Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2021.130
F. Turati, P. Bertuccio, E. Negri, C. La Vecchia
Aim: We aimed to analyze temporal trends in mortality from intrahepatic (ICC) and extrahepatic (ECC) cholangiocarcinoma in selected countries worldwide. Methods: Official death certification data for ICC and ECC and populations estimates for 29 countries worldwide (17 from Europe, 8 from the Americas, and 4 from Australasia) and for Hong Kong Special Administrative Region of the People’s Republic of China (SAR), from 1995 to 2018, were extracted from the World Health Organization and the Pan American Health Organization databases. Age-standardized mortality rates were computed. A joinpoint regression analysis was performed. Results: In both sexes, ICC mortality rates increased in most countries considered, including the USA, the UK, and Australia; in some countries, including Italy and France, the increasing trends leveled off over the most recent years. In men, around 2016, the highest rates (1.7-2.3/100,000) were observed in Hong Kong SAR, Portugal, France, Spain, Australia, Austria, the UK, and Canada; Latin American countries and some eastern European countries had the lowest rates (0.2-0.8/100,000). A similar pattern was observed in women, but with lower rates (from 1.7/100,000 in Hong Kong SAR to 0.14/100,000 in Argentina). ECC mortality declined in most European and Australasian countries, but it tended to increase in Americas. In both sexes, rates were below 1/100,000 around 2016, with the only exceptions being Japan (2.6/100,000 men and 1.2/100,000 women) and Hungary (1.5/100,000 men and 1.1/100,000 women). Conclusion: ICC mortality increased in most areas of the world, likely due to increased prevalence of risk factors and improved cancer recognition and classification. ECC mortality fell in most countries, largely due to the widespread use of cholecystectomy.
{"title":"Epidemiology of cholangiocarcinoma","authors":"F. Turati, P. Bertuccio, E. Negri, C. La Vecchia","doi":"10.20517/2394-5079.2021.130","DOIUrl":"https://doi.org/10.20517/2394-5079.2021.130","url":null,"abstract":"Aim: We aimed to analyze temporal trends in mortality from intrahepatic (ICC) and extrahepatic (ECC) cholangiocarcinoma in selected countries worldwide. Methods: Official death certification data for ICC and ECC and populations estimates for 29 countries worldwide (17 from Europe, 8 from the Americas, and 4 from Australasia) and for Hong Kong Special Administrative Region of the People’s Republic of China (SAR), from 1995 to 2018, were extracted from the World Health Organization and the Pan American Health Organization databases. Age-standardized mortality rates were computed. A joinpoint regression analysis was performed. Results: In both sexes, ICC mortality rates increased in most countries considered, including the USA, the UK, and Australia; in some countries, including Italy and France, the increasing trends leveled off over the most recent years. In men, around 2016, the highest rates (1.7-2.3/100,000) were observed in Hong Kong SAR, Portugal, France, Spain, Australia, Austria, the UK, and Canada; Latin American countries and some eastern European countries had the lowest rates (0.2-0.8/100,000). A similar pattern was observed in women, but with lower rates (from 1.7/100,000 in Hong Kong SAR to 0.14/100,000 in Argentina). ECC mortality declined in most European and Australasian countries, but it tended to increase in Americas. In both sexes, rates were below 1/100,000 around 2016, with the only exceptions being Japan (2.6/100,000 men and 1.2/100,000 women) and Hungary (1.5/100,000 men and 1.1/100,000 women). Conclusion: ICC mortality increased in most areas of the world, likely due to increased prevalence of risk factors and improved cancer recognition and classification. ECC mortality fell in most countries, largely due to the widespread use of cholecystectomy.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67653638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2022.08
N. Tagkou, N. Goossens, F. Negro
Chronic hepatitis C virus (HCV) infection is estimated to affect 56.8 million individuals globally and is a major and independent risk factor for the development of hepatocellular carcinoma (HCC). After the introduction of safe and potent direct-acting antivirals (DAAs), capable of curing HCV infection also in patients with advanced liver disease at high risk of HCC, the beneficial effect on a de novo HCC development after viral clearance has been established. However, studies addressing the relationship between DAA-induced eradication and risk of HCC recurrence (i.e., reappearance of HCC treated before starting antivirals) have produced contradictory data, suggesting either an increase or a decrease of HCC recurrence rate, while some report no effect of these treatments. Thus, there seems to be an unclear benefit of viral clearance in patients with a history of HCC curative treatment, where the recurrence rate remains worryingly high. This short review aims to summarize current evidence on the impact of DAAs on HCC recurrence rates, the pathogenic mechanisms and characteristics of HCC recurrence after DAA treatment, the predictors of tumor recurrence, and the impact of DAAs on overall survival.
{"title":"Impact of direct-acting antivirals on the recurrence of hepatocellular carcinoma in chronic hepatitis C","authors":"N. Tagkou, N. Goossens, F. Negro","doi":"10.20517/2394-5079.2022.08","DOIUrl":"https://doi.org/10.20517/2394-5079.2022.08","url":null,"abstract":"Chronic hepatitis C virus (HCV) infection is estimated to affect 56.8 million individuals globally and is a major and independent risk factor for the development of hepatocellular carcinoma (HCC). After the introduction of safe and potent direct-acting antivirals (DAAs), capable of curing HCV infection also in patients with advanced liver disease at high risk of HCC, the beneficial effect on a de novo HCC development after viral clearance has been established. However, studies addressing the relationship between DAA-induced eradication and risk of HCC recurrence (i.e., reappearance of HCC treated before starting antivirals) have produced contradictory data, suggesting either an increase or a decrease of HCC recurrence rate, while some report no effect of these treatments. Thus, there seems to be an unclear benefit of viral clearance in patients with a history of HCC curative treatment, where the recurrence rate remains worryingly high. This short review aims to summarize current evidence on the impact of DAAs on HCC recurrence rates, the pathogenic mechanisms and characteristics of HCC recurrence after DAA treatment, the predictors of tumor recurrence, and the impact of DAAs on overall survival.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67653899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2022.34
S. Gregory, Shruthi R. Perati, Zachary J. Brown
Nonalcoholic fatty liver disease (NAFLD) is a disease spectrum that spans simple steatosis, fibrosis, and ultimately cirrhosis, and is a leading cause of chronic liver disease globally. The severe variant of NAFLD, non-alcoholic steatohepatitis (NASH), is characterized by triglyceride accumulation within hepatocytes and the subsequent inflammatory pathway activation, ultimately progressing to cirrhosis in 10%-20% of patients. NASH is a known major risk factor for the development of hepatocellular carcinoma (HCC), and there is emerging data demonstrating the impact of NASH on immune subsets and the tumor microenvironment that may influence therapeutic response. This review describes the various ways in which the immune system is altered in patients with NASH. The innate immune system in NASH shows alterations in dendritic and Kupffer cells, impaired cytotoxicity of Natural Killer cells, and an accumulation of neutrophils. Additionally, there is emerging evidence emphasizing the role of the adaptive immune system in the development and progression of NASH, seen in the alteration of B-cells, T-cells, and NKT Cells. Due to the complex interplay of the immune system in NAFLD/NASH and its progression to HCC, many current treatments focus on targeting immune cells for HCC therapy. Recently, immune checkpoint inhibitors such as atezolizumab and bevacizumab have been approved as first-line therapy for unresectable HCC. Although an emerging field of research, further studies and clinical trials are needed to understand the complex interface of NASH, HCC and the immune response.
{"title":"Alteration in immune function in patients with fatty liver disease","authors":"S. Gregory, Shruthi R. Perati, Zachary J. Brown","doi":"10.20517/2394-5079.2022.34","DOIUrl":"https://doi.org/10.20517/2394-5079.2022.34","url":null,"abstract":"Nonalcoholic fatty liver disease (NAFLD) is a disease spectrum that spans simple steatosis, fibrosis, and ultimately cirrhosis, and is a leading cause of chronic liver disease globally. The severe variant of NAFLD, non-alcoholic steatohepatitis (NASH), is characterized by triglyceride accumulation within hepatocytes and the subsequent inflammatory pathway activation, ultimately progressing to cirrhosis in 10%-20% of patients. NASH is a known major risk factor for the development of hepatocellular carcinoma (HCC), and there is emerging data demonstrating the impact of NASH on immune subsets and the tumor microenvironment that may influence therapeutic response. This review describes the various ways in which the immune system is altered in patients with NASH. The innate immune system in NASH shows alterations in dendritic and Kupffer cells, impaired cytotoxicity of Natural Killer cells, and an accumulation of neutrophils. Additionally, there is emerging evidence emphasizing the role of the adaptive immune system in the development and progression of NASH, seen in the alteration of B-cells, T-cells, and NKT Cells. Due to the complex interplay of the immune system in NAFLD/NASH and its progression to HCC, many current treatments focus on targeting immune cells for HCC therapy. Recently, immune checkpoint inhibitors such as atezolizumab and bevacizumab have been approved as first-line therapy for unresectable HCC. Although an emerging field of research, further studies and clinical trials are needed to understand the complex interface of NASH, HCC and the immune response.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67654048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2021.126
C. Campani, J. Nault
Global prevalence of non-alcoholic fatty liver disease (NAFLD) and of NAFLD-hepatocellular carcinoma (HCC) is estimated to grow in the next years. The burden of NAFLD and the evidence that NAFLD-HCC arises also in non-cirrhotic patients, explain the urgent need of a better characterization of the molecular mechanisms involved in NAFLD progression. Obesity and diabetes cause a chronic inflammatory state which favors changes in serum cytokines and adipokines, an increase in oxidative stress, DNA damage, and the activation of multiple signaling pathways involved in cell proliferation. Moreover, a role in promoting NAFLD-HCC has been highlighted in the innate and adaptive immune system, dysbiosis, and alterations in bile acids metabolism. Several dietary, genetic, or combined mouse models have been used to study nonalcoholic steatohepatitis (NASH) development and its progression to HCC, but models that fully recapitulate the biological and prognostic features of human NASH are still lacking. In humans, four single nucleotide polymorphisms (PNPLA3, TM6SF2, GCKR, and MBOAT7) have been linked to the development of both NASH and HCC in cirrhotic and non-cirrhotic patients, whereas HSD17B13 polymorphism has a protective effect. In addition, higher rates of somatic ACVR2A mutations and a novel mutational signature have been recently discovered in NASH-HCC patients. The knowledge of the molecular pathogenesis of NAFLD-HCC will be helpful to personalized screening programs and allow for primary and secondary chemopreventive treatments for NAFLD patients who are more likely to progress to HCC.
{"title":"Molecular mechanisms of liver carcinogenesis related to metabolic syndrome","authors":"C. Campani, J. Nault","doi":"10.20517/2394-5079.2021.126","DOIUrl":"https://doi.org/10.20517/2394-5079.2021.126","url":null,"abstract":"Global prevalence of non-alcoholic fatty liver disease (NAFLD) and of NAFLD-hepatocellular carcinoma (HCC) is estimated to grow in the next years. The burden of NAFLD and the evidence that NAFLD-HCC arises also in non-cirrhotic patients, explain the urgent need of a better characterization of the molecular mechanisms involved in NAFLD progression. Obesity and diabetes cause a chronic inflammatory state which favors changes in serum cytokines and adipokines, an increase in oxidative stress, DNA damage, and the activation of multiple signaling pathways involved in cell proliferation. Moreover, a role in promoting NAFLD-HCC has been highlighted in the innate and adaptive immune system, dysbiosis, and alterations in bile acids metabolism. Several dietary, genetic, or combined mouse models have been used to study nonalcoholic steatohepatitis (NASH) development and its progression to HCC, but models that fully recapitulate the biological and prognostic features of human NASH are still lacking. In humans, four single nucleotide polymorphisms (PNPLA3, TM6SF2, GCKR, and MBOAT7) have been linked to the development of both NASH and HCC in cirrhotic and non-cirrhotic patients, whereas HSD17B13 polymorphism has a protective effect. In addition, higher rates of somatic ACVR2A mutations and a novel mutational signature have been recently discovered in NASH-HCC patients. The knowledge of the molecular pathogenesis of NAFLD-HCC will be helpful to personalized screening programs and allow for primary and secondary chemopreventive treatments for NAFLD patients who are more likely to progress to HCC.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67653570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2022.27
Dimitrios N Varvoglis, I. Ziogas, G. Tsoulfas
Liver transplantation is the only potentially curative option for unresectable hepatoblastoma. The introduction of platinum-based chemotherapy drastically improved the survival outcomes of patients with hepatoblastoma. However, the use of neoadjuvant chemotherapy and the optimal number of cycles required in patients listed for liver transplantation, as well as the potential use of adjuvant chemotherapy, remain unclear. Additionally, the shortage of donor liver grafts, along with the lack of clear consensus on the management of metastatic hepatoblastoma, makes the decision on whether to proceed to liver transplantation even more complex and challenging. Technological advances may optimize intraoperative imaging of both the primary tumor and metastatic sites, thus facilitating complete resection. Such improvements, along with the wider use of social media platforms to increase public awareness, could potentially pave the way for more optimal implementation of liver transplantation for the treatment of patients with unresectable hepatoblastoma.
{"title":"Liver transplantation for hepatoblastoma","authors":"Dimitrios N Varvoglis, I. Ziogas, G. Tsoulfas","doi":"10.20517/2394-5079.2022.27","DOIUrl":"https://doi.org/10.20517/2394-5079.2022.27","url":null,"abstract":"Liver transplantation is the only potentially curative option for unresectable hepatoblastoma. The introduction of platinum-based chemotherapy drastically improved the survival outcomes of patients with hepatoblastoma. However, the use of neoadjuvant chemotherapy and the optimal number of cycles required in patients listed for liver transplantation, as well as the potential use of adjuvant chemotherapy, remain unclear. Additionally, the shortage of donor liver grafts, along with the lack of clear consensus on the management of metastatic hepatoblastoma, makes the decision on whether to proceed to liver transplantation even more complex and challenging. Technological advances may optimize intraoperative imaging of both the primary tumor and metastatic sites, thus facilitating complete resection. Such improvements, along with the wider use of social media platforms to increase public awareness, could potentially pave the way for more optimal implementation of liver transplantation for the treatment of patients with unresectable hepatoblastoma.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67654036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2022.22
S. Muñoz-Martínez, J. Rimola, M. Londoño, A. Cárdenas, A. Forner
Cholangiocarcinoma (CCA) is a highly lethal malignancy that comprises approximately 15% of all the primary liver tumors and 3% of gastrointestinal cancers. Diagnosis is often done when the disease is already at advanced stages, resulting in poor outcomes. Prevention of risk factors and early diagnosis are the cornerstones for improving survival. Early diagnosis is feasible in the setting of surveillance programs in patients at high risk of CCA such as patients with primary sclerosing cholangitis. Regrettably, surveillance of CCA in this population is hampered by the low diagnostic accuracy of current tumor markers at earlier stages, the difficulties of imaging techniques for the differential diagnosis between benign and malignant biliary strictures, and the need for invasive procedures for diagnostic confirmation. In this review we discuss the rationale for surveillance of CCA in high-risk populations, particularly patients with primary sclerosing cholangitis, the recommended tools for surveillance and diagnostic work-up, and future perspectives.
{"title":"Cholangiocarcinoma: early detection and screening in high-risk population","authors":"S. Muñoz-Martínez, J. Rimola, M. Londoño, A. Cárdenas, A. Forner","doi":"10.20517/2394-5079.2022.22","DOIUrl":"https://doi.org/10.20517/2394-5079.2022.22","url":null,"abstract":"Cholangiocarcinoma (CCA) is a highly lethal malignancy that comprises approximately 15% of all the primary liver tumors and 3% of gastrointestinal cancers. Diagnosis is often done when the disease is already at advanced stages, resulting in poor outcomes. Prevention of risk factors and early diagnosis are the cornerstones for improving survival. Early diagnosis is feasible in the setting of surveillance programs in patients at high risk of CCA such as patients with primary sclerosing cholangitis. Regrettably, surveillance of CCA in this population is hampered by the low diagnostic accuracy of current tumor markers at earlier stages, the difficulties of imaging techniques for the differential diagnosis between benign and malignant biliary strictures, and the need for invasive procedures for diagnostic confirmation. In this review we discuss the rationale for surveillance of CCA in high-risk populations, particularly patients with primary sclerosing cholangitis, the recommended tools for surveillance and diagnostic work-up, and future perspectives.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67654003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2022.04
Mohamad Khalil, M. Calasso, L. Bonfrate, A. Di Ciaula, M. De Angelis, D. Q. Wang, P. Portincasa
Consumption of natural products such as herbs, spices, plant-derived compounds, and foods is on the rise globally. The use of these substances is widely recognized as an integral part of culture and tradition, with the philosophy being “no benefit is no harm”. The utility of medicinal plants and extracts is under scrutiny, and the scientific community needs to clarify many conceptual gaps. Medicinal plants are rich in bioactive phytochemicals that produce chemopreventive effects at different levels, including cellular, animal, and clinical. The ultimate translational value is often missing, and some studies suggest that botanicals may contain toxic compounds that cause acute or chronic toxicity. In this regard, the liver is the center, and herbal products can show protective effects or induce hepatotoxicity, thereby promoting liver cancer. In this review article, we examine a range of herbal products implicated in hepatocarcinogenesis and extend the discussion to herbal products that may be potentially involved in the prevention and treatment of liver carcinoma.
{"title":"The pros and cons of biological effects of herbs and herb-derived compounds on liver tumorigenesis","authors":"Mohamad Khalil, M. Calasso, L. Bonfrate, A. Di Ciaula, M. De Angelis, D. Q. Wang, P. Portincasa","doi":"10.20517/2394-5079.2022.04","DOIUrl":"https://doi.org/10.20517/2394-5079.2022.04","url":null,"abstract":"Consumption of natural products such as herbs, spices, plant-derived compounds, and foods is on the rise globally. The use of these substances is widely recognized as an integral part of culture and tradition, with the philosophy being “no benefit is no harm”. The utility of medicinal plants and extracts is under scrutiny, and the scientific community needs to clarify many conceptual gaps. Medicinal plants are rich in bioactive phytochemicals that produce chemopreventive effects at different levels, including cellular, animal, and clinical. The ultimate translational value is often missing, and some studies suggest that botanicals may contain toxic compounds that cause acute or chronic toxicity. In this regard, the liver is the center, and herbal products can show protective effects or induce hepatotoxicity, thereby promoting liver cancer. In this review article, we examine a range of herbal products implicated in hepatocarcinogenesis and extend the discussion to herbal products that may be potentially involved in the prevention and treatment of liver carcinoma.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67653848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2021.144
T. Yip, V. Wong, Mandy Sze-Man Lai, Vicki Wing-Ki Hui, Y. Tse, G. Wong
Entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are first-line antiviral therapies for patients with chronic hepatitis B (CHB) and reduce the risk of disease progression and liver-related complications, as well as improve survival by effectively suppressing viral replication. Nevertheless, since the first publication in 2019 on a lower risk of hepatocellular carcinoma (HCC) in Korean patients receiving TDF than those receiving ETV, the topic has remained a hot and unsettled debate. Multiple studies and meta-analyses have yielded conflicting results. As HCC takes time to develop, studies are mainly observational to benefit from a larger sample size and longer follow-up that provides a higher statistical power to compare the two treatments. However, TDF was available to CHB patients a few years later than ETV in most countries, thus leading to a difference in follow-up duration. Moreover, despite studying the same topic, the difference in data sources and available parameters, inclusion and exclusion criteria, and use of statistical methods complicated the interpretation and comparison of the findings and contributed to between-study heterogeneity in meta-analyses. This review describes some caveats in interpreting and comparing the results from these observational studies and meta-analyses. Future studies should explore better designed observational studies with high-quality data sources, and aggregation of patient data in meta-analysis to tackle between-study heterogeneity.
{"title":"Overview of methodologies and statistical strategies in observational studies and meta-analyses on the risk of hepatocellular carcinoma in patients with chronic hepatitis B on entecavir or tenofovir therapy","authors":"T. Yip, V. Wong, Mandy Sze-Man Lai, Vicki Wing-Ki Hui, Y. Tse, G. Wong","doi":"10.20517/2394-5079.2021.144","DOIUrl":"https://doi.org/10.20517/2394-5079.2021.144","url":null,"abstract":"Entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are first-line antiviral therapies for patients with chronic hepatitis B (CHB) and reduce the risk of disease progression and liver-related complications, as well as improve survival by effectively suppressing viral replication. Nevertheless, since the first publication in 2019 on a lower risk of hepatocellular carcinoma (HCC) in Korean patients receiving TDF than those receiving ETV, the topic has remained a hot and unsettled debate. Multiple studies and meta-analyses have yielded conflicting results. As HCC takes time to develop, studies are mainly observational to benefit from a larger sample size and longer follow-up that provides a higher statistical power to compare the two treatments. However, TDF was available to CHB patients a few years later than ETV in most countries, thus leading to a difference in follow-up duration. Moreover, despite studying the same topic, the difference in data sources and available parameters, inclusion and exclusion criteria, and use of statistical methods complicated the interpretation and comparison of the findings and contributed to between-study heterogeneity in meta-analyses. This review describes some caveats in interpreting and comparing the results from these observational studies and meta-analyses. Future studies should explore better designed observational studies with high-quality data sources, and aggregation of patient data in meta-analysis to tackle between-study heterogeneity.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67653872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.20517/2394-5079.2022.07
M. Aryan, Nicholas Forrister, Nishah N. Panchani, B. Vashi, Zahara Chowdhury, Haider A. Mejbel, Mohamed Shoreibah
Fibrolamellar hepatocellular carcinoma (FHCC) is a rare primary malignancy of the liver for which data remain limited. This tumor is more often diagnosed in younger patient populations in the absence of underlying cirrhosis and hepatitis. These lesions can be diagnosed on computed tomography scan or magnetic resonance imaging with common findings including central calcifications, a central stellate scar, and radiating fibrotic bands. Laboratory markers have not proved useful for diagnosis; however, pathologic analysis can be implemented to aid in diagnosis with findings including ample granular eosinophilic cytoplasm, nuclei with open chromatin and prominent macronuclei, hyaline and pale bodies, and dense lamellar fibrosis that divides the cells into cords or trabeculae. FHCC demonstrates aggressive malignant potential with nodal spread. Treatment patterns have remained mainly surgical; however, systemic therapies have been implemented and are under further investigation with clinical trials. Locoregional therapies and radiation therapies have been trialed sparingly. In this focused review, we discuss the most up-to-date perspective on epidemiology, clinical presentation, diagnostic approach, differential diagnosis, treatment regimens, prognosis, and future directions of FHCC.
{"title":"A focused review on recent advances in diagnosis and management of fibrolamellar hepatocellular carcinoma","authors":"M. Aryan, Nicholas Forrister, Nishah N. Panchani, B. Vashi, Zahara Chowdhury, Haider A. Mejbel, Mohamed Shoreibah","doi":"10.20517/2394-5079.2022.07","DOIUrl":"https://doi.org/10.20517/2394-5079.2022.07","url":null,"abstract":"Fibrolamellar hepatocellular carcinoma (FHCC) is a rare primary malignancy of the liver for which data remain limited. This tumor is more often diagnosed in younger patient populations in the absence of underlying cirrhosis and hepatitis. These lesions can be diagnosed on computed tomography scan or magnetic resonance imaging with common findings including central calcifications, a central stellate scar, and radiating fibrotic bands. Laboratory markers have not proved useful for diagnosis; however, pathologic analysis can be implemented to aid in diagnosis with findings including ample granular eosinophilic cytoplasm, nuclei with open chromatin and prominent macronuclei, hyaline and pale bodies, and dense lamellar fibrosis that divides the cells into cords or trabeculae. FHCC demonstrates aggressive malignant potential with nodal spread. Treatment patterns have remained mainly surgical; however, systemic therapies have been implemented and are under further investigation with clinical trials. Locoregional therapies and radiation therapies have been trialed sparingly. In this focused review, we discuss the most up-to-date perspective on epidemiology, clinical presentation, diagnostic approach, differential diagnosis, treatment regimens, prognosis, and future directions of FHCC.","PeriodicalId":12959,"journal":{"name":"Hepatoma Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67653890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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