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Hepatocellular carcinoma incidence post direct-acting antivirals in hepatitis C-related advanced fibrosis/cirrhosis patients in Australia

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Hepatobiliary & Pancreatic Diseases International 2020年第6期19卷 541-546页

作者： Patrick P Y Chan Miriam T Levy Nicholas Shackel Scott A Davison emilia prakoso Department of Gastroenterology and Hepatology Liverpool HospitalElizabeth StreetLiverpoolNSW 2170Australia South Western Clinical School University of New South WalesLiverpoolNSW 2170Australia Central Clinical School-The Faculty of Medicine and Health University of SydneyNSW 2050Australia

Background:Despite efficacy in HCV eradication,direct-acting antiviral(DAA)therapy has raised controversies around their impact on hepatocellular carcinoma(HCC)*** we reported the first Australian data on HCC incidence in DAA-treated HCV patients with advanced fibrosis/***:We conducted a retrospective single center study of DAA-treated HCV patients with advanced fibrosis/cirrhosis from April 2015 to December *** with prior HCC were included if they had complete response to HCC ***:Among 138 patients who completed DAA therapy,133(96.4%)achieved sustained virologic response(median follow-up 23.8 months).Ten had prior HCC and 5/10(50.0%)developed recurrence,while de novo HCC developed in 7/128(5.5%).Median time from DAA to HCC diagnosis was 34 weeks in recurrent HCC *** novo 52 weeks(P=0.159).In patients with prior HCC,those with recurrence(***)had shorter median time between last HCC treatment and DAA(12 vs.164 weeks,P<0.001).On bivariate analysis,failed sustained virologic response at 12 weeks(SVR12)(P=0.011),platelets(P=0.005),model for end-stage liver disease(MELD)score(P=0.029),alpha fetoprotein(AFP)(P=0.013),and prior HCC(P<0.001)were associated with HCC *** multivariate analysis,significant factors were prior HCC(OR=4.80;95%CI:1.47–48.50;P=0.010),failed SVR12(OR=2.83;95%CI:1.71–16.30;P=0.016)and platelets(OR=0.97;95%CI:0.95–0.99;P=0.009).Conclusions:Our study demonstrates a high incidence of recurrent HCC in HCV patients with advanced fibrosis/cirrhosis treated with *** associated with HCC development post-DAA were more advanced liver disease,failed SVR12 and prior HCC,with higher rates of recurrence in those who started DAA earlier.

关键词： Direct-acting antiviral Cirrhosis Hepatitis-C virus Hepatocellular carcinoma Recurrence

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Patients with non-viral liver disease have a greater tumor burden and less curative treatment options when diagnosed with hepatocellular carcinoma

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World Journal of Gastroenterology 2017年第15期23卷 2763-2770页

作者： Waled Mohsen Marcia Rodov emilia prakoso Barbara Charlton David G Bowen David J Koorey Nicholas A Shackel Geoffrey W McCaughan Simone I Strasser AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital

AIM To assess the impact of underlying liver disease etiology on the presenting features and outcomes in a large cohort of patients with hepatocellular carcinoma(HCC). METHODS A prospective database of all patients with HCC was established from 1998 to March 2012. One thousand and seventy-eight patients were categorized into three groups, based on the etiology of their liver disease: hepatitis B virus(HBV), hepatitis C virus(HCV) and non-viral liver disease(NVLD). Overall survival was determined by Kaplan Meier analysis to time of death or last *** HCC patients with HCV(85%) were more likely to be diagnosed as part of a surveillance program, compared to HBV or NVLD(both 71%)(P < 0.001). Patients with NVLD were more likely to receive best supportive care(29%) compared to those with HBV(21%) or HCV(20%)(P < 0.02). Twelve percent of NVLD and 13% of HBV patients underwent liver transplantation compared to 21% of HCV patients(P = 0.001). Median survival from presentation was lowest in NVLD(1.7 years) when compared to HBV(2.8 years) and HCV(2.6 years)(P < 0.05). In multivariate analysis, independent predictors of survival included Child Turcotte Pugh score, size of dominant lesion, absence of vascular invasion, and management with surgical resection or liver transplantation. Patient age and the etiology of the underlying liver disease were not independent predictors of survival CONCLUSION Patients with NVLD and HCC were less likely to be enrolled in a HCC surveillance program and are less likely to have curative therapies such as liver resection and transplantation after diagnosis with HCC, when compared to patients with Hepatitis B and Hepatitis C.

关键词： Hepatitis B Hepatitis C Hepatocellular carcinoma Surveillance Therapy Nonalcoholic fatty liver disease Survival

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Prospective randomized controlled trial evaluating cap-assisted colonoscopy vs standard colonoscopy

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World Journal of Gastroenterology 2010年第31期16卷 3905-3910页

作者： Hoi-Poh Tee Crispin Corte Hamdan Al-Ghamdi emilia prakoso John Darke Raman Chettiar Wassim Rahman Scott Davison Sean P Griffin Warwick S Selby Arthur J Kaffes Gastroenterology Unit Medical DepartmentHospital Tengku Ampuan AfzanJalan Tanah Putih25100 KuantanPahang Malaysia AW Morrow Gastroenter-ology and Liver Centre Royal Prince Alfred HospitalMissen-den RoadCamperdownNSW 2050Australia Gastroenterology Unit Medical DepartmentQueen Elizabeth HospitalKarung Berkunci No.202988586 Kota KinabaluMalaysia

AIM: To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate. METHODS: This study was a prospective randomized controlled trial conducted from March 2008 to February 2009 in a tertiary referral hospital at Sydney. The primary end point was cecal intubation time and the secondary endpoint was polyp detection rate. Consecutive cases of total colonoscopy over a 1-year period were recruited. Randomization into either standard colonoscopy (SC) or cap-assisted colonoscopy (CAC) was performed after consent was obtained. For cases randomized to CAC, one of the three sizes of cap was used: D-201-15004 (with a diameter of 15.3 mm), D-201-14304 (14.6 mm) and D-201-12704 (13.0 mm). All of these caps were produced by Olympus Medical Systems, Japan. Independent predictors for faster cecal time and better polyp detection rate were also determined from this study. RESULTS: There were 200 cases in each group. There was no signif icant difference in terms of demographic characteristics between the two groups. CAC, when compared to the SC group, had no signif icant difference in terms of cecal intubation rate (96.0% vs 97.0%, P = 0.40) and time (9.94 ± 7.05 min vs 10.34 ± 6.82 min, P = 0.21), or polyp detection rate (32.8% vs 31.3%, P = 0.75). On the subgroup analysis, there was no significant difference in terms of cecal intubation time by trainees (88.1% vs 84.8%, P = 0.40), ileal intubation rate (82.5% vs 79.0%, P = 0.38) or total colonoscopy time (23.24 ± 13.95 min vs 22.56 ± 9.94 min, P = 0.88). On multivariate analysis, the independent determinants of faster cecal time were consultant-performed procedures (P < 0.001), male patients (P < 0.001), non-usage of hyoscine (P < 0.001) and better bowel preparation (P = 0.01). The determinants of better polyp detection rate were older age (P < 0.001), no history of previous abdominal surgery (P = 0.04), patients not having esophagogastroduodenoscopy in the same setting (P = 0.003),

关键词： Cap Hood Cecum Colonoscopy Cecal intubation Colonic polyps

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