Epidemiological trends and trajectories of MAFLD-associated hepatocellular carcinoma 2002–2033: the ITA.LI.CA database

BackgroundMetabolic dysfunction-associated fatty liver disease (MAFLD) represents a new inclusive definition of the whole spectrum of liver diseases associated to metabolic disorders. The main objective of this study was to compare patients with MAFLD and non-MAFLD with hepatocellular carcinoma (HCC) included in a nationally representative cohort.MethodsWe analysed 6882 consecutive patients with HCC enrolled from 2002 to 2019 by 23 Italian Liver Cancer centres to compare epidemiological and future trends in three subgroups: pure, single aetiology MAFLD (S-MAFLD); mixed aetiology MAFLD (metabolic and others, M-MAFLD); and non-MAFLD HCC.ResultsMAFLD was diagnosed in the majority of patients with HCC (68.4%). The proportion of both total MAFLD and S-MAFLD HCC significantly increased over time (from 50.4% and 3.6% in 2002–2003, to 77.3% and 28.9% in 2018–2019, respectively, p<0.001). In Italy S-MAFLD HCC is expected to overcome M-MAFLD HCC in about 6 years. Patients with S-MAFLD HCC were older, more frequently men and less frequently cirrhotic with clinically relevant portal hypertension and a surveillance-related diagnosis. They had more frequently large tumours and extrahepatic metastases. After weighting, and compared with patients with non-MAFLD, S-MAFLD and M-MAFLD HCC showed a significantly lower overall (p=0.026, p=0.004) and HCC-related (p<0.001, for both) risk of death. Patients with S-MAFLD HCC showed a significantly higher risk of non-HCC-related death (p=0.006).ConclusionsThe prevalence of MAFLD HCC in Italy is rapidly increasing to cover the majority of patients with HCC. Despite a less favourable cancer stage at diagnosis, patients with MAFLD HCC have a lower risk of HCC-related death, suggesting reduced cancer aggressiveness.

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AF.79 EPIDEMIOLOGICAL TRENDS OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH METABOLIC-DYSFUNCTION-ASSOCIATED FATTY LIVER DISEASE (MAFLD) IN ITALY

Digestive and Liver Disease ◽

10.1016/s1590-8658(21)00642-3 ◽

2021 ◽

Vol 53 ◽

pp. S173

Author(s):

M. Cucco ◽

A. Vitale ◽

G. Svegliati–Baroni ◽

G. Marchesini ◽

U. Cillo ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Metabolic Dysfunction ◽

Epidemiological Trends

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Dietary Fiber and Mortality Across Kidney Function in a Nationally Representative Cohort

Journal of Renal Nutrition ◽

10.1053/j.jrn.2020.01.013 ◽

2020 ◽

Vol 30 (2) ◽

pp. 173

Keyword(s):

Dietary Fiber ◽

Kidney Function ◽

Nationally Representative ◽

Representative Cohort

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Adipose Tissue Immunomodulation and Treg/Th17 Imbalance in the Impaired Glucose Metabolism of Children with Obesity

Children ◽

10.3390/children8070554 ◽

2021 ◽

Vol 8 (7) ◽

pp. 554

Author(s):

Stefania Croce ◽

Maria Antonietta Avanzini ◽

Corrado Regalbuto ◽

Erika Cordaro ◽

Federica Vinci ◽

...

Keyword(s):

Adipose Tissue ◽

Glucose Metabolism ◽

Th17 Cells ◽

Metabolic Disorders ◽

Potential Role ◽

Immune Monitoring ◽

Metabolic Dysfunction ◽

Impaired Glucose Metabolism ◽

T Cell Infiltration

In the last few decades, obesity has increased dramatically in pediatric patients. Obesity is a chronic disease correlated with systemic inflammation, characterized by the presence of CD4 and CD8 T cell infiltration and modified immune response, which contributes to the development of obesity related diseases and metabolic disorders, including impaired glucose metabolism. In particular, Treg and Th17 cells are dynamically balanced under healthy conditions, but imbalance occurs in inflammatory and pathological states, such as obesity. Some studies demonstrated that peripheral Treg and Th17 cells exhibit increased imbalance with worsening of glucose metabolic dysfunction, already in children with obesity. In this review, we considered the role of adipose tissue immunomodulation and the potential role played by Treg/T17 imbalance on the impaired glucose metabolism in pediatric obesity. In the patient care, immune monitoring could play an important role to define preventive strategies of pediatric metabolic disease treatments.

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Preoperative Predictors of Futile Resection of Intraabdominal Extrahepatic Metastases from Hepatocellular Carcinoma

World Journal of Surgery ◽

10.1007/s00268-020-05907-2 ◽

2021 ◽

Author(s):

Yun Le Linn ◽

Yuxin Guo ◽

Ye-Xin Koh ◽

Pierce K. H. Chow ◽

Chung-Yip Chan ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Extrahepatic Metastases ◽

Preoperative Predictors

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How to Treat Hepatocellular Carcinoma in Elderly Patients

Pharmaceuticals ◽

10.3390/ph14030233 ◽

2021 ◽

Vol 14 (3) ◽

pp. 233

Author(s):

Piera Federico ◽

Emilio Francesco Giunta ◽

Annalisa Pappalardo ◽

Andrea Tufo ◽

Gianpaolo Marte ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Elderly Patients ◽

Elderly Population ◽

Primary Tumour ◽

The Elderly ◽

Chronic Liver Diseases ◽

Old Patients ◽

Choice Of Treatment ◽

Definition Of ◽

Optimal Treatment Strategy

Hepatocellular carcinoma (HCC) is the primary tumour of the liver with the greatest incidence, particularly in the elderly. Additionally, improvements in the treatments for chronic liver diseases have increased the number of elderly patients who might be affected by HCC. Little evidence exists regarding HCC in old patients, and the elderly are still underrepresented and undertreated in clinical trials. In fact, this population represents a complex subgroup of patients who are hard to manage, especially due to the presence of multiple comorbidities. Therefore, the choice of treatment is mainly decided by the physician in the clinical practice, who often tend not to treat elderly patients in order to avoid the possibility of adverse events, which may alter their unstable equilibrium. In this context, the clarification of the optimal treatment strategy for elderly patients affected by HCC has become an urgent necessity. The aim of this review is to provide an overview of the available data regarding the treatment of HCC in elderly patients, starting from the definition of “elderly” and the geriatric assessment and scales. We explain the possible treatment choices according to the Barcelona Clinic Liver Cancer (BCLC) scale and their feasibility in the elderly population.

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Relationship satisfaction and concordance in attitudes to maternal employment in British couples with young children

Journal of Social and Personal Relationships ◽

10.1177/0265407520919987 ◽

2020 ◽

Vol 37 (7) ◽

pp. 2184-2204

Author(s):

Lauren Bird ◽

Amanda Sacker ◽

Anne McMunn

Keyword(s):

Relationship Satisfaction ◽

Family Relationships ◽

Maternal Employment ◽

Potential Association ◽

Paid Labor ◽

Societal Changes ◽

Nationally Representative ◽

And Behavior ◽

Attitudes And Behavior ◽

Representative Cohort

Changes in paid labor in families have occurred within the wider context of societal changes in gendered attitudes to work. However, changes in behavior and attitudes are not necessarily correlated with each other, and their associations with family relationships are complex. This study uses data from over 12,000 two-parent families in the U.K.’s Millennium Cohort Study, a nationally representative cohort of children born during 2000–2002. The study investigates the potential association between relationship satisfaction and discordance between attitudes to maternal employment and mothers’ actual participation in paid labor, as well as agreement in attitudes within couples. Results show that attitudes in favor of maternal employment and actual maternal employment are generally associated with better relationship satisfaction for both mothers and fathers. In addition, discordance between an individual’s attitudes and behavior in relation to maternal employment, and discordant attitudes within couples, is both associated with significantly lower relationship satisfaction compared with concordant couples.

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Impact of Extrahepatic Metastases on Overall Survival in Patients with Advanced Liver Dominant Hepatocellular Carcinoma: A Subanalysis of the SORAMIC Trial

Liver Cancer ◽

10.1159/000510798 ◽

2020 ◽

Vol 9 (6) ◽

pp. 771-786

Author(s):

Kerstin Schütte ◽

Regina Schinner ◽

Mathias P. Fabritius ◽

Melina Möller ◽

Christiane Kuhl ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Median Survival ◽

Pulmonary Metastases ◽

Study Entry ◽

Extrahepatic Disease ◽

Advanced Hepatocellular Carcinoma ◽

Significant Difference ◽

Distant Organ ◽

Extrahepatic Metastases ◽

The Impact

Introduction: Extrahepatic spread is reported as a prognostic factor in patients with advanced hepatocellular carcinoma (HCC) receiving systemic therapy. However, clinical studies have reported conflicting results for the clinical impact of the pattern of tumor progression during treatment and the role of new extrahepatic metastases in length of survival. Objective: To evaluate the impact of extrahepatic metastases on survival in patients with HCC treated with sorafenib or with a combination of sorafenib and selective internal radiation treatment (SIRT). Methods: SORAMIC is a randomized, controlled trial comprising diagnostic, local ablation, and palliative cohorts. In the palliative cohort, patients not eligible for transarterial chemoembolization (TACE) were randomized 11:10 to SIRT plus sorafenib (SIRT + sorafenib) or sorafenib alone. This exploratory subanalysis evaluated the impact of extrahepatic metastases on survival. Results: In the intent-to-treat cohort, 216 patients were randomized to SIRT + sorafenib and 208 to sorafenib alone. Seventeen patients with distant organ metastases (bone, n = 11; adrenal glands, n = 5; peritoneum, n = 1) and 262 without distant metastases at study entry were analyzed in this substudy. Patients with (Group A) and without (Group B) distant organ metastases at study entry presented with a median survival of 11.3 and 14.8 months, respectively (p = 0.2807). During follow-up of patients with no organ metastases at baseline, extrahepatic disease progression occurred in 50 patients (19.1%). No statistically significant difference in survival was observed between patients without extrahepatic progression and those with new extrahepatic disease during treatment (14.8 vs. 14.9 months; p = 0.6483). Development of new pulmonary metastases during treatment significantly shortened median survival (7.6 vs. 15.0 months, p = 0.0060). Conclusions: This subanalysis of the SORAMIC trial suggests that in patients with liver-dominant advanced HCC, metastases to distant organs with the exception of pulmonary metastases do not in general exert a negative impact on patient prognosis. The choice of palliative treatment should incorporate a personalized analysis of the pattern of tumor distribution.

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Transarterial Radioembolization of Hepatocellular Carcinoma, Liver-Dominant Hepatic Colorectal Cancer Metastases, and Cholangiocarcinoma Using Yttrium90 Microspheres: Eight-Year Single-Center Real-Life Experience

Diagnostics ◽

10.3390/diagnostics11010122 ◽

2021 ◽

Vol 11 (1) ◽

pp. 122

Author(s):

Julie Pellegrinelli ◽

Olivier Chevallier ◽

Sylvain Manfredi ◽

Inna Dygai-Cochet ◽

Claire Tabouret-Viaud ◽

...

Keyword(s):

Colorectal Cancer ◽

Hepatocellular Carcinoma ◽

Liver Tumors ◽

Progression Free Survival ◽

Single Center ◽

Free Survival ◽

Risk Of Death ◽

Transarterial Radioembolization ◽

Cancer Metastases ◽

Colorectal Cancer Metastases

Liver tumors are common and may be unamenable to surgery or ablative treatments. Consequently, other treatments have been devised. To assess the safety and efficacy of transarterial radioembolization (TARE) with Yttrium-90 for hepatocellular carcinoma (HCC), liver-dominant hepatic colorectal cancer metastases (mCRC), and cholangiocarcinoma (CCA), performed according to current recommendations, we conducted a single-center retrospective study in 70 patients treated with TARE (HCC, n = 44; mCRC, n = 20; CCA, n = 6). Safety and toxicity were assessed using the National Cancer Institute Common Terminology Criteria. Treatment response was evaluated every 3 months on imaging studies using Response Evaluation Criteria in Solid Tumors (RECIST) or mRECIST criteria. Overall survival and progression-free survival were estimated using the Kaplan-Meier method. The median delivered dose was 1.6 GBq, with SIR-Spheres® or TheraSphere® microspheres. TARE-related grade 3 adverse events affected 17.1% of patients. Median follow-up was 32.1 months. Median progression-free survival was 5.6 months and median overall time from TARE to death was 16.1 months and was significantly shorter in men. Progression-free survival was significantly longer in women (HR, 0.49; 95%CI, 0.26–0.90; p = 0.031). Risk of death or progression increased with the number of systemic chemotherapy lines. TARE can be safe and effective in patients with intermediate- or advanced-stage HCC, CCA, or mCRC refractory or intolerant to appropriate treatments.

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