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Intermediate-advanced hepatocellular carcinoma in Argentina:Treatment and survival analysis

World Journal of Gastroenterology 2019年第27期25卷 3607-3618页

作者： Federico Pinero Sebastián Marciano Nora Fernández Jorge Silva Margarita Anders Alina Zerega Ezequiel Ridruejo Gustavo Romero Beatriz Ameigeiras Claudia D’Amico luis gaite Carla Bermúdez Virginia Reggiardo luis Colombato Adrián Gadano Marcelo Silva Hospital Universitario Austral Facultad de Ciencias BiomédicasUniversidad AustralBuenos Aires B1629HJArgentina Latin American Liver Research Educational and Awareness Network(LALREAN) Buenos Aires B1629HJArgentina Hospital Italiano de Buenos Cuidad Autónoma de Buenos AiresBuenos Aires C1424BYEArgentina Hospital Británico Cuidad Autonoma de Buenos AiresBuenos Aires C1280AEBArgentina Hospital G Rawson San Juan 5400Argentina Hospital Aleman Cuidad Autonoma de Buenos AiresBuenos Aires C1280AEBArgentina Sanatorio Allende from Córdoba Córdoba 5016Argentina Centro de Educación Médica e Investigaciones Clínicas“Norberto Quirno”(CEMIC) Ciudad de Buenos Aires 1431Argentina Hospital Udaondo Cuidad Autonoma de Buenos Aires C1264AAAArgentina Hospital Ramos Mejía Ciudad de Buenos Aires C1221ADCArgentina Centro Especialidades Medicas Ambulatorias(CEMA) Mar del PlataBuenos Aires 7600Argentina Clínica de Nefrología Santa Fe 3000Argentina Hospital del Centenario RosarioSanta Fe S2002KDTArgentina

BACKGROUND Hepatocellular carcinoma(HCC) represents the sixteenth most frequent cancer in Argentina. The rise of new therapeutic modalities in intermediate-advanced HCC opens up a new paradigm for the treatment of *** To describe real-life treatments performed in patients with intermediateadvanced HCC before the approval of new systemic *** This longitudinal observational cohort study was conducted between 2009 and2016 in 14 different regional hospitals from Argentina. Included subjects had intermediate-advanced Barcelona Clinic Liver Cancer(BCLC) HCC stages(BCLC B to D). Primary end point analyzed was survival, which was assessed for each BCLC stage from the date of treatment until last patient follow-up or *** Meier survival curves and Cox regression analysis were performed, with hazard ratios(HR) calculations and 95% confidence intervals(95%CI).RESULTS From 327 HCC patients, 41% were BCLC stage B, 20% stage C and 39% stage *** median survival were 15 mo(IQR 5-26 mo), 5 mo(IQR 2-13 mo)and 3 mo(IQR 1-13 mo)(P < 0.0001), respectively. Among BCLC-B patients(n =135), 57% received TACE with a median number of 2 sessions(IQR 1-3 sessions).Survival was significantly better in BCLC-B patients treated with TACE HR =0.29(CI: 0.21-0.40) than those without TACE. After tumor reassessment by RECIST 1.1 criteria following the first TACE, patients with complete response achieved longer survival (HR = 0.15(CI: 0.04-0.56, P = 0.005))Eighty-two patients were treated with sorafenib, mostly BCLC-B and C(87.8%). However,12.2% were BCLC-D. Median survival with sorafenib was 4.5 mo(IQR 2.3-11.7 mo);which was lower among BCLC-D patients 3.2 mo(IQR 2.0-14.1 mo). A total of 36 BCLC-B patients presented tumor progression after TACE. In these patients,treatment with sorafenib presented better survival when compared to those patients who received sorafenib without prior TACE [HR = 0.26(CI: 0.09-0.71);P= 0.013].CONCLUSION In this real setting, our results we

关键词： Hepatocellular carcinoma Therapeutics Survival Real-life

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Fatty liver disease,an emerging etiology of hepatocellular carcinoma in Argentina

引用

World Journal of Hepatology 2018年第1期10卷 41-50页

作者： Federico Pinero Josefina Pages Sebastián Marciano Nora Fernández Jorge Silva Margarita Anders Alina Zerega Ezequiel Ridruejo Beatriz Ameigeiras Claudia D’Amico luis gaite Carla Bermúdez Manuel Cobos Carlos Rosales Gustavo Romero Lucas McCormack Virginia Reggiardo luis Colombato Adrián Gadano Marcelo Silva Hepatology and Liver Transplantation Unit Hospital Universitario AustralBuenos Aires 1629Argentina Hepatology Section Liver Transplant ProgramDepartment of Academic ResearchHospital Italiano from Buenos AiresBuenos Aires 1424Argentina Sanatorio Trinidad San Isidro Buenos Aires 1642Argentina Clínica Privada San Fernando Buenos Aires 2013Argentina Hepatology and Gastroenterology Hospital BritánicoBuenos Aires 1280Argentina Hepatobiliary Surgery Hospital G RawsonSan Juan 5400Argentina Department of Hepatology and Liver Transplant Program Hospital AlemanBuenos Aires 1118Argentina Department of Hepatology and Liver Transplantation Sanatorio AllendeCórdoba 5016Argentina Hepatology Section Department of MedicineCentro de Educación Médica e Investigaciones Clínicas Norberto Department of Hepatology Hospital Ramos MejíaBuenos Aires 1221Argentina Department of Hepatology Centro Especialidades Medicas Ambulatorias(CEMA)Mar del Plata 7600Argentina Department of Hepatology and Liver Transplantation Clínica de Nefrología de Santa FeSanta Fe 3000Argentina Department of Hepatology and Gastroenterology Hospital C Bonorino UdaondoBuenos Aires 1264Argentina Department of Hepatology and Gastroenterology Hospital CentenarioSanta Fe 2002Argentina

AIM To investigate any changing trends in the etiologies of hepatocellular carcinoma(HCC) in Argentina during the last years. METHODS A longitudinal cohort study was conducted by 14 regional hospitals starting in 2009 through 2016. All adult patients with newly diagnosed HCC either with pathology or imaging criteria were included. Patients were classified as presenting non-alcoholic fatty liver disease(NAFLD) either by histology or clinically, provided that all other etiologies of liver disease were ruled out, fatty liver was present on abdominal ultrasound and alcohol consumption was excluded. Complete follow-up was assessed in all included subjects since the date of HCC diagnosis until death or last medical *** A total of 708 consecutive adults with HCC were included. Six out of 14 hospitals were liver transplant centers(n = 484). The prevalence of diabetes mellitus was 27.7%. Overall, HCV was the main cause of liver disease related with HCC(37%) including cirrhotic and non-cirrhotic patients, followed by alcoholic liver disease 20.8%, NAFLD 11.4%, cryptogenic 9.6%, HBV 5.4% infection, cholestatic disease and autoimmune hepatitis 2.2%, and other causes 9.9%. A 6-fold increase in the percentage corresponding to NAFLDHCC was detected when the starting year, i.e., 2009 was compared to the last one, i.e., 2015(4.3% vs 25.6%; P < 0.0001). Accordingly, a higher prevalence of diabetes mellitus was present in NAFLD-HCC group 61.7% when compared to other than NAFLD-HCC 23.3%(P < 0.0001). Lower median AFP values at HCC diagnosis were observed between NAFLD-HCC and non-NAFLD groups(6.6 ng/m L vs 26 ng/m L; P = 0.02). Neither NAFLD nor other HCC etiologies were associated with higher *** The growing incidence of NAFLD-HCC documented in the United States and Europe is also observed in Argentina, a confirmation with important Public Health implications.

关键词： Hepatocellular carcinoma Etiology Fatty liver South America

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