Rising incidence and demographics of hepatocellular carcinoma in the USA: what does it mean?
ABSTRACT The incidence of hepatocellular carcinoma (HCC) is increasing in the USA. Traditional factors, such as hepatitis C and hepatitis B, along with new emerging trends suggest that the incidence is not only increasing, but is also likely to be under-represented in the current literature. Emerging knowledge of its incidence and epidemiology reflects an increased incidence in younger patients and certain ethnic groups. Without a clear treatment algorithm for this complex cancer, therapy and its utilization remain unclear.
SourceAvailable from: Shimul Shah[Show abstract] [Hide abstract]
ABSTRACT: Background We sought to analyze the effect of pre-transplant diabetes on postoperative outcomes and resource utilization following liver transplantation.MethodsA retrospective cohort study was designed using a linkage between the University HealthSystem Consortium and Scientific Registry of Transplant Recipients databases. We identified 12,442 patients who underwent liver transplantation at 63 centers from 2007-2011 and separated cohorts of patients with diabetes (n=2971; 24%) and without (n=9471; 76%) at the time of transplant. We analyzed transplant related outcomes and short-term survival.ResultsDiabetic recipients were more likely to be male (70% vs 67%), non-white (32% vs 26%), older (age ≥60; 41% vs 28%), and have a higher BMI (29 vs 27; p<0.001). More diabetic patients were on hemodialysis (10% vs. 7%), had cirrhosis caused by NASH (24% vs 9%; p<0.001), and received liver allografts from older donors (≥ 60 years; 19% vs. 15%) with a higher donor risk index (>1.49; 46% vs. 42%; p<0.001). Post-transplant, diabetic recipients had longer hospital length of stay (10 vs. 9 days), higher peri-transplant mortality (5% vs 4%) and 30-day readmission rates (41% vs 37%), were less often discharged to home (83% vs 87%; p<0.05), and had inferior graft and patient survival. Liver transplant was more expensive for type 1 vs type 2 diabetics ($105,078 vs $100,624, p<0.001). Poorly-controlled diabetic recipients were less likely discharged home following transplant (75% vs 82%, p<0.01).Conclusions This national study indicates that pre-transplant diabetes is associated with inferior postoperative outcomes and increased resource utilization after liver transplantation.This article is protected by copyright. All rights reserved.Liver international: official journal of the International Association for the Study of the Liver 12/2014; DOI:10.1111/liv.12770 · 4.41 Impact Factor
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ABSTRACT: Carbonic anhydrase 9 (CA9), which regulates cellular proliferation and the acid-base balance, is known as prognostic factor in various types of cancer. The aim of this study is to investigate the clinical implications of CA9 expression in patients with hepatocellular carcinoma. Immunohistochemical staining for CA9 was performed on tissue microarrays of hepatocellular carcinoma and paired non-neoplastic liver tissue from a training cohort of 838 patients and a validation cohort of 225 patients. Membranous staining in more than 5 % of the tumor cells was considered to indicate CA9 positivity. The prognostic value of CA9 expression was statistically evaluated. In the training cohort, CA9 positivity (181 cases, 21.5 %) was significantly correlated with shorter overall survival (OS; p < 0.001) and recurrence-free survival (RFS; p = 0.004). In multivariate analysis, CA9 positivity was independently associated with reduced OS (p = 0.023), but not significantly associated with RFS (p = 0.384). These results were validated in an additional cohort (CA9 positivity in 35 cases, 15.6 %; OS, p = 0.015; RFS, p = 0.979). Pooled cohort analysis showed that this predictor was independently associated with higher mortality (OS; p < 0.001). These data indicate that CA9 expression is a poor prognostic factor in resectable hepatocellular carcinoma (HCC) patients.Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 01/2015; DOI:10.1007/s00428-014-1709-0 · 2.56 Impact Factor
Article: Alcoholic liver disease: Treatment.[Show abstract] [Hide abstract]
ABSTRACT: The excess consumption of alcohol is associated with alcoholic liver diseases (ALD). ALD is a major healthcare problem, personal and social burden, and significant reason for economic loss worldwide. The ALD spectrum includes alcoholic fatty liver, alcoholic hepatitis, cirrhosis, and the development of hepatocellular carcinoma. The diagnosis of ALD is based on a combination of clinical features, including a history of significant alcohol intake, evidence of liver disease, and laboratory findings. Abstinence is the most important treatment for ALD and the treatment plan varies according to the stage of the disease. Various treatments including abstinence, nutritional therapy, pharmacological therapy, psychotherapy, and surgery are currently available. For severe alcoholic hepatitis, corticosteroid or pentoxifylline are recommended based on the guidelines. In addition, new therapeutic targets are being under investigation.