Significantly Higher Mortality Following Liver Transplantation Among Patients Aged 70 Years and Older

2017 ◽  
Vol 27 (3) ◽  
pp. 225-231 ◽  
Author(s):  
Mokshya Sharma ◽  
Aijaz Ahmed ◽  
Robert J. Wong
Keyword(s):  
United States ◽  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Hepatitis C ◽  
Proportional Hazards ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Using Data ◽  
The Impact

Introduction: The age of liver transplantation recipients in the United States is steadily increasing. However, the impact of age on liver transplant outcomes has demonstrated contradictory results. Research Questions: We aim to evaluate the impact of age on survival following liver transplantation among US adults. Design: Using data from the United Network for Organ Sharing registry, we retrospectively evaluated all adults undergoing liver transplantation from 2002 to 2012 stratified by age (aged 70 years and older vs aged <70 years), presence of hepatocellular carcinoma, and hepatitis C virus status. Overall survival was evaluated with Kaplan-Meier methods and multivariate Cox proportional hazards models. Results: Compared to patients aged <70 years, those aged 70 years and older had significantly lower 5-year survival following transplantation among all groups analyzed (hepatocellular carcinoma: 59.9% vs 68.6%, P < .01; nonhepatocellular carcinoma: 61.2% vs 74.2%, P < .001; hepatitis C: 60.7% vs 69.0%, P < .01; nonhepatitis C: 62.6% vs 78.5%, P < .001). On multivariate regression, patients aged 70 years and older at time of transplantation was associated with significantly higher mortality compared to those aged <70 years (hazards ratio: 1.67; 95% confidence interval: 1.48-1.87; P < .001). Conclusion: The age at the time of liver transplantation has continued to increase in the United States. However, patients aged 70 years and older had significantly higher mortality following liver transplantation. These observations are especially important given the aging cohort of patients with chronic liver disease in the United States.

Current treatments, determinants of use, and survival for patients with hepatoma in the United States from 1998–2002

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4138-4138
Author(s):  
A. B. Siegel ◽  
R. McBride ◽  
D. Hershman ◽  
R. S. Brown ◽  
J. Emond ◽  
...  
Keyword(s):  
Tumor Size ◽  
Proportional Hazards ◽  
Case Series ◽  
Tumor Grade ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Data Set ◽  
Cox Proportional Hazards Models ◽  
Highly Correlated ◽  
The Impact

4138 Background: Multiple case series have described the use of current therapies for hepatocellular carcinoma (HCC), but recent estimates of treatment utilization in the general population and the impact of various treatments on survival are not known. Methods: We first identified 2898 adults diagnosed with HCC with known tumor size and stage in the Surveillance, Epidemiology, and End-Results Program (SEER), from 1998–2002. Treatment was categorized as transplant, resection, ablation, or none of these. We created a second data set of 1856 HCC patients who were potentially operable, as defined by SEER. We used these patients to construct Kaplan-Meier survival curves and adjusted Cox proportional hazards models. Results: The median age of the larger cohort at HCC diagnosis was 62 (range:18–96). Approximately 42% were white, 32% Asian, 16% Hispanic, and 10% African American. Overall, 10% received a transplant, 18% resection, 8% ablation, and 65% none of these. Only 5% of African Americans with HCC received a transplant, versus 12% of whites, 10% of Hispanics, and 8% of Asians. Asians were most likely to receive resection (24%) and ablation (9%), and least likely to have non-surgical treatment (60%). Using the restricted cohort, improved survival in the multivariate analysis was seen with later year of diagnosis, younger age, female sex, Asian race, smaller tumor size, lower tumor grade, and localized disease. Treatment was highly correlated with survival. This was greatest in the transplanted group (1, 3, and 5-year survivals 93%, 79%, and 71%), followed by resection (70%, 45%, and 29%), and ablation (71%, 33%, and 18%). The non-surgical group had poor survival (33%, 9%, and 0%). Conclusions: Transplantation yields excellent survival on a population scale, similar to reported series, and resection gives relatively good outcomes as well. Asians are more likely to be resected and ablated than other groups. They also had better survival than other groups, perhaps due to underlying etiology of HCC (hepatitis B) and better preserved liver function. No significant financial relationships to disclose.

scholarly journals The Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States

2020 ◽  
pp. cebp.1188.2020
Author(s):  
Parag Mahale ◽  
Meredith S. Shiels ◽  
Charles F. Lynch ◽  
Srinath Chinnakotla ◽  
Linda L Wong ◽  
...  
Keyword(s):  
United States ◽  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
The United States ◽  
The Impact

scholarly journals Clinical Trial Accrual at Initial Course of Therapy for Cancer and Its Impact on Survival

2019 ◽  
Vol 17 (11) ◽  
pp. 1309-1316 ◽  
Author(s):  
Nicholas G. Zaorsky ◽  
Ying Zhang ◽  
Vonn Walter ◽  
Leila T. Tchelebi ◽  
Vernon M. Chinchilli ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Metastatic Disease ◽  
Proportional Hazards ◽  
Private Insurance ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Patients With Cancer ◽  
Cox Proportional Hazards Models ◽  
The Impact

Background: This retrospective cohort study sought to characterize the accrual of patients with cancer into clinical trials at the time of diagnosis and analyze the impact of accrual on survival. Methods: The National Cancer Database (NCDB) was queried for patients enrolled in clinical trials at their initial course of treatment for 46 cancers from 2004 through 2015. Descriptive statistics were used to characterize the accrual of patients with cancer in clinical trials at diagnosis, and Kaplan-Meier graphical displays, log-rank tests, odds ratios, and stratified Cox proportional hazards models were used to analyze the impact of accrual on overall survival (OS). Strata were defined using 10 variables. Model-based adjusted survival curves of 2 groups were reverse-generated based on a Weibull distribution. Results: Of 12,097,681 patients in the NCDB, 11,576 (0.1%) were enrolled in trials. Patients in clinical trials typically had metastatic disease (30.9% vs 16.4%; P<.0001), were white (88.0% vs 84.8%; P<.0001), had private/managed care insurance (56.4% vs 41.8%; P<.0001), had fewer comorbidities (Charlson-Deyo score 0: 81.9% vs 75.7%; P<.0001, and Charlson-Deyo scores 1–3: 18.1% vs 24.3%; P<.0001) compared with those not in trials. At a median follow-up of 64 months, enrollment in a clinical trial was associated with improved OS in univariate and stratified analyses, with a median survival of 60.0 versus 52.5 months (hazard ratio, 0.876; 95% CI, 0.845–0.907; P<.0001). Stratified analysis with matched baseline characteristics between patients enrolled and not enrolled in a clinical trial showed superior OS at 5 years (95.0% vs 90.2%; P<.0001). Conclusions: Enrollment in clinical trials at first line of therapy in the United States is exceedingly low and favors young, healthy, white patients with metastatic disease and private insurance who are treated at academic medical centers. Patients with cancer treated in clinical trials live longer than those not treated in trials.

scholarly journals Impact of Direct Acting Antivirals on Survival in Patients with Chronic Hepatitis C and Hepatocellular Carcinoma

JMS SKIMS ◽  
2019 ◽  
Vol 22 (3) ◽  
Author(s):  
Mahrukh Hameed Zargar
Keyword(s):  
United States ◽  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Hepatitis C ◽  
Sustained Viral Response ◽  
The United States ◽  
Alcoholic Fatty Liver ◽  
Chronic Hcv ◽  
Direct Acting ◽  
The Impact

Hepatocellular carcinoma (HCC) represents a global public health burden, affecting an estimated 14 million persons worldwide, and is the third leading cause of cancer mortality. Within the United States, HCC is ranked 7th for cancer related mortality and has seen a doubling in incidence from 1975 to 2007. The primary predisposing factors for HCC carcinogenesis is liver cirrhosis. Cirrhosis risk factors include chronic alcohol use, viral hepatitis, including hepatitis c (HCV), and non-alcoholic fatty liver disease. Chronic HCV infection is the second most common risk factor for HCC and is responsible for 10–25% of all HCC cases. Over 20–30 years, 20–30% of patients with chronic HCV infections will develop cirrhosis and end stage liver disease and 1–4% of these patients will progress to HCC each year. Of all HCV related HCC cases, 80–90% occur in the setting of cirrhosis. With more than 3.5 million HCC patients in the United States and an estimated 130–170 million patients worldwide currently infected with HCV, the importance of HCV management in HCC therapeutic care and prevention is clear. The major current therapeutic goal for HCV and prevention of liver disease progression is sustained viral response (SVR), which is defined by negative HCV RNA at 12 weeks post-treatment (SVR12) and appears to be durable with a late virologic relapse rate of less than 1%. Therapeutic management of HCV has recently shifted from interferon-based therapies to all-oral interferon-free direct-acting antiviral (DAA) combination regimens. DAAs are a new class of drugs that target nonstructural proteins responsible for replication and infection of the hepatitis c virus. Genotype specific DAA therapies have been shown to reach SVR12 exceeding 90% of patients with fewer adverse effects compared with historic interferon-based regiments. SVR12 from DAA regimens have been associated with a decrease in liver outcomes including cirrhosis, hepatic decompensation, HCC and mortality. However, the impact  of DAA regimens on clinical outcomes in patients with HCC remain limited. This study evaluates the impact of DAA on overall survival in HCV patients with HCC with the a priori hypothesis that SVR12 would be associated with improved outcome.

The impact of subsequent metastasis on survival in Medicare patients with prostate cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 94-94
Author(s):  
Tracy Li ◽  
Neal D. Shore ◽  
Maneesha Mehra ◽  
Mary Beth Todd ◽  
Ryan Saadi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Proportional Hazards ◽  
Performance Status ◽  
Delayed Diagnosis ◽  
The United States ◽  
Cox Proportional Hazards ◽  
All Cause Mortality ◽  
And Performance ◽  
Using Data ◽  
The Impact

94 Background: This study assessed the impact of subsequent metastasis on survival in Medicare prostate cancer (PC) patients initially diagnosed with locoregional disease. Methods: Using data from the United States Surveillance, Epidemiology, and End Results (SEER) cancer registry linked to Medicare claims, we identified patients diagnosed with locoregional PC between 2000 and 2011, age ≥ 66 at diagnosis, and who first had a diagnosis of metastasis ≥ 4 months after PC diagnosis (cases). Cases were matched to controls (patients without metastasis) in a 1:4 ratio to assess the incremental impact of developing metastasis. For each control, the timeline to develop metastasis was matched to the cases. Kaplan-Meier (K-M) analysis was used to compare all-cause, cancer-specific, and other-cause mortality between cases and controls. Cox proportional hazards regression was used to adjust for other factors associated with all-cause mortality. Results: There were 10,370 cases and 39,200 controls. Mean age at baseline was 79 years in each group. Among the cases, the median time to first metastasis was 37 months, 85% had bone metastasis, and the median survival time (months) after metastasis was 18 months compared to 118 months for controls (P < 0.0001: Log-Rank). In K-M analysis, metastasis was associated with significantly (P < 0.0001: Log-Rank) higher all-cause, cancer-related, and other-cause mortality. In multivariable survival analysis, metastasis was associated with increased all-cause mortality (HR = 4.6, 95% CI = 4.4-4.7, P < 0.0001). High risk disease (based on Gleason score, comorbidity Index, and performance status) and delayed diagnosis of metastases were associated with worse survival. Conclusions: Development of metastasis in elderly PC patients diagnosed with locoregional disease significantly increases mortality.

scholarly journals Geographic Variations of Potentially Curative Treatments for Hepatocellular Carcinoma in the United States: A SEER-Medicare Study

2020 ◽  
Vol 18 (6) ◽  
pp. 729-736 ◽  
Author(s):  
En Cheng ◽  
Peiyin Hung ◽  
Shi-Yi Wang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Proportional Hazards ◽  
Percutaneous Ethanol Injection ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Geographic Variations ◽  
Ethanol Injection ◽  
Hospital Referral Region ◽  
Cox Proportional Hazards Models ◽  
Hospital Referral

Background: Transplantation, surgical resection, radiofrequency ablation, and percutaneous ethanol injection are generally considered potentially curative treatments for patients with hepatocellular carcinoma (HCC). With the increasing incidence of HCC, it is critical to investigate geographic variations in curative treatments and their associations with survival among patients. Methods: A total of 6,782 patients with HCC during 2004 to 2011 were identified in the SEER-Medicare linked database and placed in quartiles based on the proportions undergoing potentially curative treatments per hospital referral region (HRR). Hierarchical Cox proportional hazards models were used to examine the association between regional potentially curative treatment patterns and survival across quartiles. Results: An average of 16.9% of patients with HCC underwent potentially curative treatments during 2004 to 2011, varying substantially from 0% to 34.5% across HRRs. Compared with patients residing in the lowest-quartile regions, those in the highest-quartile regions were more likely to be of other races (vs white or black), be infected with hepatitis B virus, and have more comorbidities. The 5-year survival was 4.7% in the lowest-quartile regions and 11.4% in the highest-quartile regions (P<.001). After controlling for confounders, patients in the highest-quartile regions had a lower risk of mortality (adjusted hazard ratio, 0.78; 95% CI, 0.72–0.85). Conclusions: Patients with HCC who resided in HRRs with higher proportions of potentially curative treatments had better survival. Given its proven survival benefits, prompt clinical and policy actions are needed to reduce variations in treatment utilization.

Overeducation and the Earnings of Black, Hispanic, and White Male Workers

1988 ◽  
Vol 31 (2) ◽  
pp. 190-212 ◽  
Author(s):  
Richard R. Verdugo ◽  
Naomi Turner Verdugo
Keyword(s):  
United States ◽  
Mexican Americans ◽  
Minority Groups ◽  
Puerto Ricans ◽  
White Male ◽  
The United States ◽  
Using Data ◽  
The Impact ◽  
Male Workers ◽  
White Minority

This study addresses two issues: (1) the impact of overeducation on the earnings of male workers in the United States, and (2) white-minority earnings differences among males. Given that educational attainment levels are increasing among workers, there is some suspicion that earnings returns to education are not as great as might be expected. This topic is examined by including an overeducation variable in an earnings function. Regarding the second issue addressed in this article, little is actually known about white-minority differences because the bulk of such research compares whites and blacks. By including selected Hispanic groups in this analysis (Mexican Americans, Puerto Ricans, Cubans, and Other Hispanics) we are able to assess white-minority earnings differences to a greater degree. Using data from a 5% sample of the 1980 census to estimate an earnings function, we find that overeducated workers earn less than either undereducated or adequately educated workers. Second, we find that there are substantial earnings differences between whites and minorities, and, also, between the five minority groups examined.

Characteristics of Hepatitis B virus induced Hepatocellular Carcinoma in Egyptian patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Eman Mahmoud Fathy Barakat ◽  
Khalid Mahmoud AbdAlaziz ◽  
Mohamed Mahmoud Mahmoud El Tabbakh ◽  
Mohamed Kamal Alden Ali
Keyword(s):  
United States ◽  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Risk Factor ◽  
Hepatitis C ◽  
Hepatitis B ◽  
The United States ◽  
Age Difference ◽  
Co Morbidity ◽  
Incidence And Mortality

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and is a leading cause of cancer-related death worldwide. In the United States, HCC is the ninth leading cause of cancer deaths. Despite advances in prevention techniques, screening, and new technologies in both diagnosis and treatment, incidence and mortality continue to rise. Cirrhosis remains the most important risk factor for the development of HCC regardless of etiology. Hepatitis B and C are independent risk factors for the development of cirrhosis. Alcohol consumption remains an important additional risk factor in the United States as alcohol abuse is five times higher than hepatitis C. Diagnosis is confirmed without pathologic confirmation. Screening includes both radiologic tests, such as ultrasound, computerized tomography, and magnetic resonance imaging, and serological markers such as αfetoprotein at 6-month interval. Aim To compare characteristics and behavior of Hepatocellular carcinoma (HCC) in chronic HCV patients and HVB patients Patients and Methods The current study was conducted on patients with de HCC presented at HCC clinic, Tropical medicine department Ain Shams University Hospitals between December 2017 and D ecember 2018, aged (18-70 years old) . Results eline characteristics of study population shown in Table 1 at enrolment, including gender, Education status, co-morbidity, underlying presence or absence of cirrhosis, Child-Pugh class of patients infected with viral hepatitis, and alpha-fetoprotein levels. Male proportion observed to be predominant in both HCV (62%) and HBV (75.4%) infected HCC population. Overall prevalence of HCV and HBV in patients having HCC was 65.95% and 34.04%, respectively. Presence of underlying liver cirrhosis was more significantly associated with HCV seropositives as compared to HBV seropositive patients (p0.05). Table 2 shows comparison of means between HCV and HBV seropositive patients with HCC. In univariate analysis, mean age difference (11.6 years), and total bilirubin levels (-1.91mg/dl) were the only statistically significant observations noted among HCV-HCC group (p = 0.05) Conclusion Hepatocellular carcinoma is mainly caused by Hepatitis C and Hepatitis B viruses, but latter showed predominance, comparatively worldwide and correlated HBV directly as a cause of HCC rather than HCV whose relation with HCC is still unclear (Shepard et al., 2006; Di Bisceglie, 2009). Because of the geographical differences and risk factors, the epidemiological burden of HCV and HBV has been observed different in different areas of the world. In developing countries due to high burden of HCV infection as compared to HBV such as in Taiwan (HCV 17.0%, HBV 13.8%) (Kao et al., 2011), Guam (HCV 19.6%, HBV 18%) (Haddock et al., 2013), and Pakistan (HCV 4.8%, HBV 2.5%) (Rehman et al., 1996; Raza et al., 2007; Qureshi et al., 2010; Butt et al., 2012;) will possibly

scholarly journals The impact of direct-acting anti-virals on the hepatitis C care cascade: identifying progress and gaps towards hepatitis C elimination in the United States

2019 ◽  
Vol 50 (1) ◽  
pp. 66-74 ◽  
Author(s):  
Jagpreet Chhatwal ◽  
Qiushi Chen ◽  
Emily D. Bethea ◽  
Chin Hur ◽  
Anne C. Spaulding ◽  
...  
Keyword(s):  
United States ◽  
Hepatitis C ◽  
The United States ◽  
Care Cascade ◽  
Direct Acting ◽  
The Impact
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