCC development in Latin Americans (OR: 0.699, 95 %CI 0.456-1.072, p = 0.101) or Europeans (OR: 0.736, 95 %CI 0.447-1.211, p = 0.228). TLL1 AT/TT was not correlated with fibrosis stages among metabolic dysfunction-associated steatotic liver disease (MASLD) patients from Latin America (OR: 0.975, 95 %CI 0.496-1.918, p = 0.941). Among Europeans, alcohol-related HCC had lower TLL1 AT/TT frequencies than cirrhosis (18.3 % versus 42.3 %, OR: 0.273, 95 %CI 0.096-0.773, p = 0.015). CONCLUSIONS We found no evidence that the TLL1 rs17047200 AT/TT genotype is a risk factor for HCC development in Latin Americans or Europeans. A larger study integrating ethnic and etiology backgrounds is needed to determine the importance of the TLL1 SNP in HCC development.
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Affiliation(s)
- Siyu Fu
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dhamina Karim
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jhon Prieto
- Centro de Enfermedades Hepaticas y Digestivas, Bogota, Distrito Capital de Bogota, Colombia
| | - Domingo Balderramo
- Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Cordoba, Argentina
| | | | - Angelo Z Mattos
- Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Marco Arrese
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Enrique Carrera
- Hospital Especialidades Eugenio Espejo, Universidad San Francisco de Quito, Quito, Ecuador
| | - Jeffrey Oliveira
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jose D Debes
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; School of Public Health, University of Minnesota, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Andre Boonstra
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Goble S, Akambase J, Prieto J, Balderramo D, Ferrer JD, Mattos AZ, Arrese M, Carrera E, Groothuismink ZMA, Oliveira J, Boonstra A, Debes JD. MBOAT7 rs641738 Variant Is Not Associated with an Increased Risk of Hepatocellular Carcinoma in a Latin American Cohort. Dig Dis Sci 2023; 68:4212-4220. [PMID: 37684433 PMCID: PMC10570183 DOI: 10.1007/s10620-023-08104-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The rs641738 C > T single-nucleotide polymorphism of MBOAT7 has been associated with hepatocellular carcinoma (HCC) and nonalcoholic fatty liver disease (NAFLD). Latin Americans have high rates of HCC and NAFLD, but no assessment between MBOAT7 and HCC has been performed in this population. AIMS We provide the first assessment of the impact of MBOAT7 on HCC risk in Latin Americans. METHODS Patients were prospectively recruited into the ESCALON network, designed to collect samples from Latin American patients with HCC in 6 South American countries (Argentina, Ecuador, Brazil, Chile, Peru, and Colombia). A European cohort and the general Hispanic population of gnomAD database were included for comparison. Associations between HCC and MBOAT7 were evaluated using logistic regression. RESULTS In total, 310 cases of HCC and 493 cases of cirrhosis without HCC were assessed. The MBOAT7 TT genotype was not predictive of HCC in Latin Americans (TT vs CC OR adjusted = 1.15, 95% CI 0.66-2.01, p = 0.610) or Europeans (TT vs CC OR adjusted = 1.20, 95% CI 0.59-2.43, p = 0.621). No significant association was noted on subgroup analysis for NAFLD, viral hepatitis, or alcohol-related liver disease. The TT genotype was increased in the NAFLD-cirrhosis cohort of Latin Americans compared to a non-cirrhotic NAFLD cohort (TT vs CC + CT OR = 2.75, 95% CI 1.10-6.87, p = 0.031). CONCLUSION The rs631738 C > T allele of MBOAT7 was not associated with increased risk of HCC in Latin Americans or Europeans. An increase in the risk of cirrhosis was noted with the TT genotype in Latin Americans with NAFLD.
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Affiliation(s)
| | | | - Jhon Prieto
- Centro de Enfermedades Hepaticas y Digestives, Bogotá, Colombia
| | - Domingo Balderramo
- Department of Gastroenterology, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | | | - Angelo Z Mattos
- Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Marco Arrese
- Department of Gastroenterology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Enrique Carrera
- Departamento de Gastroenterologia y Hepatologia, Hospital Eugenio Espejo, Quito, Ecuador
| | - Zwier M A Groothuismink
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeffrey Oliveira
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Andre Boonstra
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jose D Debes
- Hennepin Healthcare, Minneapolis, MN, USA.
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
- Department of Medicine, University of Minnesota, Mayo Memorial Building, MMC 250, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
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Beudeker BJ, Fu S, Balderramo D, Mattos AZ, Carrera E, Diaz J, Prieto J, Banales J, Vogel A, Arrese M, Oliveira J, Groothuismink ZM, van Oord G, Hansen BE, de Man RA, Debes JD, Boonstra A. Validation and optimization of AFP-based biomarker panels for early HCC detection in Latin America and Europe. Hepatol Commun 2023; 7:e0264. [PMID: 37708457 PMCID: PMC10503685 DOI: 10.1097/hc9.0000000000000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/21/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND HCC is a major cause of cancer death worldwide. Serum biomarkers such as alpha-fetoprotein (AFP), protein induced by vitamin K absence-II, and the Gender, Age, AFP-L3, AFP, Des-gamma-carboxy prothrombin (GALAD) score have been recommended for HCC surveillance. However, inconsistent recommendations in international guidelines limit their clinical utility. METHODS In this multicenter study, over 2000 patient samples were collected in 6 Latin American and 2 European countries. The performance of the GALAD score was validated in cirrhotic cases, and optimized versions were tested for early-stage HCC and prediagnostic HCC detection. RESULTS The GALAD score could distinguish between HCC and cirrhosis in Latin American patients with an AUC of 0.76, sensitivity of 70%, and specificity of 83% at the conventional cutoff value of -0.63. In a European cohort, GALAD had an AUC of 0.69, sensitivity of 66%, and specificity of 72%. Optimizing the score in the 2 large multicenter cohorts revealed that AFP-L3 contributed minimally to early-stage HCC detection. Thus, we developed a modified GALAD score without AFP-L3, the ASAP (age, sex, AFP, and protein induced by vitamin K absence-II), which showed promise for early-stage HCC detection upon validation. The ASAP score also identified patients with cirrhosis at high risk for advanced-stage HCC up to 15 months before diagnosis (p < 0.0001) and differentiated HCC from hemangiomas, with a specificity of 100% at 71% sensitivity. CONCLUSION Our comprehensive analysis of large sample cohorts validates the GALAD score's utility in Latin American, Spanish, and Dutch patients for early-stage HCC detection. The optimized GALAD without AFP-L3, the ASAP score, is a good alternative and shows greater promise for HCC prediction.
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Affiliation(s)
- Boris J.B. Beudeker
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Siyu Fu
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Domingo Balderramo
- Department of Gastroenterology, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Angelo Z. Mattos
- Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Enrique Carrera
- Departamento de Gastroenterologia y Hepatologia, Hospital Eugenio Espejo, Quito, Ecuador
| | - Javier Diaz
- Department of Gastroenterology, Hospital Nacional Edgardo Rebagliati Martins, HNERM, Lima, Peru
| | - Jhon Prieto
- Centro de Enfermedades Hepáticas y Digestivas (CEHYD), Bogota, Colombia
| | - Jesus Banales
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain
- Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Marco Arrese
- Department of Gastroenterology, Pontificia Universidad Catolica de Chile, Santiago, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Jeffrey Oliveira
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Zwier M.A. Groothuismink
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Gertine van Oord
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Bettina E. Hansen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands, IHPME, University of Toronto & Toronto Center for Liver Disease, University Health Network, Toronto, Canada, Toronto
| | - Robert A. de Man
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - José D. Debes
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andre Boonstra
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Ayoub A, Anugwom CM, Prieto J, Balderramo D, Ferrer JD, Mattos AZ, Arrese M, Carrera E, Groothuismink ZMA, Oliveira J, Boonstra A, Debes JD. Assessment of STAT4 Variants and Risk of Hepatocellular Carcinoma in Latin Americans and Europeans. Cancers (Basel) 2023; 15:4530. [PMID: 37760499 PMCID: PMC10527221 DOI: 10.3390/cancers15184530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/02/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide. The STAT4 rs7574865 genetic variant has been associated with an increased risk of developing HCC in Asian populations. However, this association has not been studied in Latin America and is poorly assessed in European populations. This case-control study investigated the association between STAT4 rs7574865 and HCC risk in these populations. We evaluated DNA samples from seven medical institutions across six Latin American countries and one Dutch institution in 1060 individuals (344 HCC and 716 controls). STAT4 rs7574865 SNP was genotyped using TaqMan-genotyping assay and analyzed using logistic regression. We found no significant association between the homozygous risk allele (G) of STAT4 and HCC development in either population, with odds ratios (OR) for GG versus TT of 0.85 (CI: 0.48-1.52, p = 0.58) and 0.81 (CI: 0.34-1.93, p = 0.67) for Latin Americans and Europeans respectively. No correlation was found between the risk allele and HCC based on underlying liver disease. However, we found that Latin Americans of European ancestry were more likely to carry the risk allele. Our results suggest that the STAT4 SNP rs7574865 does not influence the risk of developing HCC in Latin American or European populations, highlighting the importance of evaluating genetic risk factors in various ethnic groups and understanding the possible influence of ancestry on the genetic basis of disease.
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Affiliation(s)
- Alan Ayoub
- Faculty of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Chimaobi M. Anugwom
- Department of Medicine, Division of Gastroenterology, Division of Infectious Disease, University of Minnesota, Minneapolis, MN 55455, USA;
- Health Partners Digestive Care, Saint Paul, MN 55130, USA
| | - Jhon Prieto
- Centro de Enfermedades Hepaticas y Digestives, Bogota 110121, Colombia;
| | - Domingo Balderramo
- Department of Gastroenterology, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba X5016, Argentina;
| | - Javier Diaz Ferrer
- Department of Gastroenterology, Universidad San Martin de Porres, Lima 15024, Peru;
| | - Angelo Z. Mattos
- Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil;
| | - Marco Arrese
- Department of Gastroenterology, Pontificia Universidad Católica de Chile, Santiago 3580000, Chile;
| | - Enrique Carrera
- Department of Gastroenterology, Universidad San Francisco de Quito, Quito 170901, Ecuador;
| | - Zwier M. A. Groothuismink
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; (Z.M.A.G.); (J.O.); (A.B.)
| | - Jeffrey Oliveira
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; (Z.M.A.G.); (J.O.); (A.B.)
| | - Andre Boonstra
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; (Z.M.A.G.); (J.O.); (A.B.)
| | - Jose D. Debes
- Department of Medicine, Division of Gastroenterology, Division of Infectious Disease, University of Minnesota, Minneapolis, MN 55455, USA;
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; (Z.M.A.G.); (J.O.); (A.B.)
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Goble S, Mattos AZ, Mendizabal M, Debes JD. Hepatitis C and hepatocellular carcinoma in Latin America: Elimination as a path to cancer prevention. Ann Hepatol 2023; 28:101149. [PMID: 37660995 DOI: 10.1016/j.aohep.2023.101149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Spencer Goble
- Division of Gastroenterology & Hepatology, Hennepin Healthcare, Minneapolis, MN, USA
| | - Angelo Z Mattos
- Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Manuel Mendizabal
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
| | - Jose D Debes
- Division of Gastroenterology & Hepatology, Hennepin Healthcare, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
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Intagliata NM, Rahimi RS, Higuera-de-la-Tijera F, Simonetto DA, Farias AQ, Mazo DF, Boike JR, Stine JG, Serper M, Pereira G, Mattos AZ, Marciano S, Davis JPE, Benitez C, Chadha R, Méndez-Sánchez N, deLemos AS, Mohanty A, Dirchwolf M, Fortune BE, Northup PG, Patrie JT, Caldwell SH. Procedural-Related Bleeding in Hospitalized Patients With Liver Disease (PROC-BLeeD): An International, Prospective, Multicenter Observational Study. Gastroenterology 2023; 165:717-732. [PMID: 37271290 DOI: 10.1053/j.gastro.2023.05.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND & AIMS Hospitalized patients with cirrhosis frequently undergo multiple procedures. The risk of procedural-related bleeding remains unclear, and management is not standardized. We conducted an international, prospective, multicenter study of hospitalized patients with cirrhosis undergoing nonsurgical procedures to establish the incidence of procedural-related bleeding and to identify bleeding risk factors. METHODS Hospitalized patients were prospectively enrolled and monitored until surgery, transplantation, death, or 28 days from admission. The study enrolled 1187 patients undergoing 3006 nonsurgical procedures from 20 centers. RESULTS A total of 93 procedural-related bleeding events were identified. Bleeding was reported in 6.9% of patient admissions and in 3.0% of the procedures. Major bleeding was reported in 2.3% of patient admissions and in 0.9% of the procedures. Patients with bleeding were more likely to have nonalcoholic steatohepatitis (43.9% vs 30%) and higher body mass index (BMI; 31.2 vs 29.5). Patients with bleeding had a higher Model for End-Stage Liver Disease score at admission (24.5 vs 18.5). A multivariable analysis controlling for center variation found that high-risk procedures (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.44-8.84), Model for End-Stage Liver Disease score (OR, 2.37; 95% CI, 1.46-3.86), and higher BMI (OR, 1.40; 95% CI, 1.10-1.80) independently predicted bleeding. Preprocedure international normalized ratio, platelet level, and antithrombotic use were not predictive of bleeding. Bleeding prophylaxis was used more routinely in patients with bleeding (19.4% vs 7.4%). Patients with bleeding had a significantly higher 28-day risk of death (hazard ratio, 6.91; 95% CI, 4.22-11.31). CONCLUSIONS Procedural-related bleeding occurs rarely in hospitalized patients with cirrhosis. Patients with elevated BMI and decompensated liver disease who undergo high-risk procedures may be at risk to bleed. Bleeding is not associated with conventional hemostasis tests, preprocedure prophylaxis, or recent antithrombotic therapy.
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Affiliation(s)
| | | | | | | | | | - Daniel F Mazo
- School of Medical Sciences of University of Campinas (UNICAMP), São Paulo, Brazil
| | - Justin R Boike
- Northwestern University Feinburg School of Medicine, Chicago, Illinois
| | - Jonathan G Stine
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Marina Serper
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Gustavo Pereira
- Bonsucesso Federal Hospital (Ministry of Health), Rio de Janeiro, Brazil, and Estácio de Sá School of Medicine-Instituto de Educação Médica, Rio de Janeiro, Brazil
| | - Angelo Z Mattos
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | | | | | - Carlos Benitez
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Nahum Méndez-Sánchez
- Medica Sur Clinic & Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Andrew S deLemos
- Wake Forest University School of Medicine, Atrium Health, Charlotte, North Carolina
| | - Arpan Mohanty
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | | | - Brett E Fortune
- Montefiore Einstein Center for Transplantation, New York, New York
| | | | - James T Patrie
- University of Virginia School of Medicine, Charlottesville, Virginia
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8
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Farias AQ, Curto Vilalta A, Momoyo Zitelli P, Pereira G, Goncalves LL, Torre A, Diaz JM, Gadano AC, Mattos AZ, Mendes LSC, Alvares-da-Silva MR, Bittencourt PL, Benitez C, Couto CA, Mendizabal M, Toledo CL, Mazo DFC, Castillo Barradas M, Uson Raposo EM, Padilla-Machaca PM, Zarela Lozano Miranda A, Malé-Velázquez R, Castro Lyra A, Dávalos-Moscol MB, Pérez Hernández JL, Ximenes RO, Faria Silva G, Beltrán-Galvis OA, González Huezo MS, Bessone F, Rocha TDS, Fassio E, Terra C, Marín JI, Sierra Casas P, de la Peña-Ramirez C, Aguilar Parera F, Fernandes F, da Penha Zago-Gomes M, Méndez-Guerrero O, Marciano S, Mattos AA, Oliveira JC, Guerreiro GTS, Codes L, Arrese M, Nardelli MJ, Silva MO, Palma-Fernandez R, Alcantara C, Sánchez Garrido C, Trebicka J, Gustot T, Fernández J, Clària J, Jalan R, Angeli P, Arroyo V, Moreau R, Carrilho FJ. Genetic Ancestry, Race, and Severity of Acutely Decompensated Cirrhosis in Latin America. Gastroenterology 2023; 165:696-716. [PMID: 37263305 DOI: 10.1053/j.gastro.2023.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND & AIMS Genetic ancestry or racial differences in health outcomes exist in diseases associated with systemic inflammation (eg, COVID-19). This study aimed to investigate the association of genetic ancestry and race with acute-on-chronic liver failure (ACLF), which is characterized by acute systemic inflammation, multi-organ failure, and high risk of short-term death. METHODS This prospective cohort study analyzed a comprehensive set of data, including genetic ancestry and race among several others, in 1274 patients with acutely decompensated cirrhosis who were nonelectively admitted to 44 hospitals from 7 Latin American countries. RESULTS Three hundred ninety-five patients (31.0%) had ACLF of any grade at enrollment. Patients with ACLF had a higher median percentage of Native American genetic ancestry and lower median percentage of European ancestry than patients without ACLF (22.6% vs 12.9% and 53.4% vs 59.6%, respectively). The median percentage of African genetic ancestry was low among patients with ACLF and among those without ACLF. In terms of race, a higher percentage of patients with ACLF than patients without ACLF were Native American and a lower percentage of patients with ACLF than patients without ACLF were European American or African American. In multivariable analyses that adjusted for differences in sociodemographic and clinical characteristics, the odds ratio for ACLF at enrollment was 1.08 (95% CI, 1.03-1.13) with Native American genetic ancestry and 2.57 (95% CI, 1.84-3.58) for Native American race vs European American race CONCLUSIONS: In a large cohort of Latin American patients with acutely decompensated cirrhosis, increasing percentages of Native American ancestry and Native American race were factors independently associated with ACLF at enrollment.
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Affiliation(s)
- Alberto Queiroz Farias
- The Department of Gastroenterology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Anna Curto Vilalta
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
| | - Patricia Momoyo Zitelli
- The Department of Gastroenterology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Gustavo Pereira
- Gastroenterology and Hepatology Unit, Bonsucesso Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil; Estácio de Sá University, School of Medicine, Rio de Janeiro, Brazil
| | - Luciana L Goncalves
- Gastroenterology and Hepatology Unit, Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Aldo Torre
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán," Mexico City, Mexico
| | - Juan Manuel Diaz
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain; Liver Unit and Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Adrian C Gadano
- Liver Unit and Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Angelo Z Mattos
- Federal University of Health Sciences of Porto Alegre, and Gastroenterology and Hepatology Unit, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | | | - Mario R Alvares-da-Silva
- Gastrointestinal and Liver Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Carlos Benitez
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Alves Couto
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Manuel Mendizabal
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Claudio L Toledo
- Universidad Austral de Chile, Hospital Valdivia, Valdivia, Chile
| | - Daniel F C Mazo
- Division of Gastroenterology, University of Campinas, Campinas, Brazil
| | - Mauricio Castillo Barradas
- Servicio de Gastroenterología y Hepatología, Hospital de Especialidades Centro Médico Nacional La Raza Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Eva M Uson Raposo
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
| | | | | | | | - André Castro Lyra
- Hospital Universtário Professor Edgard Santos, Salvador, Brazil; Hospital São Rafael, Salvador, Brazil
| | | | - José L Pérez Hernández
- Clínica de hígado, Hospital General de México "Dr. Eduardo Liceaga," Mexico City, Mexico
| | - Rafael O Ximenes
- Serviço de Gastroenterologia e Hepatologia, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia, Brazil
| | | | - Oscar A Beltrán-Galvis
- Grupo Gastro-Hepatología y Trasplante Fundación Cardioinfantil LaCardio, Medellín, Colombia
| | - María S González Huezo
- Departamento de Gastroenterología, Centro Médico Instituto de Seguridad Social del Estado de México y Municipios, Metepec, Mexico
| | - Fernando Bessone
- Hospital Provincial del Centenario, Universidad Nacional de Rosario, Rosario, Argentina
| | | | - Eduardo Fassio
- Sección Hígado, Vías Biliares y Páncreas del Servicio de Gastroenterología, Hospital Nacional Profesor Alejandro, Buenos Aires, Argentina
| | - Carlos Terra
- Serviço de Gastroenterologia, Unidade de Hepatologia, Hospital Universitario Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juan I Marín
- Bogotá and Hospital Pablo Tobón Uribe, Medellín, Colombia
| | | | | | | | - Flavia Fernandes
- Gastroenterology and Hepatology Unit, Bonsucesso Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil
| | - Maria da Penha Zago-Gomes
- Gastroenterology and Hepatology Unit, Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Osvely Méndez-Guerrero
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán," Mexico City, Mexico
| | - Sebastián Marciano
- Liver Unit and Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Angelo A Mattos
- Federal University of Health Sciences of Porto Alegre, and Gastroenterology and Hepatology Unit, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | | | - Gabriel T S Guerreiro
- Gastrointestinal and Liver Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Liana Codes
- Hospital Português da Bahia, Salvador, Brazil
| | - Marco Arrese
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro de Envejecimiento y Regeneracion, Departamento de Biologia Celular y Molecular, Facultad de Ciencias Biologicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mateus J Nardelli
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marcelo O Silva
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | | | - Camila Alcantara
- Gastroenterology and Hepatology Unit, Bonsucesso Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil
| | | | - Jonel Trebicka
- Medizinische Klinik B (Gastroenterologie, Hepatologie, Endokrinologie, Klinische Infektiologie), Münster, Germany
| | - Thierry Gustot
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain; Department of Gastroenterology and Hepato-Pancreatology, Cliniques Universitaires de Bruxelles Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Javier Fernández
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain; Hospital Clínic Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Joan Clària
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain; Hospital Clínic Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas Barcelona, Spain
| | - Rajiv Jalan
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain; Liver Failure Group, Institute for Liver Disease Health, University College London, Royal Free Hospital, London, United Kingdom
| | - Paolo Angeli
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain; Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Vicente Arroyo
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
| | - Richard Moreau
- European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain; Institut National de la Santé et de la Recherche Médicale, Université Paris Cité, Centre de Recherche sur l'Inflammation, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Service d'Hépatologie, Clichy, France.
| | - Flair J Carrilho
- The Department of Gastroenterology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
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9
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Akambase JA, Prieto JE, Mattos AZ, Mattos AA, Carrera E, Díaz-Ferrer J, Gallardo P, Curia A, Ballerga EG, Tovo CV, Balderramo D, Debes JD. Epidemiology and risk factors for histopathologic characteristics of non-alcoholic fatty liver disease in South America. Aliment Pharmacol Ther 2023; 58:526-536. [PMID: 37349900 DOI: 10.1111/apt.17615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The burden of non-alcoholic fatty liver disease (NAFLD) in South America is among the highest in the world. However, the epidemiology and risk factors for NAFLD are insufficiently described in the region. AIM To explore the associations between clinical characteristics and histopathological features of NAFLD METHODS: This was a descriptive study of 2722 patients with NAFLD from 8 medical centres across 5 South American countries. We collected clinical, biochemical and histopathological data using a templated chart. Fibrosis was assessed by elastography or fibrosis scores and confirmed with biopsy when available. We examined associations between histopathological features and clinical characteristics with logistic regression models. Models were adjusted for country, age and sex. RESULTS The median age was 53 years (IQR: 41-62), and 63% were women. Subjects from Brazil had the highest body mass index at 42 kg/m2 . Sixty-seven percent had dyslipidemia, 46% had obesity, 30% had hypertension, 17% had type 2 diabetes mellitus (T2DM) and 34% had metabolic syndrome. Biopsy reports were available for 948 (35%), of which 58% showed fibrosis, 91% steatosis and 65% inflammation; 25% showed significant fibrosis and 27% severe steatosis. Metabolic syndrome, T2DM and hypertension were significantly associated with significant fibrosis (OR = 1.94, p < 0.001; OR = 2.93, p < 0.001 and OR = 1.60, p = 0.003, respectively), severe steatosis (OR = 2.05, p < 0.001; OR = 1.91, p = 0.001 and OR = 2.17, p < 0.001, respectively) and liver inflammation (OR = 1.66, p = 0.007; OR = 2.00, p = 0.002; OR = 1.62, p = 0.001, respectively). CONCLUSIONS In the largest NAFLD cohort study to date from South America, metabolic syndrome, hypertension and T2DM were independently associated with significant fibrosis, severe steatosis, and inflammation. The prevalence of T2DM was lower than the reported global prevalence.
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Affiliation(s)
- Joseph A Akambase
- Division of Epidemiology and Community Health, School of Medicine, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Jhon E Prieto
- Centro de Enfermedades Hepáticas y Digestivas, Bogotá, Colombia
| | - Angelo Z Mattos
- Graduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Angelo A Mattos
- Graduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Enrique Carrera
- Departamento de Gastroenterología y Hepatología, Hospital Eugenio Espejo, Quito, Ecuador
| | - Javier Díaz-Ferrer
- Department of Gastroenterology, Hospital Nacional Edgardo Rebagliati Martins, HNERM, Lima, Peru
| | | | - Andrea Curia
- División Gastroenterology, Hospital de Clínicas José de San Martín - UBA, Buenos Aires, Argentina
| | - Esteban G Ballerga
- División Gastroenterology, Hospital de Clínicas José de San Martín - UBA, Buenos Aires, Argentina
| | - Cristiane V Tovo
- Graduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Domingo Balderramo
- Departamento de Gastroenterología, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Jose D Debes
- Division of Epidemiology and Community Health, School of Medicine, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
- Department of Medicine, University of MInnesota, Minneapolis, United States
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10
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Farah M, Anugwom C, Ferrer JD, Baca EL, Mattos AZ, Possebon JPP, Arrese M, Prieto J, Balderramo D, Carrera E, Debes JD. Changing epidemiology of hepatocellular carcinoma in South America: A report from the South American liver research network. Ann Hepatol 2023; 28:100876. [PMID: 36400386 DOI: 10.1016/j.aohep.2022.100876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Most epidemiological data on hepatocellular carcinoma (HCC) originate from resource-rich countries. We have previously described the epidemiology of HCC in South America through the South American Liver Research Network. Here, we provide an update on the changing epidemiology of HCC in the continent seven years since that report. MATERIALS AND METHODS We evaluated all cases of HCC diagnosed between 2019 to 2021 in centers from six countries in South America. A templated, retrospective chart review of patient characteristics at the time of HCC diagnosis, including basic demographic, clinical and laboratory data, was completed. Diagnosis of HCC was made radiologically or histologically for all cases via institutional standards. RESULTS Centers contributed to a total of 339 HCC cases. Peru accounted for 37% (n=125) of patients; Brazil 16% (n=57); Chile 15% (n=51); Colombia 14% (n=48); Argentina 9% (n=29); and Ecuador 9% (n=29). The median age at HCC diagnosis was 67 years (IQR 59-73) and 61% were male. The most common risk factor was nonalcoholic fatty liver disease (NAFLD, 37%), followed by hepatitis C (17%), alcohol use disorder (11%) and hepatitis B (12%). The majority of HCCs occurred in the setting of cirrhosis (80%). HBV-related HCC occurred at a younger age compared to other causes, with a median age of 46 years (IQR 36-64). CONCLUSIONS We report dramatic changes in the epidemiology of HCC in South America over the last decade, with a substantial increase in NAFLD-related HCC. HBV-related HCC still occurs at a much younger age when compared to other causes.
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Affiliation(s)
| | - Chimaobi Anugwom
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Javier Diaz Ferrer
- Department of Gastroenterology, Hospital Nacional Edgardo Rebagliati Martins, HNERM, Lima, Peru
| | - Estefania Liza Baca
- Department of Gastroenterology, Hospital Nacional Edgardo Rebagliati Martins, HNERM, Lima, Peru
| | - Angelo Z Mattos
- Department of Gastroenterology, Federal University of Health Sciences of Porto Alegre, Graduate Program in Medicine: Hepatology, Porto Alegre, Brazil
| | - João Pedro P Possebon
- Department of Gastroenterology, Federal University of Health Sciences of Porto Alegre, Graduate Program in Medicine: Hepatology, Porto Alegre, Brazil
| | - Marco Arrese
- Department of Gastroenterology, Pontificia Universidad Catolica de Chile, Santiago, Chile. and Centro de Envejecimiento y Regeneracion (CARE), Facultad de Ciencias Biologicas, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Jhon Prieto
- Centro de Enfermedades Hepáticas y Digestivas (CEHYD), Bogota, Colombia
| | - Domingo Balderramo
- Department of Gastroenterology, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Enrique Carrera
- Departamento de Gastroenterologia y Hepatologia, Hospital Eugenio Espejo, Quito, Ecuador
| | - Jose D Debes
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.
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11
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Debes JD, Romagnoli PA, Prieto J, Arrese M, Mattos AZ, Boonstra A. Serum Biomarkers for the Prediction of Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13071681. [PMID: 33918270 PMCID: PMC8038187 DOI: 10.3390/cancers13071681] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/22/2021] [Accepted: 03/28/2021] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of global cancer death. Major etiologies of HCC relate to chronic viral infections as well as metabolic conditions. The survival rate of people with HCC is very low and has been attributed to late diagnosis with limited treatment options. Combining ultrasound and the biomarker alpha-fetoprotein (AFP) is currently one of the most widely used screening combinations for HCC. However, the clinical utility of AFP is controversial, and the frequency and operator-dependence of ultrasound lead to a variable degree of sensitivity and specificity across the globe. In this review, we summarize recent developments in the search for non-invasive serum biomarkers for early detection of HCC to improve prognosis and outcome for patients. We focus on tumor-associated protein markers, immune mediators (cytokines and chemokines), and micro-RNAs in serum or circulating extracellular vesicles and examine their potential for clinical application.
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Affiliation(s)
- José D. Debes
- Department of Gastroenterology and Hepatology, Erasmus MC Rotterdam, 3015 CE Rotterdam, The Netherlands
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
- Correspondence: (J.D.D.); (A.B.)
| | - Pablo A. Romagnoli
- Centro de Investigaciones en Medicina Translacional “Severo Amuchastegui” (CIMETSA), Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba 5016, Argentina;
| | - Jhon Prieto
- Centro de Enfermedades Hepaticas y Digestivas, Bogota CS412, Colombia;
| | - Marco Arrese
- Department of Gastroenterology, Escuela de Medicina, & Centro de Envejecimiento y Regeneración (CARE), Pontificia Universidad Católica de Chile, Santiago 8330077, Chile;
| | - Angelo Z. Mattos
- Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porte Alegre 90050-170, Brazil;
| | - André Boonstra
- Department of Gastroenterology and Hepatology, Erasmus MC Rotterdam, 3015 CE Rotterdam, The Netherlands
- Correspondence: (J.D.D.); (A.B.)
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12
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Anugwom CM, Allaire M, Akbar SMF, Sultan A, Bollipo S, Mattos AZ, Debes JD. Hepatitis B-related hepatocellular carcinoma: surveillance strategy directed by immune-epidemiology. Hepatoma Res 2021; 7. [PMID: 33884303 PMCID: PMC8057710 DOI: 10.20517/2394-5079.2021.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hepatitis B infection (HBV) is one of the most common causes of hepatocellular carcinoma (HCC) worldwide. The age of occurrence, prognosis and incidence vary dramatically depending on the region of the world. This geographic variation is largely dependent on the contrasting incidence of HBV, age of transmission of the virus, the timing of integration into the human genome, and different HBV genotypes, as well as environmental factors. It results in a wide difference in viral interaction with the immune system, genomic modulation and the consequent development of HCC in an individual. In this review, we describe many factors implicated in HCC development, provide insight regarding at-risk populations and explain societal recommendations for HCC surveillance in persons living with HBV in different continents of the world.
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Affiliation(s)
- Chimaobi M Anugwom
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis 55455, USA
| | - Manon Allaire
- Sorbonne Université, Service d'Hépatologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris 75103, France.,Inserm U1149, Centre de Recherche sur l'Inflammation, France Faculté de Médecine, Xavier Bichat, Université Paris Diderot, Paris 75108, France
| | - Sheikh Mohammad Fazle Akbar
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon 791-0295, Japan
| | - Amir Sultan
- College of Health Sciences, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa 5657, Ethiopia
| | - Steven Bollipo
- Department of Gastroenterology, John Hunter Hospital, Newcastle, Australia & School of Medicine & Public Health, University of Newcastle, New South Wales 2310, Australia
| | - Angelo Z Mattos
- Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre 90050-170, Brazil.,Gastroenterology and Hepatology Unit, Irmandade Santa Casa de Misericórdia de Porto Alegre 90020-090, Brazil
| | - Jose D Debes
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis 55455, USA.,Department of Medicine, Division of Infectious Diseases, University of Minnesota, Minneapolis, MN 55455, USA.,Department of Gastroenterology & Hepatology, Erasmus MC, Rotterdam 3015-CE, Netherlands
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13
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Debes JD, Carrera E, Mattos AZ, Prieto JE, Boonstra A. Hepatocellular carcinoma, a unique tumor with a lack of biomarkers. Ann Hepatol 2020; 18:786-787. [PMID: 31494068 DOI: 10.1016/j.aohep.2019.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 02/04/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. Interestingly, the great majority of individuals affected by the tumor have underlying liver disease, therefore narrowing the population to be screened. Still, however, there is a clear lack of blood biomarkers, and surveillance in those at risk is performed by frequent imaging of the liver. A variety of multinational collaborations are currently invested in finding biomarkers for HCC based on liver-produced proteins. A new approach with assessment of peripheral proteins might be necessary for the successful early detection of this malignancy.
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Affiliation(s)
- Jose D Debes
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Enrique Carrera
- Universidad San Francisco de Quito, Hospital Eugenio Espejo, Quito, Ecuador
| | - Angelo Z Mattos
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Jhon E Prieto
- Centro de Enfermedades Hepaticas y Digestivas (CEHYD), Bogota, Colombia
| | - Andre Boonstra
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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14
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Schacher FC, Mattos AA, Mulazzani CM, Detanico RB, Favero B, Fonseca BB, Felix PH, Pase THS, Kupski C, Machado MB, Coral GP, Wiltgen D, Mattos AZ. IMPACT OF ACUTE KIDNEY INJURY STAGING ON PROGNOSIS OF PATIENTS WITH CIRRHOSIS. Arq Gastroenterol 2020; 57:244-248. [PMID: 32935742 DOI: 10.1590/s0004-2803.202000000-46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common and severe complication of cirrhosis. OBJECTIVE To evaluate the impact of AKI staging on 30-day mortality of patients with cirrhosis. METHODS We performed a retrospective cohort study of hospitalized patients with cirrhosis. Acute kidney injury (AKI) was diagnosed according to the International Club of Ascites recommendations and staged according to the European Association for the Study of the Liver guidelines. Comparisons between groups were made by one-way analysis of variance and Tukey test. Chi-square was calculated for dichotomous variables. Comparisons of renal impairment status among patients were performed using Kaplan-Meier statistics and differences between groups were analyzed using the log-rank test. A P-value <0.05 was considered to be statistically significant. RESULTS Two hundred and thirty-two patients were included in the study. The diagnosis of AKI was performed in 98 (42.2%) of them. The overall 30-day mortality was 19.8% (46/232). Mortality increased as the degree of AKI progressed. Among patients who did not have AKI, mortality was 5.2% (7/134). When compared to patients without AKI, patients diagnosed with AKI stage 1a had mortality of 12.1% (4/33, P=0.152); patients with AKI stage 1b had mortality of 45% (18/40, P<0.001); and patients with AKI stages 2 or 3 had mortality of 68% (17/25, P<0.001). Moreover, it is noteworthy that full response to treatment was associated to a decreased mortality when compared to patients who did not show complete recovery of renal function (14.3% vs 57.9%, P<0.001). CONCLUSION AKI stages 1b or greater, but not AKI stage 1a, are associated to higher 30-day mortality of patients with cirrhosis.
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Affiliation(s)
- Fernando C Schacher
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | - Angelo A Mattos
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Medicina: Hepatologia, Porto Alegre, RS, Brasil
| | | | - Rafaela B Detanico
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Bruna Favero
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Bárbara B Fonseca
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Patricia H Felix
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Carlos Kupski
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Marta B Machado
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Gabriela P Coral
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Medicina: Hepatologia, Porto Alegre, RS, Brasil
| | - Denusa Wiltgen
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Medicina: Hepatologia, Porto Alegre, RS, Brasil
| | - Angelo Z Mattos
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Medicina: Hepatologia, Porto Alegre, RS, Brasil
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15
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Debes JD, Boonstra A, Balderramo D, Mattos AZ, Arrese M, Roa JC, Valle JW, Banales JM, Carrera E, Romagnoli PA, Prieto JE, Hansen BE, Vogel A, Lamarca A. Hepatobiliary cancers in South America: disparity strikes. Lancet Gastroenterol Hepatol 2019; 4:581. [DOI: 10.1016/s2468-1253(19)30188-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 11/26/2022]
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16
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Leathers JS, Balderramo D, Prieto J, Diehl F, Gonzalez-Ballerga E, Ferreiro MR, Carrera E, Barreyro F, Diaz-Ferrer J, Singh D, Mattos AZ, Carrilho F, Debes JD. PIB: A Score to Select Sorafenib Treatment Candidates for Hepatocellular Carcinoma in Resource-Limited Settings. Hepat Mon 2018; 18:e82345. [PMID: 30467514 PMCID: PMC6243140 DOI: 10.5812/hepatmon.82345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- James S Leathers
- School of Medicine, Vanderbilt University, Nashville, USA
- Corresponding author: School of Medicine, Vanderbilt University, Nashville, USA. Tel: +1-5038300412,
| | - Domingo Balderramo
- Department of Gastroenterology, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Jhon Prieto
- Centro de Enfermedades Hepaticas y Digestivas (CEHYD), Bogota, Colombia
| | - Fernando Diehl
- Department of Gastroenterology, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | | | - Melina R. Ferreiro
- Department of Gastroenterology, Hospital Clinicas, Buenos Aires, Argentina
| | - Enrique Carrera
- Departament of Gastroenterology and Hepatology, Hospital Eugenio Espejo, Quito, Ecuador
| | - Fernando Barreyro
- Consejo Nacional de Investigaciones Científicas y Técnicas, Posadas, Argentina
| | - Javier Diaz-Ferrer
- Department of Gastroenterology, Hospital Nacional Edgardo Rebagliati Martins (HNERM), Lima, Peru
| | - Dupinder Singh
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Angelo Z. Mattos
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Flair Carrilho
- Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jose D. Debes
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Corresponding author: Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minnesota, USA.
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17
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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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18
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Abstract
BACKGROUND AND RATIONALE Many different non-invasive methods have been studied with the purpose of staging liver fibrosis. The objective of this study was verifying if transient elastography is superior to aspartate aminotransferase to platelet ratio index for staging fibrosis in patients with chronic hepatitis C. MATERIAL AND METHODS A systematic review with meta-analysis of studies which evaluated both non-invasive tests and used biopsy as the reference standard was performed. A random-effects model was used, anticipating heterogeneity among studies. Diagnostic odds ratio was the main effect measure, and summary receiver operating characteristic curves were created. A sensitivity analysis was planned, in which the meta-analysis would be repeated excluding each study at a time. RESULTS Eight studies were included in the meta-analysis. Regarding the prediction of significant fibrosis, transient elastography and aspartate aminotransferase to platelet ratio index had diagnostic odds ratios of 11.70 (95% confidence interval = 7.13-19.21) and 8.56 (95% confidence interval = 4.90-14.94) respectively. Concerning the prediction of cirrhosis, transient elastography and aspartate aminotransferase to platelet ratio index had diagnostic odds ratios of 66.49 (95% confidence interval = 23.71-186.48) and 7.47 (95% confidence interval = 4.88-11.43) respectively. CONCLUSION In conclusion, there was no evidence of significant superiority of transient elastography over aspartate aminotransferase to platelet ratio index regarding the prediction of significant fibrosis, but the former proved to be better than the latter concerning prediction of cirrhosis.
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Affiliation(s)
- A Z Mattos
- Pontifical Catholic University of Rio Grande do Sul, Brazil
| | - A A Mattos
- Post-Graduation Course of Hepatology of the Federal University of Health Sciences of Porto Alegre, Brazil
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19
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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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