Anti‐viral therapy is associated with improved survival but is underutilised in patients with hepatitis B virus‐related hepatocellular carcinoma: real‐world east and west experience

Chen, Vincent; Yeh, Ming‐Lun; Le, An K.; Jun, Mi Jung; Saeed, Waqar Khalid; Yang, Ju Dong; Huang, Ching‐I; Lee, H. Y.; Tsai, Pei‐Chien; Lee, M. H.; Giama, Nasra H.; Kim, N. G.; Nguyen, Pauline; Dang, Hansen; Ali, Hamdi A.; Zhang, N.; Huang, Jee‐Fu; Dai, Chia Yen; Chuang, Wan‐Long; Roberts, Lewis R.; Jun, Dae Won; Lim, Young‐Suk; Yu, Ming‐Lung; Nguyen, Mindie H.

doi:10.1111/apt.14801

Cited by 36 publications

(41 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is not clear why survival in MAFLD‐related HCC is unaffected by cirrhosis status, which is different than what has been reported in chronic hepatitis B‐related HCC, ( 19,37 ) although consistent with the limited earlier literature in MAFLD‐related HCC. ( 17,20‐22 ) One potential explanation is that the superior liver function in patients without cirrhosis was offset by the later presentation due to a decrease in screening; however, cirrhosis status was not associated with mortality after adjustment for meeting Milan criteria (Table 4).…”

Section: Discussionmentioning

confidence: 56%

“…(16,17) In the case of chronic hepatitis B-related HCC, cirrhosis is associated with poorer prognosis. (18,19) The effect of cirrhosis on MAFLD-related HCC has been investigated only in small cohorts and primarily in Caucasian populations. (17,(20)(21)(22) Unlike chronic hepatitis B, current practice guidelines do not recommend routine HCC surveillance for noncirrhotic MAFLD because the incidence of HCC in this population is too low to justify surveillance.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Effects of Cirrhosis and Diagnosis Scenario in Metabolic‐Associated Fatty Liver Disease‐Related Hepatocellular Carcinoma

et al. 2020

Self Cite

View full text Add to dashboard Cite

Metabolic-associated fatty liver disease (MAFLD) is a major cause of liver-related complications, including hepatocellular carcinoma (HCC). While MAFLD-related HCC is known to occur in the absence of cirrhosis, our understanding of MAFLD-related HCC in this setting is limited. Here, we characterize MAFLD-related HCC and the impact of cirrhosis and screening on survival. This was a multicenter, retrospective, cohort study of MAFLD-related HCC. MAFLD was defined based on the presence of race-adjusted overweight, diabetes, or both hypertension and dyslipidemia in the absence of excess alcohol use or other underlying cause of liver disease. The primary outcome of interest was overall survival, and the primary dependent variables were cirrhosis status and prior HCC screening. We used Kaplan-Meier methods to estimate overall survival and Cox proportional hazards models and random forest machine learning to determine factors associated with prognosis. This study included 1,382 patients from 11 centers in the United States and East/Southeast Asia. Cirrhosis was present in 62% of patients, but under half of these patients had undergone imaging within 12 months of HCC diagnosis. Patients with cirrhosis were more likely to have early stage disease but less often received curative therapy. After adjustment, cirrhosis was not associated with prognosis, but the presence of cancer-related symptoms at diagnosis was associated with poorer prognosis. Conclusion: Cirrhosis was not associated with overall survival in this cohort of MAFLD-related HCC, while diagnosis in the presence of symptoms was associated with poorer prognosis. The HCC surveillance rate in patients with MAFLD-related HCC was disappointingly low in a multicenter cohort. (Hepatology Communications 2020;0:1-11). H epatocellular carcinoma (HCC) is the third most common cause of cancer death worldwide. (1,2) The most rapidly growing cause of HCC in developed countries is nonalcoholic fatty liver disease or metabolic-associated fatty liver disease (MAFLD), (3,4) which is projected to become a leading

show abstract

Section: Discussionmentioning

confidence: 56%

mentioning

confidence: 99%

Effects of Cirrhosis and Diagnosis Scenario in Metabolic‐Associated Fatty Liver Disease‐Related Hepatocellular Carcinoma

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Many reports have shown that treatments based on etiology are beneficial to improve HCC patients' prognosis. [30][31][32][33][34] In order to identify the prognostic value of the constructed model, we tested an internal cohort, and the results were consistent with those of the primary cohort. Furthermore, even when we divided the whole cohort into a 2:1 ratio, as for training and validation, the results were indistinguishable (data not shown).…”

Section: Discussionmentioning

confidence: 88%

Construction of a 13‐microRNA‐based signature and prognostic nomogram for predicting overall survival in patients with hepatocellular carcinoma

Zheng

Wen

Nie

et al. 2020

Hepatology Research

View full text Add to dashboard Cite

Aim: Hepatocellular carcinoma (HCC) is a common malignancy associated with a poor prognosis due to difficulties in reliably estimating overall survival (OS). MicroRNAs (miRNAs) play critical roles in HCC initiation, progression, and metastasis and are highly correlated with patient prognosis. Thus, miRNA based risk signatures and nomograms are urgently required for predicting OS in patients with HCC. Methods: We constructed a 13 miRNA based signature and prognostic nomogram using 408 HCC samples and 58 normal tissues with miRNA sequencing data and clinical data from 323 patients downloaded from The Cancer Genome Atlas. A total of 195 patients were assigned as the internal validation cohort for verification and testing. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis was applied to investigate pathway enrichment for the signature. Results: We identified and validated a 13 miRNA risk signature highly associating with the OS of HCC patients. The signature showed good performances by calculating C index, area under the curve, and calibration curves. After verification and testing using an internal validation cohort, the results yielded a miRNA based signature and a prognostic nomogram with reliable predictive accuracy. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis indicated that various genes and multiple pathways were closely related to the mechanisms of HCC proliferation and metastasis. Conclusion: We successfully identified a 13 miRNA based signature and prognostic nomogram that are capable of predicting OS in patients with HCC.

show abstract

“…Several professional societal guidelines recommend HCC surveillance in at‐risk populations, including those with cirrhosis, using ultrasound (US) with or without alpha‐foetoprotein (AFP) . However, HCC surveillance in patients with cirrhosis does not have level I evidence and has been primarily supported by cohort studies demonstrating an association with earlier stage detection, greater likelihood of receiving curative therapy and improved survival . These studies have notable limitations including potential for lead‐time bias, length time bias and residual confounding .…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] However, HCC surveillance in patients with cirrhosis does not have level I evidence and has been primarily supported by cohort studies demonstrating an association with earlier stage detection, greater likelihood of receiving curative therapy and improved survival. [9][10][11] These studies have notable limitations including potential for leadtime bias, length time bias and residual confounding. 12 It is well recognized that US and AFP can have limited sensitivity for early stage HCC detection in clinical practice, with a recent meta-analysis reporting a sensitivity of only 63% for early-stage HCC detection when using the two tests in combination.…”

mentioning

confidence: 99%

Hepatocellular carcinoma surveillance, early detection and survival in a privately insured US cohort

Chen

Singal

Tapper

et al. 2020

Liver International

Self Cite

View full text Add to dashboard Cite

Background/Aims Semiannual hepatocellular carcinoma (HCC) surveillance is recommended in patients with cirrhosis; however, recent studies have raised questions over its utility. We investigated the impact of surveillance on early detection and survival in a nationally representative database. Methods We included patients with cirrhosis and HCC from the Optum database (2001‐2015) with >6 months of follow‐up between cirrhosis and HCC diagnoses. Surveillance adherence was defined as proportion of time covered (PTC), with each 6‐month period after abdominal imaging defined as ‘covered’. To determine the association between surveillance and mortality, we compared PTC between fatal and non‐fatal HCC. Results Of 1001 patients with cirrhosis and HCC, 256 died with median follow‐up 30 months. Median PTC by any imaging was greater in early‐stage vs late‐stage HCC (43.6% vs 37.4%, P = .003) and non‐fatal vs fatal HCC (40.8% vs 34.3%, P = .001). In multivariable analyses, each 10% increase in PTC was associated with increased early HCC detection (OR 1.07, 95% CI 1.01‐1.12) and decreased mortality (HR 0.95; 95% CI 0.90‐1.00). On subgroup analysis, PTC by CT/MRI was associated with early tumour detection and decreased mortality; however, PTC by ultrasound was only associated with early detection but not decreased mortality. These findings were robust across sensitivity analyses. Conclusions In a US cohort of privately insured HCC patients, PTC by any imaging modality was associated with increased early detection and decreased mortality. Continued evaluation of HCC surveillance strategies and effectiveness is warranted.

show abstract

Anti‐viral therapy is associated with improved survival but is underutilised in patients with hepatitis B virus‐related hepatocellular carcinoma: real‐world east and west experience

Abstract: Anti-viral therapy improved overall survival in patients with HBV-related HCC across cancer stages and treatment types but was underutilised at both US and Asia centres. Expanded use of anti-viral therapy in HBV-related HCC and better linkage-to-care for HBV patients are needed.

Cited by 36 publications

References 38 publications

Effects of Cirrhosis and Diagnosis Scenario in Metabolic‐Associated Fatty Liver Disease‐Related Hepatocellular Carcinoma

Effects of Cirrhosis and Diagnosis Scenario in Metabolic‐Associated Fatty Liver Disease‐Related Hepatocellular Carcinoma

Construction of a 13‐microRNA‐based signature and prognostic nomogram for predicting overall survival in patients with hepatocellular carcinoma

Hepatocellular carcinoma surveillance, early detection and survival in a privately insured US cohort

Contact Info

Product

Resources

About