scholarly journals Age independent survival benefit for patients with hepatocellular carcinoma (HCC) without metastases at diagnosis: a population-based study

Gut ◽  
2019 ◽  
Vol 69 (1) ◽  
pp. 168-176 ◽  
Author(s):  
Enrico N De Toni ◽  
Anne Schlesinger-Raab ◽  
Martin Fuchs ◽  
Wolfgang Schepp ◽  
Ursula Ehmer ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Real World ◽  
Survival Benefit ◽  
Treatment Options ◽  
Relative Survival ◽  
Population Based ◽  
Real World Data ◽  
Cancer Specific Survival ◽  
Kaplan Meier ◽  
German Region

ObjectiveHepatocellular carcinoma (HCC) is a major cause of death worldwide and its incidence is expected to increase globally. Aim of this study was to assess whether the implementation of screening policies and the improvement of treatment options translated into a real-world survival benefit in HCC patients.Design4078 patients diagnosed with HCC between 1998 and 2016 from the Munich Cancer Registry were analysed. Tumour characteristics and outcome were analysed by time period and according to age and presence of metastases at diagnosis. Overall survival (OS) was analysed using Kaplan-Meier method and relative survival (RS) was computed for cancer-specific survival. Cox proportional hazard models were conducted to control for prognostic variables.ResultsWhile incidence of HCC remained substantially stable, tumours were diagnosed at increasingly earlier stages, although the median age at diagnosis increased. The 3 years RS in HCC improved from 19.8% in 1998–2002, 22.4% in 2003–2007, 30.6% in 2008–2012 up to 31.0% in 2013–2016. Median OS increased from 6 months in 1998–2002 to 12 months in 2008–2016. However, analysis according to the metastatic status showed that survival improved only in patients without metastases at diagnosis whereas the prognosis of patients with metastatic disease remained unchanged.ConclusionThese real-world data show that, in contrast to the current assumptions, the incidence of HCC did not increase in a representative German region. Earlier diagnosis, likely related to the implementation of screening programmes, translated into an increasing employment of effective therapeutic options and a clear survival benefit in patients without metastases at diagnosis, irrespective of age.

Curative treatments and survival benefit in elderly patients with hepatocellular carcinoma: A SEER population-based analysis.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 355-355
Author(s):  
Oxana V. Makarova-Rusher ◽  
Susanna Varkey Ulahannan ◽  
Austin G. Duffy ◽  
Tim F. Greten ◽  
Sean Altekruse
Keyword(s):  
Hepatocellular Carcinoma ◽  
Elderly Patients ◽  
Age Groups ◽  
Relative Survival ◽  
Population Based ◽  
Outcome Data ◽  
Chi Square ◽  
Diagnostic Codes ◽  
Kaplan Meier ◽  
Young Old

355 Background: Transplant, resection, and ablation are potentially curative treatments for hepatocellular carcinoma (HCC) with limited outcome data in young-old (65-74) and older (≥75) patients. Methods: We evaluated curative treatment and relative survival (RS) outcomes in patients with HCC in 3 age groups (<65 years, 65-74 years, and ≥75 years). Patients with HCC diagnostic codes (histology 8,170-8,175, morphology C22) were identified in the SEER 18 database from 2000 to 2011. Treatments included curative (transplant, resection, radiofrequency ablation (RFA), and other ablations) and palliative therapies. Primary outcome was 5 year RS. Statistical analysis was performed using Kaplan-Meier and Chi-Square tests. Results: We identified 29,654 cases. The mean age was 62 years with almost 40% of HCC cases in patients over 65 years old. Potentially curable, localized stage rates were similar in all age groups, 46%, 48% and 46%, respectively. As a result of less resection and rare transplant use, fewer cases underwent curative treatments in the group 75 years and older in comparison to all other age groups (15% vs. 27%, p = 0.001). Five-year RS in all 3 age groups (<65 years, 65-74 years, and ≥75 years) was better after resection relative to RFA (47% vs. 35% p<0.0001, 44% vs. 37%, p=0.0093, and 43% vs. 28% p=0.0002). The highest survival was seen after liver transplant. Interestingly, among transplanted patients with HCC, 13% were 65-75 years old. Five-year RS was similar in transplanted patients 65-75 vs. those under 65 (76% vs 74% p=0.65). Conclusions: The use of curative treatments for HCC significantly decreases with age, yet there are clear survival benefits in elderly patients receiving such. Even when considering transplant, the data shows that outcome is as good in elderly patients as in younger patients. The benefit of hepatic resection appears to be superior compared to RFA in all age groups, in our analysis. [Table: see text]

scholarly journals An Easy-to-use Clinical Nomogram for Predicting the Prognosis of Patients with Hepatocellular Carcinoma Concomitantly Suffer from Severe Fibrosis or Cirrhosis: A Population-based Analysis.

2020 ◽  
Author(s):  
Wang Hanyue ◽  
Ruan Shiye ◽  
Zou Yiping ◽  
Jin Liang ◽  
Jin Haosheng ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cox Regression ◽  
Staging System ◽  
Population Based ◽  
Seer Database ◽  
Cancer Specific Survival ◽  
Kaplan Meier ◽  
Prediction Of Survival ◽  
Ishak Fibrosis Score ◽  
Severe Fibrosis

Abstract Background Patients with hepatocellular carcinoma (HCC) concomitantly suffer from liver cirrhosis may have worse prognosis. Based on Surveillance, Epidemiology, and End Results (SEER) database, we evaluated the overall survival (OS) and cancer-specific survival (CSS) of these patients. Methods A total of 2,369 patients were selected from the SEER database. They were classified into F0 (n=691) and F1 (n=1,678) groups by different Ishak fibrosis score. Propensity score matching (PSM) and Kaplan-Meier method were performed to evaluate the OS and CSS. The F1 group were randomized into training sub-set (n = 1,176, 70%) and validation sub-set (n = 502, 30%) for further construction and validation of nomogram . Results After matched, there were statistically significant worse outcome for F1 group patients compared with F0 group (n=587, OS: P<0.001, CSS: P<0.001). Six independent predictors for both OS and CSS were identified to construct the nomograms by COX regression analyses. The nomogram performed well concerning its ability of discrimination and calibration and its net benefits compared with the conventional staging system. Conclusions Patients with HCC concomitantly suffer from severe fibrosis or cirrhosis has a significant worse survival compared with none or moderate fibrosis patients. The validated nomograms provided useful prediction of survival.

Real-world treatment patterns in relapsed/refractory multiple myeloma: Clinical and economic outcomes in patients treated with pomalidomide or daratumumab

2021 ◽  
pp. 107815522199553
Author(s):  
Joshua Richter ◽  
Vamshi Ruthwik Anupindi ◽  
Jason Yeaw ◽  
Suneel Kudaravalli ◽  
Stojan Zavisic ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Real World ◽  
Treatment Options ◽  
Proteasome Inhibitors ◽  
Economic Outcomes ◽  
Office Visits ◽  
Refractory Multiple Myeloma ◽  
Kaplan Meier ◽  
Real World Evidence ◽  
New Treatment

Introduction Real-world evidence on later line treatment of relapsed/refractory multiple myeloma (RRMM) is sparse. We evaluated clinical outcomes among RRMM patients in the 1-year following treatment with pomalidomide or daratumumab and compared economic outcomes between RRMM patients and non-MM patients. Patient and Methods Adult patients with ≥1 claim of pomalidomide or daratumumab were identified between January 2012 and February 2018 using IQVIA PharMetrics® Plus US claims database. Patients were required to have a diagnosis or treatment for MM and a claim of any immunomodulatory drugs and proteasome inhibitors before the index date. Mean time to new therapy, overall survival (OS) using Kaplan-Meier curve and adverse events (AEs) were reported over the 1-year post-index period. RRMM patients were also matched to a non-MM comparator cohort and economic outcomes were compared between the two cohorts. Results 289 RRMM patients were matched to 1,445 patients without MM. Most prevalent hematological AE was anemia (72.0%) and non-hematological AE was infections (75.4%). Mean (SD) time to a new treatment was 4.7 (5.3) months and median OS was 14.6 months. RRMM patients had significantly higher hospitalizations and physician office visits (Both P < .0001) compared to non-MM patients. Adjusting for baseline characteristics, patients with RRMM had 4.9 times (95% CI 3.8-6.4, P < .0001) the total healthcare costs compared with patients without MM. The major driver of total costs among RRMM patients was pharmacy costs (67.3%). Conclusion RRMM patients showed a high frequency of AEs, low OS, and a substantial economic burden suggesting need for effective treatment options.

scholarly journals Patterns of Survival Among Patients With Myeloproliferative Neoplasms Diagnosed in Sweden From 1973 to 2008: A Population-Based Study

2012 ◽  
Vol 30 (24) ◽  
pp. 2995-3001 ◽  
Author(s):  
Malin Hultcrantz ◽  
Sigurdur Yngvi Kristinsson ◽  
Therese M.-L. Andersson ◽  
Ola Landgren ◽  
Sandra Eloranta ◽  
...  
Keyword(s):  
General Population ◽  
Life Expectancy ◽  
Excess Mortality ◽  
Myeloproliferative Neoplasms ◽  
Treatment Options ◽  
Large Population ◽  
Relative Survival ◽  
Population Based ◽  
Population Based Study ◽  
Over Time

PurposeReported survival in patients with myeloproliferative neoplasms (MPNs) shows great variation. Patients with primary myelofibrosis (PMF) have substantially reduced life expectancy, whereas patients with polycythemia vera (PV) and essential thrombocythemia (ET) have moderately reduced survival in most, but not all, studies. We conducted a large population-based study to establish patterns of survival in more than 9,000 patients with MPNs.Patients and MethodsWe identified 9,384 patients with MPNs (from the Swedish Cancer Register) diagnosed from 1973 to 2008 (divided into four calendar periods) with follow-up to 2009. Relative survival ratios (RSRs) and excess mortality rate ratios were computed as measures of survival.ResultsPatient survival was considerably lower in all MPN subtypes compared with expected survival in the general population, reflected in 10-year RSRs of 0.64 (95% CI, 0.62 to 0.67) in patients with PV, 0.68 (95% CI, 0.64 to 0.71) in those with ET, and 0.21 (95% CI, 0.18 to 0.25) in those with PMF. Excess mortality was observed in patients with any MPN subtype during all four calendar periods (P < .001). Survival improved significantly over time (P < .001); however, the improvement was less pronounced after the year 2000 and was confined to patients with PV and ET.ConclusionWe found patients with any MPN subtype to have significantly reduced life expectancy compared with the general population. The improvement over time is most likely explained by better overall clinical management of patients with MPN. The decreased life expectancy even in the most recent calendar period emphasizes the need for new treatment options for these patients.

scholarly journals Real-World Data on Clinical Outcomes of Patients with Liver Cancer: A Prospective Validation of the National Cancer Centre Singapore Consensus Guidelines for the Management of Hepatocellular Carcinoma

Liver Cancer ◽  
2021 ◽  
pp. 1-16
Author(s):  
Xin Hui Chew ◽  
Rehena Sultana ◽  
Eshani N. Mathew ◽  
David Chee Eng Ng ◽  
Richard H.G. Lo ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cancer ◽  
Clinical Outcomes ◽  
Real World ◽  
Compliance Rate ◽  
Locally Advanced ◽  
Consensus Guidelines ◽  
Real World Data ◽  
World Data ◽  
Cancer Centre

<b><i>Introduction:</i></b> Real-world management of patients with hepatocellular carcinoma (HCC) is crucially challenging in the current rapidly evolving clinical environment which includes the need for respecting patient preferences and autonomy. In this context, regional/national treatment guidelines nuanced to local demographics have increasing importance in guiding disease management. We report here real-world data on clinical outcomes in HCC from a validation of the Consensus Guidelines for HCC at the National Cancer Centre Singapore (NCCS). <b><i>Method:</i></b> We evaluated the NCCS guidelines using prospectively collected real-world data, comparing the efficacy of treatment received using overall survival (OS) and progression-free survival (PFS). Treatment outcomes were also independently evaluated against 2 external sets of guidelines, the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC). <b><i>Results:</i></b> Overall treatment compliance to the NCCS guidelines was 79.2%. Superior median OS was observed in patients receiving treatment compliant with NCCS guidelines for early (nonestimable vs. 23.5 months <i>p</i> &#x3c; 0.0001), locally advanced (28.1 vs. 22.2 months <i>p</i> = 0.0216) and locally advanced with macrovascular invasion (10.3 vs. 3.3 months <i>p</i> = 0.0013) but not for metastatic HCC (8.1 vs. 6.8 months <i>p</i> = 0.6300), but PFS was similar. Better clinical outcomes were seen in BCLC C patients who received treatment compliant with NCCS guidelines than in patients with treatment only allowed by BCLC guidelines (median OS 14.2 vs. 7.4 months <i>p</i> = 0.0002; median PFS 6.1 vs. 4.0 months <i>p</i> = 0.0286). Clinical outcomes were, however, similar for patients across all HKLC stages receiving NCCS-recommended treatment regardless of whether their treatment was allowed by HKLC. <b><i>Conclusion:</i></b> The high overall compliance rate and satisfactory clinical outcomes of patients managed according to the NCCS guidelines confirm its validity. This validation using real-world data considers patient and treating clinician preferences, thus providing a realistic analysis of the usefulness of the NCCS guidelines when applied in the clinics.

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