scholarly journals Identification of an Upper Limit of Tumor Burden for Downstaging in Candidates with Hepatocellular Cancer Waiting for Liver Transplantation: A West–East Collaborative Effort

Cancers ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 452 ◽  
Author(s):  
Quirino Lai ◽  
Alessandro Vitale ◽  
Karim Halazun ◽  
Samuele Iesari ◽  
André Viveiros ◽  
...  
Keyword(s):  
New York ◽  
Liver Transplantation ◽  
Risk Analysis ◽  
External Validation ◽  
Hepatocellular Cancer ◽  
Tumor Burden ◽  
Competing Risk ◽  
Competing Risk Analysis ◽  
Intention To Treat ◽  
Upper Limit

Since the introduction of Milan Criteria, all scoring models describing the prognosis of hepatocellular cancer (HCC) after liver transplantation (LT) have been exclusively based on characteristics available at surgery, therefore neglecting the intention-to-treat principles. This study aimed at developing an intention-to-treat model through a competing-risk analysis. Using data available at first referral, an upper limit of tumor burden for downstaging was identified beyond which successful LT becomes an unrealistic goal. Twelve centers in Europe, United States, and Asia (Brussels, Sapienza Rome, Padua, Columbia University New York, Innsbruck, Medanta-The Medicity Dehli, Hong Kong, Kyoto, Kaohsiung Taiwan, Mainz, Fukuoka, Shulan Hospital Hangzhou) created a Derivation (n = 2318) and a Validation Set (n = 773) of HCC patients listed for LT between January 2000–March 2017. In the Derivation Set, the competing-risk analysis identified two independent covariables predicting post-transplant HCC-related death: combined HCC number and diameter (SHR = 1.15; p < 0.001) and alpha-fetoprotein (AFP) (SHR = 1.80; p < 0.001). WE-DS Model showed good diagnostic performances at internal and external validation. The identified upper limit of tumor burden for downstaging was AFP ≤ 20 ng/mL and up-to-twelve as sum of HCC number and diameter; AFP = 21–200 and up-to-ten; AFP = 201–500 and up-to-seven; AFP = 501–1000 and up-to-five. The WE-DS Model proposed here, based on morphologic and biologic data obtained at first referral in a large international cohort of HCC patients listed for LT, allowed identifying an upper limit of tumor burden for downstaging beyond which successful LT, following downstaging, results in a futile transplantation.

scholarly journals An intention-to-treat competing-risk model for candidates with hepatocellular cancer awaiting liver transplantation

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S189
Author(s):  
Quirino Lai ◽  
Umberto Cillo ◽  
Karim Halazun ◽  
Arvinder Singh Soin ◽  
Shinji Uemoto ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Risk Model ◽  
Hepatocellular Cancer ◽  
Competing Risk ◽  
Competing Risk Model ◽  
Intention To Treat

An Intention-to-Treat Competing-Risk Model for Candidates with Hepatocellular Cancer Awaiting Liver Transplantation

2018 ◽  
Author(s):  
Quirino Lai ◽  
Alessandro Cucchetti ◽  
Alessandro Vitale ◽  
Karim Halazun ◽  
Samuele Iesari ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Risk Model ◽  
Hepatocellular Cancer ◽  
Competing Risk ◽  
Competing Risk Model ◽  
Intention To Treat

scholarly journals Risk of active tuberculosis among COPD patients treated with fixed combinations of long-acting beta2 agonists and inhaled corticosteroids

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tsan-Ming Huang ◽  
◽  
Kuan-Chih Kuo ◽  
Ya-Hui Wang ◽  
Cheng-Yi Wang ◽  
...  
Keyword(s):  
Risk Analysis ◽  
Inhaled Corticosteroids ◽  
Statistical Significance ◽  
Incidence Rates ◽  
Active Tuberculosis ◽  
Competing Risk ◽  
Competing Risk Analysis ◽  
Intention To Treat ◽  
Copd Patients ◽  
Significant Difference

Abstract Objectives To investigate the incidence of active tuberculosis (TB) among COPD patients using fluticasone/salmeterol or budesonide/formoterol, and to identify any differences between these two groups of patients. Methods The study enrolled COPD patients from Taiwan NHIRD who received treatment with fluticasone/salmeterol or budesonide/formoterol for > 90 days between 2004 and 2011. The incidence of active TB was the primary outcome. Results Among the intention-to-treat population prior to matching, the incidence rates of active TB were 0.94 and 0.61% in the fluticasone/salmeterol and budesonide/formoterol groups, respectively. After matching, the fluticasone/salmeterol group had significantly higher rates of active TB (adjusted HR, 1.41, 95% CI, 1.17–1.70) compared with the budesonide/formoterol group. The significant difference between these two groups remained after a competing risk analysis (HR, 1.45, 95% CI, 1.21–1.74). Following propensity score matching, the fluticasone/salmeterol group had significantly higher rates of active TB compared with the budesonide/formoterol group (adjusted HR, 1.45, 95% CI, 1.14–1.85). A similar trend was observed after a competing risk analysis (HR, 1.44, 95% CI, 1.19–1.75). A higher risk of active TB was observed in the fluticasone/salmeterol group compared with the budesonide/formoterol group across all subgroups, but some differences did not reach statistical significance. Conclusion Fluticasone/salmeterol carried a higher risk of active TB compared with budesonide/formoterol among COPD patients.

scholarly journals Tenofovir Is Superior to Entecavir on Tertiary Prevention for BCLC Stage 0/A Hepatocellular Carcinoma after Curative Resection

Liver Cancer ◽  
2021 ◽  
pp. 1-16
Author(s):  
Ming-Chao Tsai ◽  
Chih-Chi Wang ◽  
Wei-Chen Lee ◽  
Chih-Che Lin ◽  
Kuo-Chin Chang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Risk Analysis ◽  
Lower Risk ◽  
Late Recurrence ◽  
Competing Risk ◽  
Competing Risk Analysis ◽  
Risk Of Death ◽  
Hcc Recurrence ◽  
Curative Hepatectomy

<b><i>Background:</i></b> It is unclear whether entecavir (ETV) and tenofovir disoproxil fumarate (TDF) have different effects on hepatocellular carcinoma (HCC) recurrence and death in patients receiving curative hepatectomy for hepatitis B virus (HBV)-related HCC. <b><i>Aims:</i></b> The aim of this study was to compare the long-term efficacy of ETV and TDF in HCC recurrence and overall survival (OS) of patients after curative hepatectomy. <b><i>Methods:</i></b> From January 2010 to December 2019, 20,572 patients with HCC who received hepatectomy were screened for study eligibility. Finally, a total of 219 consecutive patients treated with ETV (<i>n</i> = 146) or TDF (<i>n</i> = 73) after curative hepatectomy for HBV-related HCC of Barcelona Clinic Liver Cancer stage 0 or A were analyzed by propensity score matching (PSM) (2:1) analysis and competing risk analysis. HCC recurrence and OS of patients were compared between ETV and TDF groups. <b><i>Result:</i></b> After a median follow-up of 52.2 months, 81 patients (37.0%) had HCC recurrence, 33 (15.1%) died, and 5 (2.3%) received liver transplantation. TDF therapy was an independent protective factor for HCC recurrence compared with ETV therapy (HR, 1.687; 95% CI, 1.027–2.770, <i>p</i> = 0.039); however, no difference in the risk of death or liver transplantation. Results were similar in competing risk analysis. We further found that TDF therapy was significantly associated with a lower risk of late recurrence (HR, 4.705; 95% CI, 1.763–12.558, <i>p</i> = 0.002), but not in early recurrence. <b><i>Conclusions:</i></b> TDF therapy is associated with a significantly lower risk of HCC recurrence, especially of late recurrence, than ETV therapy among patients who undergo curative hepatectomy for HBV-related early-stage HCC.

scholarly journals Bayesian competing risk analysis: An application to nasopharyngeal carcinoma patients data

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Rakesh Kumar Saroj ◽  
K. Narasimha Murthy ◽  
Mukesh Kumar ◽  
Atanu Bhattacharjee ◽  
Kamalesh Kumar Patel
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Risk Analysis ◽  
Competing Risk ◽  
Competing Risk Analysis
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