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Njei B, Rotman Y, Ditah I, Lim JK. Emerging trends in hepatocellular carcinoma incidence and mortality. Hepatology 2015; 61:191-199. [PMID: 25142309 PMCID: PMC4823645 DOI: 10.1002/hep.27388] [Citation(s) in RCA: 431] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 08/19/2014] [Indexed: 02/06/2023]
Abstract
UNLABELLED The rise in incidence of hepatocellular carcinoma (HCC) in the United States has been well documented. The purpose of this analysis was to examine temporal trends in HCC incidence, mortality, and survival within the U.S. population. The Surveillance, Epidemiology, and End Results data were used to examine incidence and incidence-based (IB) mortality in HCC from 1973 to 2011. Secular trends in age-adjusted incidence and IB mortality by sex and cancer stage were characterized using the Joinpoint Regression program. In 1973, HCC incidence was 1.51 cases per 100,000, whereas in 2011, HCC incidence was 6.20 cases per 100,000. Although HCC incidence continues to increase, a slowing of the rate of increase occurs around 2006. In a sensitivity analysis, there was no significant increase in incidence and IB mortality from 2009 to 2011. There was a significant increase in overall median survival from the 1970s to 2000s (2 vs. 8 months; P < 0.001). On multivariable Cox's regression analysis, age, sex, race, tumor grade, stage at diagnosis, lymph/vascular invasion, number of primary tumors, tumor size, and liver transplant were independently associated with mortality. CONCLUSION Our results indicate a deceleration in the incidence of HCC around 2006. Since 2009 and for the first time in four decades, there is no increase in IB mortality and incidence rates for HCC in the U.S. population. The nonsignificant increase in incidence and IB mortality in recent years suggest that the peak of the HCC epidemic may be near. A significant survival improvement in HCC was also noted from 1973 to 2010, which seems to be driven by earlier detection of HCC at a curative stage and greater utilization of curative modalities (especially transplant).
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Affiliation(s)
- Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT
| | - Yaron Rotman
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Ivo Ditah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Joseph K. Lim
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT
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A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations?: an observational study of the HCC East-West study group. Ann Surg 2013; 257:929-37. [PMID: 23426336 DOI: 10.1097/sla.0b013e31828329b8] [Citation(s) in RCA: 415] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to investigate in a retrospective setting the patients' profile and results of those undergoing surgery for hepatocellular carcinoma (HCC) in high-volume surgical centers throughout the world. BACKGROUND Whether surgery for HCC is a suitable approach and for which subset of patients is still controversial. The EASL/AASLD (European Association for the Study of Liver Disease/American Association for the Study of Liver Disease) guidelines, based on the Barcelona Clinic Liver Cancer (BCLC) classification, leave little room for hepatic resection; inversely, other reports promote its wider application. METHODS On the basis of the network "Hepatocellular Carcinoma: Eastern & Western Experiences," data for 2046 consecutive patients resected for HCC in 10 centers were collected. According to the BCLC classification, 1012 (50%) were BCLC 0-A, 737 (36%) BCLC B, and 297 (14%) BCLC C. Analysis of overall survival and disease-free survival and multivariate analysis of prognostic factors were performed. FINDINGS The 90-day mortality rate was 2.7%. Overall morbidity was 42%. After a median follow-up of 25 months (range, 1-209 months), the 1-, 3-, and 5-year overall survival rates were 95%, 80%, and 61% for BCLC 0-A; 88%, 71%, and 57% for BCLC B; and 76%, 49%, and 38% for BCLC C (P = 0.000). The 1-, 3-, and 5-year disease-free survival rates were as follows: 77%, 41%, and 21% for BCLC 0-A; 63%, 38%, and 27% for BCLC B; and 46%, 28%, and 18% for BCLC C (P = 0.000). The multivariate analysis identified bilirubin, cirrhosis, esophageal varices, tumor size, and macrovascular invasion to be statistical and independent prognostic factors for overall survival. CONCLUSIONS This large multicentric survey shows that surgery is in current practice widely applied among patients with multinodular, large, and macrovascular invasive HCC, providing acceptable short- and long-term results and justifying an update of the EASL/AASLD therapeutic guidelines in this sense.
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Topic A, Ljujic M, Radojkovic D. Alpha-1-antitrypsin in pathogenesis of hepatocellular carcinoma. HEPATITIS MONTHLY 2012; 12:e7042. [PMID: 23162602 PMCID: PMC3496874 DOI: 10.5812/hepatmon.7042] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/29/2012] [Accepted: 06/30/2012] [Indexed: 12/11/2022]
Abstract
CONTEXT Alpha-1-antitrypsin (A1AT) is the most abundant liver-derived, highly polymorphic, glycoprotein in plasma. Hereditary deficiency of alpha-1-antitrypsin in plasma (A1ATD) is a consequence of accumulation of polymers of A1AT mutants in endoplasmic reticulum of hepatocytes and other A1AT-producing cells. One of the clinical manifestations of A1ATD is liver disease in childhood and cirrhosis and/or hepatocellular carcinoma (HCC) in adulthood. Epidemiology and pathophysiology of liver failure in early childhood caused by A1ATD are well known, but the association with hepatocellular carcinoma is not clarified. The aim of this article is to review different aspects of association between A1AT variants and hepatocellular carcinoma, with emphasis on the epidemiology and molecular pathogenesis. The significance of A1AT as a biomarker in the diagnosis of HCC is also discussed. EVIDENCE ACQUISITIONS Search for relevant articles were performed through Pub Med, HighWire, and Science Direct using the keywords "alpha-1-antitrypsin", "liver diseases", "hepatocellular carcinoma", "SERPINA1". Articles published until 2011 were reviewed. RESULTS Epidemiology studies revealed that severe A1ATD is a significant risk factor for cirrhosis and HCC unrelated to the presence of HBV or HCV infections. However, predisposition to HCC in moderate A1ATD is rare, and probably happens in combination with HBV and/or HCV infections or other unknown risk factors. It is assumed that accumulation of polymers of A1ATD variants in endoplasmic reticulum of hepatocytes leads to damage of hepatocytes by gain-of-function mechanism. Also, increased level of A1AT was recognized as diagnostic and prognostic marker of HCC. CONCLUSIONS Clarification of a carcinogenic role for A1ATD and identification of proinflammatory or some still unknown factors that lead to increased susceptibility to HCC associated with A1ATD may contribute to a better understanding of hepatic carcinogenesis and to the development of new drugs.
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Affiliation(s)
- Aleksandra Topic
- University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade, Serbia
- Corresponding author: Aleksandra Topic, University of Belgrade, Faculty of Pharmacy, Department of Medical Biochemistry, Vojvode Stepe, 45011221, Belgrade, Serbia. Tel.: +38-1113951283, Fax: +38-1113972840, E-mail:
| | - Mila Ljujic
- University of Belgrade, Institute of Molecular Genetics and Genetic Engineering, Belgrade, Serbia
| | - Dragica Radojkovic
- University of Belgrade, Institute of Molecular Genetics and Genetic Engineering, Belgrade, Serbia
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Trinchet JC. Carcinome hépatocellulaire : une incidence croissante, une prise en charge « optimisée ». ACTA ACUST UNITED AC 2009; 33:830-9. [DOI: 10.1016/j.gcb.2009.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Al Nozha OM, Al Ashgar H, Khan M, Al Mana H. Hepatocellular carcinoma in the absence of liver cirrhosis in a treated hepatitis C virus patient. Ann Saudi Med 2009; 29:235-6. [PMID: 19448362 PMCID: PMC2813657 DOI: 10.4103/0256-4947.51789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Robbins AS, Daily MF, Aoki CA, Chen MS, Troppmann C, Perez RV. Decreasing disparity in liver transplantation among white and Asian patients with hepatocellular carcinoma : California, 1998-2005. Cancer 2008; 113:2173-9. [PMID: 18792066 PMCID: PMC4280013 DOI: 10.1002/cncr.23766] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND A preliminary study using national cancer surveillance data from 1998 through 2002 suggested that there were significant differences between non-Hispanic whites ('whites') and Asian/Pacific Islanders (APIs) in the use of liver transplantation as a treatment for hepatocellular carcinoma (HCC). METHODS The objective of the current study was to examine whether differences in liver transplantation between whites and APIs with HCC were changing over time. By using a population-based, statewide cancer registry, data were obtained on all HCC cases diagnosed in California between 1998 and 2005, and the study was limited to white and API patients with nonmetastatic HCC who had tumors that measured < or = 5 cm in greatest dimension (n = 1728 patients). RESULTS From 1998 through 2003 (n = 1051 patients), the odds of undergoing liver transplantation were 2.56 times greater for white patients than for API patients (95% confidence interval [CI], 1.72-3.80 times higher), even after adjusting for age, sex, marital status, year of diagnosis, TNM stage, and tumor grade. In contrast, during 2004 and 2005 (n = 677 patients), there were no significant differences in the odds of undergoing liver transplantation. Between 2002 and 2004, changes in liver transplantation policy assigned priority points to patients with HCC (initially to stage I and II, then to stage II only). After the policy changes, API patients with HCC experienced a significant increase in stage II diagnoses, whereas white patients did not. CONCLUSIONS In California, there was a large and significant disparity in the rate of liver transplantation among white and API patients with HCC from 1998 through 2003 but not during 2004 and 2005. Changes in liver transplantation policy from 2002 through 2004 may have played a role in decreasing this difference.
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Affiliation(s)
- Anthony S Robbins
- California Cancer Registry, Public Health Institute, Sacramento, California, USA.
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Guiu B, Loffroy R, Ben Salem D, Lepage C, Guiu S, Aho S, Jouve JL, Krausé D, Cercueil JP. Combined SPIO-gadolinium magnetic resonance imaging in cirrhotic patients: negative predictive value and role in screening for hepatocellular carcinoma. ACTA ACUST UNITED AC 2008; 33:520-8. [PMID: 17912584 DOI: 10.1007/s00261-007-9327-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The objective of our study was to assess the negative predictive value (NPV) of double-contrast MRI (DC-MRI) with SPIO and gadolinium, and to determine the role of DC-MRI in screening for hepatocellular carcinoma (HCC) in cirrhotic patients. METHODS We retrospectively included 160 DC-MRI scans done as second-line investigations in 119 patients with cirrhosis over a 25-month period. Two radiologists independently classified the MRI scans as strongly suggesting HCC (HCC Group), showing benign nodules (benign nodules Group), showing no nodules (no-nodules Group) or indeterminate; they assigned a diagnostic confidence score (DCS) using a 0-10 scale. The reference standard was histology or results of follow-up investigations. Mean follow-up was 16.9 months (12-28 months). RESULTS The radiologists disagreed for two scans (kappa = 0.98). Of 112 scans [benign nodules Group (n = 32) and no-nodules Group (n = 80)], 11 were excluded (3 patients lost to follow-up and 8 who died with no known cancer) while a HCC was detected during follow-up in 8 patients, yielding a NPV of 92% (93/101) (95% confidence interval, 85%-97%). The DCS was in the 4-6 range (indicating uncertainty) for only 6 (3.75%) scans. CONCLUSIONS DC-MRI is reliable and reproducible. Its high NPV suggests a role as a second-line investigation after ultrasonography, for HCC screening.
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Affiliation(s)
- Boris Guiu
- Radiology Departement, CHU le Bocage, University Hospital of Dijon, Boulevard Maréchal de Lattre de Tassigny, Dijon, 21000, France.
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Time trends in incidence and prognosis of primary liver cancer and liver metastases of unknown origin in a Danish region, 1985-2004. Eur J Gastroenterol Hepatol 2008; 20:104-10. [PMID: 18188029 DOI: 10.1097/meg.0b013e3282f17517] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Changes, over the last 20 years, in the diagnostic procedures and treatment of primary liver cancer (PLC) and liver metastases of unknown origin (LMUO) may have affected the clinical course of both cancers. Few longitudinal studies examined this issue. In a population-based setting, we studied changes in the incidence and prognosis of PLC and LMUO over time. METHODS Between 1985 and 2004, we identified 2675 patients with PLC and LMUO in three Danish counties, with a population of 1.4 million. We computed the standardized incidence rate (SIR), ratio of PLC to LMUO diagnoses, median survival, and estimated mortality rate ratio adjusted for age, sex, and comorbidity. RESULTS The SIR of PLC increased from 3.2 in 1985 to 5.0 in 2003, and the SIR of LMUO increased from 3.7 to 6.4. No increase was noted in the PLC-to-LMUO ratio over time (P=0.1 for trend). From 1985 to 2004, the median survival of PLC patients increased from 1.6 to 2.9 months whereas that of LMUO patients decreased from 1.7 to 1.3 months. Adjusting for age, sex, and comorbidity did not affect the mortality rate ratio estimates. CONCLUSIONS The incidence of both PLC and LMUO increased over time, whereas the PLC-to-LMUO ratio remained unchanged. Median survival of PLC patients has increased whereas that of LMUO patients remained practically unchanged.
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Scaife C. Liver. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Trinchet JC, Ganne-Carrié N, Nahon P, N'kontchou G, Beaugrand M. Hepatocellular carcinoma in patients with hepatitis C virus-related chronic liver disease. World J Gastroenterol 2007; 13:2455-60. [PMID: 17552029 PMCID: PMC4146764 DOI: 10.3748/wjg.v13.i17.2455] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) is a major cause of hepatocellular carcinoma (HCC) worldwide due to the high prevalence of HCV infection and the high rate of HCC occurrence in patients with HCV cirrhosis. A striking increase in HCC incidence has been observed during the past decades in most industrialized countries, partly related to the growing number of patients infected by HCV. HCC is currently the main cause of death in patients with HCV-related cirrhosis, a fact that justifies screening as far as curative treatments apply only in patients with small tumors. As a whole, treatment options are similar in patients with cirrhosis whatever the cause. Chemoprevention could be also helpful in the near future. It is strongly suggested that antiviral treatment of HCV infection could prevent HCC occurrence, even in cirrhotic patients, mainly when a sustained virological response is obtained.
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Affiliation(s)
- Jean-Claude Trinchet
- Service d'Hépato-Gastroentérologie, Hôpital Jean Verdier, 93143 Bondy Cedex, France.
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Baccarani U, Adani GL, Avellini C, Lorenzin D, Currò G, Beltrami A, Pasqualucci A, Bresadola V, Risaliti A, Viale PL, Beltrami CA, Bresadola F. Comparison of clinical and pathological staging and long-term results of liver transplantation for hepatocellular carcinoma in a single transplant center. Transplant Proc 2006; 38:1111-3. [PMID: 16757280 DOI: 10.1016/j.transproceed.2006.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Liver transplantation (OLT) is a treatment for hepatocellular carcinoma (HCC) superimposed on cirrhosis provided that the disease meets defined criteria. The aim of the study was to evaluate our experience with respect to clinical and pathological staging and long-term results. From 1996 to 2005, 50 patients underwent OLT for HCC including 43 men (86%) and seven women (14%) of median age 57 years (range 37 to 67). All patients fulfilled the Milan criteria. The HCC diagnosis was based on preoperative imaging and alpha-fetoprotein levels; no tumor biopsy was performed. Upon histological examination of the resected specimens, we discovered 6 (12%) incidentalomas and 8 (16%) cases of no HCC. Finally we had 42 "true" HCC. Twenty-six patients (52%) have been downstaged and 10 (20%) upstaged by preoperative imaging; 15% were pT1, 45% were pT2, 27% pT3, and 13% pT4a. Twenty-six percent of cases exceeded the Milan criteria. One patient (pT4a) with microvascular invasion died of pulmonary metastases at 14 months after transplantation. No HCC recurrences within the liver have been encountered at a median follow-up of 20 months (range 0 to 80 months). Overall the estimated 1-, 3-, and 5-year survival rates were 83%, 77%, and 72%, respectively. One-, 3-, and 5-year estimated survival rates were 87%, 75%, and 75% for pT1, and pT2, and 75%, 67%, and 67% for pT3 and pT4a, respectively (P = .99). Based on our experience OLT for HCC has long-term results comparable to those without HCC despite the presence of a significant number of cases exceeding the Milan criteria upon pathological staging.
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Affiliation(s)
- U Baccarani
- Department of Surgery and Transplantation, University Hospital Udine, Italy.
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Trinchet JC, Ganne-Carrié N. [Should we screen for hepatocellular carcinoma?]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2006; 30:880-6. [PMID: 16885873 DOI: 10.1016/s0399-8320(06)73336-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Jean-Claude Trinchet
- Hépato-Gastroentérologie, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris, UFR SMBH-Université Paris 13, 93143 Bondy Cedex.
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Ward DG, Cheng Y, N'kontchou G, Thar TT, Barget N, Wei W, Billingham LJ, Martin A, Beaugrand M, Johnson PJ. Changes in the serum proteome associated with the development of hepatocellular carcinoma in hepatitis C-related cirrhosis. Br J Cancer 2006; 94:287-92. [PMID: 16404431 PMCID: PMC2361123 DOI: 10.1038/sj.bjc.6602923] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Early diagnosis of hepatocellular carcinoma (HCC) is the key to the delivery of effective therapies. The conventional serological diagnostic test, estimation of serum alpha-fetoprotein (AFP) lacks both sensitivity and specificity as a screening tool and improved tests are needed to complement ultrasound scanning, the major modality for surveillance of groups at high risk of HCC. We have analysed the serum proteome of 182 patients with hepatitis C-induced liver cirrhosis (77 with HCC) by surface-enhanced laser desorption/ionisation time-of-flight mass spectrometry (SELDI). The patients were split into a training set (84 non-HCC, 60 HCC) and a ‘blind’ test set (21 non-HCC, 17 HCC). Neural networks developed on the training set were able to classify the blind test set with 94% sensitivity (95% CI 73–99%) and 86% specificity (95% CI 65–95%). Two of the SELDI peaks (23/23.5 kDa) were elevated by an average of 50% in the serum of HCC patients (P<0.001) and were identified as κ and λ immunoglobulin light chains. This approach may permit identification of several individual proteins, which, in combination, may offer a novel way to diagnose HCC.
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Affiliation(s)
- D G Ward
- Cancer Research UK Institute for Cancer Studies, School of Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Y Cheng
- Cancer Research UK Institute for Cancer Studies, School of Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - G N'kontchou
- Hepto-gastroenterology and Pathology Department, Jean Verdier Hospital, Assistance Publique-Hospitaux de Paris, UPRES EA 3409, UFR SMBH, Université Paris 13, Bondy, France
| | - T T Thar
- Hepto-gastroenterology and Pathology Department, Jean Verdier Hospital, Assistance Publique-Hospitaux de Paris, UPRES EA 3409, UFR SMBH, Université Paris 13, Bondy, France
| | - N Barget
- Hepto-gastroenterology and Pathology Department, Jean Verdier Hospital, Assistance Publique-Hospitaux de Paris, UPRES EA 3409, UFR SMBH, Université Paris 13, Bondy, France
| | - W Wei
- Cancer Research UK Institute for Cancer Studies, School of Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - L J Billingham
- Cancer Research UK Institute for Cancer Studies, School of Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - A Martin
- Cancer Research UK Institute for Cancer Studies, School of Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - M Beaugrand
- Hepto-gastroenterology and Pathology Department, Jean Verdier Hospital, Assistance Publique-Hospitaux de Paris, UPRES EA 3409, UFR SMBH, Université Paris 13, Bondy, France
| | - P J Johnson
- Cancer Research UK Institute for Cancer Studies, School of Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Cancer Research UK Institute for Cancer Studies, School of Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. E-mail:
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Abstract
Primary care physicians see many of the estimated 250 000 Canadians chronically infected with the hepatitis C virus (HCV). Of this number, about one-third are unaware they are infected, which constitutes a large hidden epidemic. They continue to spread HCV unknowingly and cannot benefit from advances in antiviral therapy that may clear them of the virus. Many HCV-infected people remain asymptomatic, which means it is important to assess for risk factors and test patients accordingly. The third-generation enzyme immunoassay for HCV antibodies is a sensitive and specific test, although the presence of the virus can be confirmed by polymerase chain reaction testing for HCV RNA in some circumstances. Pegylated interferon-alpha and ribavirin combination therapy clears the virus in about 45%-80% of patients, depending on viral genotype. Preventive strategies and counselling recommendations are also reviewed.
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Affiliation(s)
- Tom Wong
- Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada and the University of Ottawa, Ottawa, Ont.
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Abstract
Surgery is often not a treatment option in patients with hepatocellular carcinoma with the numerous limitations of liver transplantation or surgical resection due to coexisting cirrhosis in the later case. Non-surgical treatments deal with 3 types of methods: local ablation with curative purpose, transarterial treatments with many technical variants and systemic treatment. Local treatments rely on chemical or thermic agents to achieve ablation of liver lesions, which not exceed initially 3 cm in diameter. The use of radiofrequency ablation allows now larger limits. Intra-arterial treatment usually combines intra-arterial chemotherapy with embolisation of hepatic artery in a procedure called chemoembolisation. Its antitumoral effect mainly due to ischemia is well documented but the influence on survival remains controversial. Finally systemic treatments have yet to be demonstrated useful: new agents and new randomised trials are still needed.
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Affiliation(s)
- Michel Beaugrand
- Service d'hépatogastroentérologie, hôpital Jean-Verdier, Assistance-publique-hôpitaux-de-Paris et UFR SMBH-université Paris-XIII, 93143 Bondy cedex, France.
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