The latest medical research on Liver Cancer
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about liver cancer gathered by our medical AI research bot.
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Binge drinking induces an acute burst of markers of hepatic fibrogenesis (PRO-C3).Liver International
Binge drinking is associated with increased risk of liver-disease. Morbidity and mortality of alcohol-related liver disease (ALD) is associated with collagen deposition in the hepatic extracellular matrix (ECM). However, acute effects of binge drinking on ECM turnover are unknown. We aimed to investigate the effects on hepatic ECM turnover following a binge drinking episode.
We performed a pathophysiological intervention study with 15 non-alcoholic fatty liver disease (NAFLD) patients, 15 ALD patients and 10 healthy controls. We used 40% ethanol in 9 mg/mL NaCl administered through a nasogastric tube to simulate binge drinking. Hepatic vein catheterisation allowed simultaneous hepatic- and systemic vein sampling. Markers of ECM formation and degradation were measured with competitive ELISA.
The interstitial matrix formation marker PRO-C3 increased by 1.2 ng/mL (10%, P<0.001) 24 hours after binge drinking. In participants with existing liver fibrosis determined by elevated baseline PRO-C3, hepatic levels increased by 0.09 ng/mL (95% CI: 0.03; 0.15, P=0.005) while systemic PRO-C3 decreased 0.11 ng/mL (95% CI: -0.15; -0.06, P<0.001) in 3-hours. PRO-C8 increased by 30% (+0.9 ng/mL, P=0.014) in liver-diseased patients with F0-F1 but not in any other group. 24-hour changes in systemic C3M and PRO-C3 were not associated (P=0.911).
Binge drinking induced an acute burst of PRO-C3 in healthy individuals and patients with liver-disease. Markers of ECM degradation were not correlated to markers of ECM formation, suggestive that even a single episode of binge drinking promotes excessive hepatic fibrogenesis.
State of the art treatment of HBV hepatocellular carcinoma and the role of HBsAg post liver transplantation and resection.Liver International
Chronic hepatitis B virus (HBV) infection is the major aetiology of hepatocellular carcinoma (HCC). The optimal goal of therapy, hepatitis B surfac...
Chronic Liver Disease in Homeless Individuals and Performance of Non-Invasive Liver Fibrosis and Injury Markers: VALID Study.Liver International
Community-based assessment and management of chronic liver disease (CLD) in people who are homeless (PWAH) remains poorly described. We aimed to determine prevalence/predictors of chronic liver disease (CLD) in PWAH and assess performance of non-invasive hepatocyte fibrosis and injury markers.
The Vulnerable Adult LIver Disease (VALID) study provided a "one-stop" liver service based at homeless hostels. Our primary outcome was the prevalence of clinically significant hepatic fibrosis (CSHF) (liver stiffness measurement (LSM) ≥ 8kPa).
Total individuals recruited were 127, mean±SD age 47±9.4 years, 50% (95% CI 41%-59%) and 39% (95% CI 31%- 48%) having alcohol dependence and a positive HCV RNA respectively. CSHF was detected in 26% (95% CI 17%-35%), independent predictors being total alcohol unit/week (OR 1.01, 95% CI 1.00-1.02, p=0.002) and HCV RNA positivity (OR 2.93, 95% CI 1.12-7.66, p=0.029). There was moderate agreement between LSM and Enhanced Liver Fibrosis (ELF) score (kappa 0.536, p<0.001) for CSHF as assessed by LSM ≥8kPa. Those with CSHF had significantly higher levels of IFN-γ (p=0.002), IL-6 (p=0.001), MMP-2 (p=0.006), ccCK-18 (p<0.001) and ELF biomarkers (p<0.001), compared to those without CSHF. Service uptake was ≥95%. Direct acting antiviral (DAA) treatment completion was 93% (95% CI 77%-99%), sustained virological response (SVR) being 83% (95% CI 64%-94%).
There is a significant liver disease burden from HCV and alcohol in PWAH. Non-invasive hepatocyte fibrosis and injury markers can help in identifying such individuals in the community. Despite a challenging cohort, excellent service uptake and high DAA-based SVRs can be achieved.
Cost-effectiveness analysis of hepatitis C virus (HCV) point-of-care assay for HCV screening.Liver International
Hepatitis C virus (HCV) continues to pose significant public health concerns with approximately 44% of chronically infected Canadians undiagnosed. The current HCV screening in Canada is a two-step diagnosis pathway consisting of anti-HCV testing and HCV ribonucleic acid (RNA) testing. The introduction of HCV point-of-care assays, such as the Xpert HCV viral load finger-stick assay, can facilitate HCV RNA diagnosis during a single visit and provide quick linkage to care. We evaluated the cost-effectiveness of HCV point-of-care testing compared with current HCV screening strategies for injection drug users (IDUs) from a Canadian provincial Ministry of Health perspective.
A state-transition model based on published literature was developed to compare HCV point-of-care assay with the standard-of-care blood screening for a one-time HCV screening and treatment program. It adopted a lifetime time horizon and included health states related to treatment, fibrosis stages, and advanced liver disease clinical states. Outcomes were expressed in costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. Sensitivity analyses were conducted to assess the robustness of the model.
HCV point-of-care assay generated an additional 0.035 QALYs/person at a cost reduction of $21.15 compared with the standard-of-care screening. The results were the most sensitive to the specificity of HCV point-of-care assay.
The implementation of HCV point-of-care screening in Canada is likely to be cost-saving for IDUs. Early detection and treatment of undiagnosed individuals can prolong people's life span and save healthcare costs associated with HCV-related complications.
HCV disease burden and population segments in Switzerland.Liver International
Switzerland has made strides towards hepatitis C virus elimination, but as of 2019, elimination was not guaranteed. However, political interest in viral hepatitis has been increasing. We sought to develop a better understanding of Switzerland's progress toward HCV elimination and the profile of remaining HCV-RNA positive patients.
A previously described Markov model was updated with recent diagnosis and treatment data and run to generate new forecasts for HCV disease burden. Two scenarios were developed to evaluate HCV morbidity and mortality under the status quo and a scenario that achieves the Swiss Hepatitis Strategy Elimination targets. Next, an analysis was conducted to identify population segments bearing a high burden of disease, where future elimination efforts could be directed.
At the beginning of 2020, an estimated 32,100 viremic infections remained in Switzerland (0.37% viremic prevalence). Adult (≥18 years of age) permanent residents born abroad represented the largest sub-population, accounting for 56% of HCV infections. Thirteen countries accounted for ≥60% of viremic infections among permanent residents born abroad, with most people currently residing in Zurich, Vaud, Geneva, Bern, Aargau and Ticino. Among Swiss-born HCV-RNA+ persons, two thirds had a history of IDU, corresponding to 33% of total infections.
In Switzerland, extra efforts for diagnosis and linkage to care are warranted in foreign-born populations and people with a history of drug use. Population-level measures (e.g., increasing the number of providers, increase screening) can identify patients who may have otherwise fallen through the gaps or avoided care due to stigma.
Causal effects from non-alcoholic fatty liver disease on kidney function: A Mendelian randomization study.Liver International
An observational association between nonalcoholic fatty liver disease (NAFLD) and kidney function impairment has been reported. We aimed to investigate the causal effects from NAFLD on estimated glomerular filtration rate (eGFR) by an Mendelian randomization (MR) study.
We first performed single-variant MR with rs738409 as a genetic instrument for NAFLD. Another genetic instrument was developed from a genome-wide association study for biopsy-confirmed NAFLD among individuals of European ancestry (1,483 cases and 17,781 controls). The eGFR outcome was assessed in individuals of white British ancestry from the UK Biobank (N = 321,405). The associations were reassessed in the negative control subgroup (body mass index < 30 kg/m2 , absence of central obesity, and serum alanine aminotransferase level ≤ 20 IU/mL) with a low probability of developing NAFLD. As a replication analysis, a summary-level MR was performed with the European ancestry CKDGen dataset (N = 567,460).
In the UK Biobank, a genetic predisposition for NAFLD, determined either by the single SNP rs738409 or by the group of variants, was significantly associated with a reduced eGFR even with adjustment for metabolic disorders. Although the associations were not significant in the negative control subgroups with a low probability of developing NAFLD, they were significant in the subgroups with a remaining risk of NAFLD, suggesting the absence of a horizontal pleiotropic pathway. The summary-level MR from the CKDGen dataset supported the causal effects of NAFLD on reduced eGFR.
This MR analysis supports the causal reduction in kidney function by NAFLD.
Hepatitis Delta virus in migrants: the challenge of elimination (ANRS CO22 HEPATHER cohort).Liver International
The review by Loureiro et al.  explores the promising opportunities that new therapies provide against hepatitis B virus (HBV) and hepatitis Del...
Pattern of progression of intrahepatic cholangiocarcinoma: Implications for second-line clinical trials.Liver International
Intrahepatic cholangiocarcinoma (iCCA) is the second most frequent liver cancer. The overall survival of iCCA and other biliary tract cancers (BTC) remain poor. Recently, the ABC-06 trial reported the superiority of FOLFOX vs clinical observation as a second line treatment. Still, survival benefit was less than expected. We hypothesized that the pattern of progression of iCCA can drive post progression survival (PPS), similarly to hepatocellular carcinoma.
Multicenter retrospective evaluation of consecutive iCCA patients who progressed after a frontline systemic treatment with gemcitabine as monotherapy, or in combination with platinum. Radiological assessment of progression was evaluated according to RECIST 1.1. The progression pattern was divided according to the presence/absence of new extrahepatic lesions (NEH).
We included 206 patients from 5 centers. The median OS was 14.1 months and its independent predictors (hazard ratio [HR], 95% confidence interval [CI]) were: previous surgery 0.699 [0.509-0.961], performance status>0 2.445 [1.788-3.344], permanent first line discontinuation 16.072 [5.102-50.633], registration of ascites 2.226 [1.448-3.420] or bilirubin>3mg/dl 3.004 [1.935-4.664] during the follow-up, and disease progression 2.523 [1.261-5.050]. The appearance of NEH independent predicted OS 2.18 [1.55-3.06] in patients with radiological progression. Amongst 138 patients eligible for a second-line treatment, PPS was 16.8 and 5.9 months in cases without and with NEH, respectively (p=0.001). Progression due to NEH lesions was an independent predictors of PPS 1.873[1.333-2.662], together with performance status, time-to-progression to the frontline treatment, bilirubin>3mg/dl, and ascites.
PPS of iCCA is influenced by progression pattern, with important implications for second-line trial design and analysis.
A multi-site, nurse-coordinated hepatitis C model of care in primary care and community services in Melbourne, Australia.Liver International
Hepatitis C virus (HCV) treatment through primary care and community-based services will be a critical component of HCV elimination. We evaluated a nurse-coordinated program providing care across eight sites and analysed progression through the HCV care cascade.
People accessing services from six primary care clinics, a homeless crisis accommodation provider and a mental health service were directly referred to nurses or engaged by nurses during regular clinic visits. Nurses supported HCV testing, treatment, and follow-up. Prescription was provided by affiliated clinicians. Logistic regression was used to examine factors associated with treatment commencement and sustained virological response (SVR) testing.
Of 640 people referred to and/or engaged by the nurses from January 2017 to July 2019, 518 had an HCV RNA test of whom 381 (74%) were HCV RNA positive. Treatment was commenced by 281 (74%) people of whom 161 had an SVR test; 157 (97.5%) were cured. Opioid agonist therapy was associated with treatment commencement (aOR 2.68, 95%CI 1.48-4.88). People who were homeless/unstably housed were less likely to commence treatment (aOR 0.45, 95%CI 0.23-0.87). Treatment prescription from a specialist (aOR 2.39, 95%CI 1.20-4.74) and recent injection drug use (<6 months) (aOR 2.15, 95%CI 1.07-4.31) was associated with SVR testing.
A nurse-coordinated model of care led to high levels of HCV treatment uptake and cure among people attending primary care and community services. More tailored models of care may be beneficial for people who are homeless or have unstable housing. These results support primary care and community-based hepatitis C treatment.
Inflammatory activity affects the accuracy of liver stiffness measurement by transient elastography, but not by two-dimensional shear wave elastography in nonalcoholic fatty liver disease.Liver International
In patients with non-alcoholic fatty liver disease (NAFLD), the impact of the severity of steatosis and inflammatory activity on the accuracy of liver stiffness measurement (LSM) by transient elastography (TE) and by two-dimensional-shear-wave elastography (2D-SWE) in staging liver fibrosis is still debated and scarce, respectively. We aimed to focus on this aspect.
We prospectively studied 104 patients requiring biopsy for the assessment of NAFLD. We used ordinary least squares regression to test for differences in the association between fibrosis and LSM by TE and 2D-SWE when other factors (steatosis, inflammatory activity) are considered.
Among 104 patients, 102 had reliable LSM by TE, and 88 had valid LSM by 2D-SWE. The association between fibrosis based on histology and LSM was significantly stronger when 2D-SWE assessed LSM compared to TE (Spearman's correlation coefficient of 0.71; p<0.001 vs. 0.51, p<0.001; Z=2.21, p=0.027). Inflammatory activity was an independent predictor of LSM by TE but not of LSM by 2D-SWE. After controlling for fibrosis, age, sex, and BMI, the inflammatory activity and the interaction between inflammatory activity and fibrosis independently explained 11% and 13% of variance in LSM by TE, respectively. Steatosis did not affect the association of fibrosis and LSM by either method.
Inflammatory activity on histology significantly affects LSM by TE, but not LSM by 2D-SWE in NAFLD. LSM by 2D-SWE reflects liver fibrosis more accurately than LSM by TE. Furthermore, the severity of steatosis on histology did not influence the association of LSM and fibrosis by either elastography method.
Association of Skeletal Muscle Index with Postoperative Acute Kidney Injury in Living Donor Hepatectomy: A Retrospective Single-center Cohort Study.Liver International
Although, living donor liver transplantation (LDLT) is the standard treatment option for patients with end-stage liver disease, it always entails ethical concerns about the risk of living donors. Recent studies have reported a correlation between sarcopenia and surgical prognosis in recipients. However, there are few studies of donor sarcopenia and the surgical prognosis of donors. This study investigated the association between sarcopenia and postoperative acute kidney injury in liver donors.
This retrospective study analyzed 2,892 donors who underwent donor hepatectomy for LDLT between January 2008 and January 2018. Sarcopenia was classified into pre-sarcopenia and severe sarcopenia, which were determined to be -1 standard deviation (SD), and -2 SD from the mean baseline of the skeletal muscle index, respectively. Multivariate regression analysis was performed to evaluate the association between donor sarcopenia and postoperative AKI. Additionally, we assessed the association between donor sarcopenia and delayed recovery of liver function (DRHF).
In the multivariate analysis, donor sarcopenia was significantly associated a higher incidence of postoperative AKI (adjusted odds ratio [OR]: 2.65, 95% confidence interval [CI]: 1.15-6.11, P=0.022 in pre-sarcopenia, OR: 5.59, 95% CI: 1.11-28.15, P=0.037 in severe sarcopenia, respectively). Additionally, hypertension, and synthetic colloid use were significantly associated with postoperative AKI. In the multivariate analysis, risk factors of DRHF were male gender, indocyanine green retention rate at 15 minutes, and graft type, however, donor sarcopenia was not a risk factor.
Donor sarcopenia is associated with postoperative AKI following donor hepatectomy.
Albumin for AKI in cirrhosis - sham therapy or effective?Liver International
We read with great interest the original article by Patidar et al. , studying the outcomes associated with intravenous (IV) albumin in patients ...