Diagnoses Of Hepatocellular Carcinoma Research Articles

Clinical Therapy: HAIC Combined with Tyrosine Kinase Inhibitors and Programmed Cell Death Protein-1 Inhibitors versus HAIC Alone for Unresectable Hepatocellular Carcinoma.

The majority of new diagnoses of hepatocellular carcinoma (HCC) still pertain to unresectable cases. Currently, the combination therapy of tyrosine kinase inhibitors (TKIs) and programmed cell death protein-1 (PD-1) inhibitors has become the mainstream treatment. According to multiple clinical guidelines, it is strongly advised to consider local therapy as the primary treatment choice for uHCC. This research was conducted to examine the safety and effectiveness of combining hepatic arterial infusion chemotherapy (HAIC) with TKIs and PD-1 inhibitors for the treatment of uHCC. Between 2015 and 2020, 208 HCC patients received HAIC alone or HAIC in combination with TKIs and PD-1 inhibitors. The overall survival(OS), and progression-free survival(PFS) and the best treatment response were compared between the two treatment groups. Propensity score matching (PSM)was used to minimize confounding bias. Among the enrolled patients, 116 patients (55.8%) received combination therapy, while 92 patients (44.2%) received HAIC alone. The baseline characteristics were similar between the two groups. After PSM, 82 pairs of well-matched liver cancer patients were selected; the overall response rate in the combination group trended better than that in the HAIC alone group. The hazard ratios (HRs) for OS and PFS of the combination approach compared to the HAIC-alone approach were 0.47 (95% CI, 0.322-0.687; p<0.001) and 0.58 (95% CI, 0.397-0.848; p=0.005), respectively. For uHCC patients, combination therapy can provide better OS and PFS compared to HAIC alone.

Preoperative prediction of microvascular invasion: new insights into personalized therapy for early-stage hepatocellular carcinoma.

Owing to advances in diagnosis and treatment methods over past decades, a growing number of early-stage hepatocellular carcinoma (HCC) diagnoses has enabled a greater of proportion of patients to receive curative treatment. However, a high risk of early recurrence and poor prognosis remain major challenges in HCC therapy. Microvascular invasion (MVI) has been demonstrated to be an essential independent predictor of early recurrence after curative therapy. Currently, biopsy is not generally recommended before treatment to evaluate MVI in HCC according clinical guidelines due to sampling error and the high risk of tumor cell seeding following biopsy. Therefore, the postoperative histopathological examination is recognized as the gold standard of MVI diagnosis, but this lagging indicator greatly impedes clinicians in selecting the optimal effective treatment for prognosis. As imaging can now noninvasively and completely assess the whole tumor and host situation, it is playing an increasingly important role in the preoperative assessment of MVI. Therefore, imaging criteria for MVI diagnosis would be highly desirable for optimizing individualized therapeutic decision-making and achieving a better prognosis. In this review, we summarize the emerging image characteristics of different imaging modalities for predicting MVI. We also discuss whether advances in imaging technique have generated evidence that could be practice-changing and whether advanced imaging techniques will revolutionize therapeutic decision-making of early-stage HCC.

Investigation of racial disparities in hepatocellular carcinoma and rates of liver transplant: A SEER 2000-2020 study.

e13754 Background: Hepatocellular carcinoma (HCC) most commonly occurs in patients with pre-established liver disease and is occurring with increasing incidence and mortality across the United States while disproportionately affecting all US racial/ethnic minority populations. Surgical resection or liver transplant is the preferred treatment for HCC if patient is a surgical candidate and offers the best chance to cure HCC. Previous literature analysis of HCC racial disparities using the Surveillance, Epidemiology, and End Results (SEER) database between the years 1998 and 2012 has been reported, however recent data has not yet been investigated to compare trends. Methods: The SEER database was used to identify 134,212 patients diagnosed with HCC between 2000 and 2020 in the US. Patients with HCC were identified using the ICD-0-3 primary site code C220 and histologic type codes 8170, 8172, 8173, 8174, and 8175. Patient race was categorized as White, Black, American Indian/Alaska Native, Asian or Pacific Islander, and Unknown based on SEER coding scheme. Racial disparities were then determined using chi-squared testing. Results: Patients with reported Unknown race or American Indian/Alaska Native had the greatest increase in proportion of new HCC diagnoses when comparing the years 2016-2020 to 2000-2005. Across all races, the average age at diagnosis was between 60-69 and males were more likely than females to be diagnosed with HCC. Those with Unknown race were more likely to present with Tumor grade I. American Indian/Alaskan Native patients were more likely to be reported as unstaged for HCC and also more likely to have surgery recommended, but not performed for an unknown reason. American Indian/Alaskan Native patients were less likely to receive liver transplant. Patients with Unknown race were more likely to be alive or dead of other cause and less likely to be dead from HCC diagnosis. When comparing this data to previously reported data from 1998-2012, there is an increase in proportion of patients having unstaged HCC especially in the American Indian/Alaskan Native cohort. Conclusions: Native American Indian/Alaskan Native patients continue to have significantly decreased rate of liver transplant (p&lt;0.001) compared to White patients (24.24% vs 30.31%). Previous rates reported 4.4% vs 5.5%.

Productivity loss by cancer stage in patients newly diagnosed with hepatocellular carcinoma: A claims database analysis.

New cancer diagnoses are associated with employment decrease, workplace absenteeism, and attributable costs to employers. To estimate the workplace productivity loss in the year following a new diagnosis of early-, intermediate-, or advanced-stage hepatocellular carcinoma (HCC) in commercially insured US adults. We conducted a retrospective cohort study using Merative MarketScan commercial claims to identify incident HCC diagnoses from 2010 to 2020. Patients were stratified into early-, intermediate-, or advanced-stage cohorts based on presence of secondary malignancy codes or first treatment received. Mean workdays lost and attributable cost in the year following a new diagnosis were calculated using the Kaplan-Meier sample averages to account for censoring. An exploratory analysis was conducted on subgroups in the early and advanced cohorts to assess productivity loss in patients with and without treatment. Mean workdays lost in the year following a new HCC diagnosis among the early, intermediate, and advanced cohorts was 22.6 days (95% CI = 16.0-29.8), 17.4 days (95% CI = 11.9-23.2), and 19.5 days (95% CI = 15.6-23.6), respectively. Corresponding indirect costs were $6,031(95% CI = $4,270-$7,953), $4,644 (95% CI = $3,176-$6,192), and $5,204 (95% CI = $4,163-$6,298). Early-stage patients without a liver transplant and advanced-stage patients who received systemic therapy had 19.7 (95% CI = 12.7-27.4) and 22.0 (95% CI = 16.6-27.7) mean workdays lost, respectively. Productivity loss varies by stage and appears to be higher in early-stage patients who receive more intensive treatments in the first year following a new HCC diagnosis.

Effect of novel anti-tumor and anti-angiogenesis drug taurolactone on angiogenic factor AGGF1 and angiogenesis mimicry in patients with hepatocellular carcinoma

ObjectiveOur study was to investigate the impact of taurolactone, a novel anti-tumor and anti-angiogenic drug, on AGGF1, an angiogenic factor, and angiogenesis mimicry in patients diagnosed with hepatocellular carcinoma (HCC).MethodsA total of 120 HCC patients were enrolled from the Department of Oncology and Hepatobiliary Surgery at our hospital between May 2021 and December 2022. HCC diagnoses were confirmed through imaging or tissue biopsy for all patients. The age of patients ranged from 37 to 72 years, with an average age of 64.29 ± 4.58 years. These participants were divided equally into two groups: the control group and the observation group, each consisting of 60 individuals. While the control group received standard drug treatment, the observation group was administered taurolactone treatment. Before being included in the study, all participants or their legal representatives provided signed informed consent. Patient demographic information was collected through a questionnaire survey. ELISA was used to measure the levels of VEGF and AGGF1 in patients following treatment. Western blot was applied to assess the protein expression of PDGF, Angiopoietin, and AGGF1. MRI imaging technology was utilized to assess the perfusion characteristics of tumor blood vessels in patients. Tumor vessel density was compared between patients using ultrasonography. We also conducted a comparison between the two groups in terms of progression-free survival and overall survival.ResultsGeneral patient information between the two groups showed no significant differences (P > 0.05). Of note, the observation group exhibited greatly lower levels of VEGF and AGGF1 compared to the control group (P < 0.05). Moreover, the levels of PDGF, Angiopoietin, and AGGF1 protein expression were significantly reduced in the observation group compared to the control group (P < 0.05). In terms of tumor perfusion, the observation group displayed lower average and maximum perfusion volumes in tumor blood vessels compared to the control group (P < 0.05). Additionally, the observation group demonstrated delayed peak times and arrival times of tumor blood vessels in comparison to the control group (P < 0.05). Furthermore, the density of tumor blood vessels was notably lower in the observation group compared to the control group (P < 0.05). Patients in the observation group had longer progression-free survival and overall survival than the control group (P < 0.05).ConclusionIn HCC patients, our study highlighted the potential efficacy of taurolactone treatment as it effectively inhibited angiogenic factors and angiogenesis mimicry, ultimately leading to an improved prognosis for these patients.

Hepatitis-C-Related Hepatocellular Carcinoma, Still a Relevant Etiology beyond a Hepatitis C Infection Cure.

In the past decades, global changes, including hepatitis B vaccination, hepatitis B and C antiviral therapies, and the increasing prevalence of steatotic liver disease, have influenced the landscape of liver cancer etiologies. We performed a retrospective study focused on the etiological factors of de novo hepatocellular carcinoma (HCC) diagnoses in an academic center between 2019 and 2022. Among 352 consecutive patients with HCC, alcohol-related liver disease was the predominant etiology (33.3%), followed by hepatitis C (HCV) infection (30.7%). Significant associations were found between HCC etiology and patient demographics, BCLC stage at diagnosis, and cirrhosis prevalence. Whereas accessibility to antiviral therapy is granted, HCV infection remains as one of the main HCC etiologies. MASLD-related HCC, although growing globally, is not as relevant in our area. Strong public policies need to be implemented to prevent alcohol consumption, the main etiology of liver disease and liver cancer.

Canine primary liver tumors treated with stereotactic body radiation therapy: A case series.

Stereotactic body radiation therapy (SBRT) is an increasingly used alternative treatment option for nonresectable hepatocellular carcinoma (HCC) in people. Comparatively, the publication of SBRT of dogs with HCC is limited. The objective of this retrospective, descriptive case series was to evaluate the clinical outcomes and toxicity data of SBRT in dogs with HCC and imaging-documented primary liver tumors using volumetric-modulated arc therapy delivery at two private institutions. Medical records of 14 dogs treated between 2018 and 2023 were reviewed. All dogs had macroscopic tumors, and 9 of 14 dogs had HCC diagnoses confirmed on cytology or histopathology. The median longest tumor diameter was 5.5cm. The median percentage of planning target volume relative to liver volume was 27.1%. Most dogs were treated with three daily fractions of 7-7.5Gy. All dogs completed their radiotherapy protocols. Three of nine HCC dogs experienced partial responses and clinical improvement. Five of nine HCC dogs had stable disease. Overall median survival time was 164 days for nine HCC dogs (range: 93-706 days). One late grade 5 liver and two late grade 3 kidney side effects were reported. One dog received repeated SBRT to the same HCC treatment field, and one dog had two courses of SBRT to bifocal HCC treatment fields, both with no more than grade 2 acute and chronic toxicities.

Race/ethnicity and sex differences in the association between area-level arsenic exposure concentration and hepatocellular carcinoma (HCC) incidence rates in Texas. An ecological study

IntroductionTexas has the highest rates of hepatocellular carcinoma (HCC) in the United States. Exposure to toxicants may play a role in liver disease. Several mechanisms of arsenic carcinogenesis have been proposed, however, the evidence in human populations is limited to associations between HCC and ingestion of arsenic-contaminated drinking water. Through an ecological study, we examined associations between ambient arsenic and HCC incidence rates. MethodsPrimary outcome was HCC incidence rates based on Texas Cancer Registry (TCR) data. Primary exposure of interest was the simulated census-tract level estimate of arsenic exposure concentration (EC) from the U.S. Environmental Protection Agency 2011 National Air Toxics Assessment (NATA). We analyzed the association between the arsenic EC and HCC using the negative binomial Poisson regression model separately for six study groups that were based on race/ethnicity and sex. We adjusted the main analyses for selected characteristics. ResultsTexas has 5265 census tracts and TCR reported 18,235 new ≥20 years old HCC diagnoses between 2007 and 2015. We observed significant differences along racial-ethnic and sex groups while accounting for socioeconomic deprivation, urban/rural residency, and senior residents’ health insurance status. Census tracts with the highest arsenic EC had elevated rates of HCC among NH black men (Quintile 5 vs. Quintile 1: IRR = 2.18, 95% CI: 1.66–2.86), NH black women (Quintile 5 vs. Quintile 1: IRR = 1.72, 95% CI: 1.33–2.22) and NH white men (Quintile 5 vs. Quintile 1: IRR = 1.38, 95% CI: 1.24–1.54). The associations in the remaining study groups were either inconsistent or attenuated. ConclusionsOur finding suggests a potential inhalation pathway for the Arsenic-HCC association; however, the ecological nature of our study precludes the interpretation of a causal link between exposure to aerial arsenic and HCC. This finding needs to be further examined in cohort studies.

Hepatocellular Carcinoma Diagnosis and Management in 2021: A National Veterans Affairs Quality Improvement Project

The coronavirus disease-2019 pandemic profoundly disrupted preventative health care services including cancer screening. As the largest provider of cirrhosis care in the United States, the Department of Veterans Affairs (VA) National Gastroenterology and Hepatology Program aimed to assess factors associated with hepatocellular carcinoma (HCC) stage at diagnosis, treatment, and survival. Veterans with a new diagnosis of HCC in 2021 were identified from electronic health records (N= 2306). Structured medical record extraction was performed by expert reviewers in a 10% random subsample of Veterans with new HCC diagnoses. Factors associated with stage at diagnosis, receipt of treatment, and survival were assessed using multivariable models. Among 199 patients with confirmed HCC, the average age was 71 years and most (72%) had underlying cirrhosis. More than half (54%) were at an early stage (T1 or T2) at diagnosis. Less-advanced liver disease, number of imaging tests adequate for HCC screening, HCC diagnosis in the VA, and receipt of VA primary care were associated significantly with early stage diagnosis. HCC-directed treatments were administered to 145 (73%) patients after a median of 37 days (interquartile range, 19-54 d) from diagnosis, including 70 (35%) patients who received potentially curative treatments. Factors associated with potentially curative (vs no) treatments included HCC screening, early stage at diagnosis, and better performance status. Having fewer comorbidities and better performance status were associated significantly with noncurative (vs no) treatment. Early stage diagnosis, diagnosis in the VA system, and receipt of curative treatment were associated significantly with survival. These results highlight the importance of HCC screening and engagement in care for HCC diagnosis, treatment, and survival while demonstrating the feasibility of developing a national quality improvement agenda for HCC screening, diagnosis, and treatment.

Hepatocellular carcinoma surveillance in the telehealth era: A single-centre review.

Real-world hepatocellular carcinoma (HCC) surveillance uptake remains suboptimal, despite evidence that surveillance is associated with lower cancer-related mortality in patients with cirrhosis and chronic hepatitis B. We aimed to examine the impact of telehealth consultations on HCC surveillance rates within a specialist liver clinic. We conducted a retrospective observational study within an Australian outreach liver clinic within a culturally diverse community, comparing standard consultations before the COVID-19 pandemic to telehealth consultations during the pandemic. The primary outcome was surveillance uptake defined as the percentage of time up-to-date with surveillance (PTUDS) with the 6-month interval following each scan considered up-to-date. Over 18 months of follow-up for each cohort, the median PTUDS was 86.5% in the standard consultation cohort and 85.5% in the telehealth consultation cohort (p = 0.12). HCC diagnoses did not differ between groups and hospitalisation and mortality rates were low. Using multivariate regression, increasing age, the need for an interpreter and being born in South-East Asia independently predicted PTUDS in the standard consultation cohort, whereas being born in Australia or New Zealand was predictive of a lower PTUDS. Current alcohol use and distance from the clinic predicted a lower PTUDS in the telehealth consultation cohort. In both groups, missed clinic attendances were strongly predictive of a lower PTUDS. Telehealth hepatology consultations effectively coordinate HCC surveillance and are associated with similar outcomes to standard consultations. Its implementation should be widely considered given its advantages with regards to accessibility for patients.

Human Epidermal Growth Factor Receptor 2 (HER2) Expression by Immunohistochemistry and Its Clinical Significance in Hepatocellular Carcinoma: A Single-Center Analysis.

Human epidermal growth factor receptor 2 (HER2) is a member of the tyrosine kinase receptor family. It has been identified as an oncogene and is associated with poor outcomes in multiple tumortypes. In hepatocellular carcinoma (HCC), there are contradictory data regarding the HER2 expression and its role in tumor development and progression. Some studies have identified HER2 expression as an early event during tumorigenesis, which decreases with progression and metastasis. Additional data provided evidence that treatment with anti-HER2 therapy resulted in local response and reduction in the metastasis rate in HCC micemodels. Patients with histological diagnoses of HCC between 2010 and 2020 were included. HER2 staining was performed by immunohistochemistry (IHC), and scoring was done in accordance with the gastric cancer guidelines as 0, 1+, 2+, and 3+. Clinicopathological features were accessed by medical records. This study aims to evaluate HER2 expression by IHC in HCCand to correlate this expression with some clinicopathological features such as Barcelona Clinic Liver Cancer (BCLC) staging,number of hepatic lesions,alpha-fetoprotein level, underlying liver disease, presence of livercirrhosis, Child-Pugh score, and tumor recurrence. A total of 57 specimens from 54 patients were included. Of the patients, 85% were men, and the median age at diagnosis was 71 years (interquartile range: 59-75 years). Regarding stage, 61% were at stage 0-A of BCLC. Of the patients,57% had a solitary HCC nodule. Concerning treatment, surgery was performed in 50% of the patients.HER2 expression was identified in seven patients: five in the membrane and two in the cytoplasm. Concerning the membrane staining, HER2 expression was scored as 1+/2+ in 7.4% (n = 4 patients). Of the patients with HER2 expression, fourhad a BCLC stage of 0-A and a single HCC nodule; alpha-fetoprotein was <400 ng/mL in all cases. There was no correlation to clinicopathological features. In one patient with HER2 2+ expressionat diagnosis, this expression was not identified at tumor progression. Median disease-free survival in HER2 with IHC scores 1+/2+ and cytoplasmatic was 38 months versus 22 months in HER2 with a score of 0 (p = 0.604). HER2 expression is a rare event in HCC. It was not possible to identify any relation to clinicopathological features. However, when we relate our data to previous trials, HER2 appears to be an early event in the course of HCC.

Treatment patterns, clinical outcomes, and costs following the approval of new systemic therapy medications for hepatocellular carcinoma.

398 Background: Between March 2017 and May 2020, ten new systemic medication therapies for hepatocellular carcinoma (HCC) were approved for the US market. However, clinical trials for medications only showed marginal improvement in health outcomes compared to placebo or sorafenib, the only medication previously approved for HCC. The objective of this study was to examine the change in treatment patterns and outcomes of incident patients with HCC before and after multiple medication approvals. Methods: This observational cohort study used administrative medical and pharmacy claims data for adult commercially insured and Medicare Advantage patients with at least two diagnoses of HCC during July 2013 to December 2020. Patients were categorized into two groups: the pre-approval group (identified between July 2013 and March 2017) and the post-approval group (identified between April 2017 and December 2020). We compared systemic therapy treatment (e.g., sorafenib and lenvatinib) patterns, survival, hospitalization for serious infections, other treatments such as G-CSF use and liver transplants, and cost (e.g, total all-cause costs and anti-HCC systemic therapy). Generalized linear model and Cox proportional hazards regression were used to assess the effect of new approvals on outcomes while controlling for baseline characteristics. Results: We identified 2,730 patients in the pre-approval group and 2,290 patients in the post-approval group. After risk adjustment, the latter was more likely to use systemic therapy medications (20.4% vs. 13.7%, adjusted odds ratio [aOR] 1.41, 95% confidence interval [CI] 1.22-1.62). Overall survival remained similar between the two groups (adjusted hazard ratio [HR] 0.96, 95% CI 0.87-1.06) and among the subsets who used systemic therapy (aHR 1.10, 95% CI 0.91-1.32). Odds of liver transplant (aOR 1.03, 95% CI 0.80-1.34) and hospitalization for serious infections (aOR 0.95, 95% CI 0.87-1.09) were similar, while the post-approval group had lower odds of G-CSF use (aOR 0.59, 95% CI 0.48-0.73). No differences in total per-member-per-month (PMPM) costs were seen, but the post-approval group had lower PMPM pharmacy-related costs (adj cost diff -$1,188, 95% CI -$1,575 to -$755) and higher PMPM systemic therapy costs (adj cost diff $971, 95% CI $584 to $1446). Conclusions: As expected, use of newer systemic therapies in HCC patients increased following approval of new medications. However, there was no associated change in clinical outcomes such as survival or serious infections, providing additional real-world evidence of marginal improvement, if any. Pharmacy costs decreased in the post-approval group, which may reflect a shift from oral sorafenib to newer injectable systemic therapies.

Routine screening of emergency admissions at risk of chronic hepatitis (SEARCH) identifies and links hepatitis B cases to care.

Significant barriers exist with hepatitis B (HBV) case detection and effective linkage to care (LTC). The emergency department (ED) is a unique healthcare interaction where hepatitis screening and LTC could be achieved. We examined the efficacy and utility of automated ED HBV screening for Overseas Born (OB) patients. A novel-automated hepatitis screening service "SEARCH" (Screening Emergency Admissions at Risk of Chronic Hepatitis) was piloted at a metropolitan hospital. A retrospective and comparative analysis of hepatitis testing during the SEARCH pilot compared to a period of routine testing was conducted. During the SEARCH pilot, 4778 OB patients were tested for HBV (86% of eligible patient presentations), compared with 1.9% of eligible patients during a control period of clinician-initiated testing. SEARCH detected 108 (2.3%) hepatitis B surface antigen positive patients including 20 (19%) in whom the diagnosis was new. Among 88 patients with known HBV, 57% were receiving medical care, 33% had become lost to follow-up and 10% had never received HBV care. Overall, 30/88 (34%) patients with known HBV were receiving complete guideline-based care prior to re-engagement via SEARCH. Following SEARCH, LTC was successful achieved in 48/58 (83%) unlinked patients and 19 patients were commenced on anti-viral therapy. New diagnoses of cirrhosis and hepatocellular carcinoma were made in five and one patient(s) respectively. Automated ED screening of OB patients is effective in HBV diagnosis, re-diagnosis and LTC. Prior to SEARCH, the majority of patients were not receiving guideline-based care.

Trends in decompensated cirrhosis and hepatocellular carcinoma among people with a hepatitis B notification in New South Wales

Background & AimsPopulation-level trends and factors associated with HBV-related decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and liver-related mortality are crucial to evaluate the impacts of therapeutic interventions.MethodsTrends in HBV-DC and -HCC diagnoses and liver-related mortality in New South Wales, Australia, were determined through linkage of HBV notifications (1993-2017) to hospital admissions (2001-2018), mortality (1993-2018), and cancer registry (1994-2014) databases. Late HBV notification was defined as notification at or within 2 years of a DC or HCC diagnosis. Cox proportional-hazards regression and multivariable logistic regression analyses were performed to evaluate associated factors.ResultsAmong 60,660 people with a HBV notification, 1,276 (2.0%) DC and 1,087 (1.8%) HCC diagnoses, and 1,219 (2.0%) liver-related deaths were documented. Since the early 2000s, the number of DC and HCC diagnoses increased; however, age-standardised incidence decreased from 2.64 and 1.95 in 2003 to 1.14 and 1.09 per 1,000 person-years in 2017, respectively. Similarly, age-standardised liver mortality decreased from 2.60 in 2003 to 1.14 per 1,000 person-years in 2017. Among people with DC and HCC diagnoses, late HBV notification declined from 41% and 40% between 2001-2009 to 29% and 25% in 2010-2018, respectively. Predictors of DC diagnosis included older age (birth <1944, adjusted hazard ratio [aHR] 2.06, 95% CI 1.57–2.69), alcohol use disorder (aHR 4.82, 95% CI 3.96–5.87) and HCV co-infection (aHR 1.88, 95% CI 1.53–2.31). Predictors of HCC diagnosis included older age (birth <1944, aHR 3.94, 95% CI 2.91–5.32) and male sex (aHR 3.79, 95% CI 3.05–4.71).ConclusionIn an era of improved antiviral therapies, the risk of HBV-related liver morbidity and mortality has declined. HCV co-infection and alcohol use disorder are key modifiable risk factors associated with the burden of HBV.Lay summaryRising hepatitis B-related morbidity and mortality is a major public health concern. However, the development of highly effective medicines against hepatitis B virus (HBV) has brought renewed optimism for its elimination by 2030. This study shows a steady decline in HBV-related liver morbidity and mortality in New South Wales, Australia. Moreover, late hepatitis notification has also declined, allowing individuals with HBV to have access to timely antiviral treatment. Despite this, hepatitis C co-infection and alcohol use disorder are key modifiable risk factors associated with HBV disease burden. To attain the desired benefits from highly effective antiviral treatment, managing comorbidities, including hepatitis C and high alcohol use, must improve among individuals with hepatitis B.

FRI217 - Metabolomic profiling of capillary dry blood samples for the differential diagnoses of hepatocellular carcinoma and liver diseases

FRI217 - Metabolomic profiling of capillary dry blood samples for the differential diagnoses of hepatocellular carcinoma and liver diseases

Effect of COVID-19 Pandemic on Hepatocellular Carcinoma Diagnosis: Results from a Tertiary Care Center in North-West Italy.

The COVID-19 pandemic has forced us to direct most of the available resources towards its management. This has led to the neglect of all other pathologies, including cancer. The aim of this study was to verify whether the difficulty in accessing the health system has led to a reduction in new diagnoses of hepatocellular carcinoma (HCC) and whether this has already been reflected in a more advanced stage of the cancer. A single-center, retrospective study including adult patients with a new diagnosis of HCC was performed. Patients were divided into three groups: the prelockdown phase (May 2019–February 2020), the lockdown phase (March 2020–December 2020), and the postlockdown phase (January 2021–October 2021); 247 patients were included. The number of patients diagnosed with HCC distinctly diminished in the periods March 2020–December 2020 (n = 69; −35%) and January 2021–October 2021 (n = 72; −32%) as compared to the period May 2019–February 2020 (n = 106). Noteworthy was the reduced surveillance in the period January 2021–October 2021 as compared to May 2019–February 2020 (22.9% vs. 36.6%, p = 0.056). No significant changes have yet been observed in tumor characteristics (BCLC staging distribution remained unvaried, p = 0.665). In conclusion, the number of new HCC diagnoses decreased sharply in the first 2 years of the pandemic, with no worsening of the stage. A more advanced stage of the disease could be expected in the next few years in patients who have escaped diagnosis.

Association between ultrasound quality and test performance for HCC surveillance in patients with cirrhosis: a retrospective cohort study.

Ultrasound visualisation is limited in approximately 20% of patients with cirrhosis undergoing hepatocellular carcinoma (HCC) surveillance; however, it is unknown if impaired visualisation directly impacts test performance. We aimed to evaluate the association between ultrasound visualisation and surveillance test performance. We performed a retrospective cohort study among patients with cirrhosis, with or without HCC, who underwent ultrasound-based surveillance at two large health systems between July 2016 and July 2019. Ultrasound visualisation assessment was recorded by interpreting radiologists using the ultrasound LI-RADS Visualisation score. We performed logistic regression analyses to evaluate the association between ultrasound visualisation and diagnostic test performance. We assessed sensitivity for HCC detection among ultrasounds performed in the year prior to HCC diagnoses and specificity using ultrasounds in those without HCC. Among 186 patients with HCC, severely limited visualisation (Vis Score C) on ultrasound prior to HCC diagnosis was associated with increased odds of false-negative results, that is lower sensitivity (OR 7.94, 95% CI 1.23-51.16) in multivariable analysis. Ultrasound sensitivity with visualisation scores A or B exceeded 75%, compared to only 27.3% with visualisation score C. Among 2052 cirrhosis patients without HCC, moderate visualisation limitations (Vis score B) were associated with increased odds of false-positive results (OR 1.60, 1.13-2.27), although specificity exceeded 95% across all visualisation scores. Impaired ultrasound visualisation is associated with worse surveillance test performance. Alternative blood-based biomarkers and imaging strategies are needed for patients at risk for ultrasound-based surveillance failure.

Radiation and Checkpoint Inhibition Amongst HCC Patients With Portal Vein Invasion

<h3>Purpose/Objective(s)</h3> Recent studies established atezolizumab and bevacizumab as a new standard of care for Barcelona Clinic Liver Cancer (BCLC) hepatocellular carcinoma (HCC) stage C patients. However, many patients are not candidates for this combination and progression-free survival was only 6.8 months, suggesting that local therapy might be beneficial. This study explores combination radiotherapy and nivolumab for HCC with portal vein thrombus (PVT). <h3>Materials/Methods</h3> We retrospectively reviewed charts of patients with HCC and PVT treated with nivolumab and radiation at a single institution from 2016-2020. Patients were eligible if they had at least one follow up imaging scan to assess response. Progression-free survival (PFS) and overall survival (OS) were assessed. Baseline characteristics were used to predict for outcomes. <h3>Results</h3> 64 patients met inclusion criteria with a median follow up of 7 months (0.13-39.0 months). 42 (65.6%) patients were <b>de novo</b> diagnoses of HCC with PVT, and the remainder had prior therapy. 37 (57.8%) patients received nivolumab prior or concurrent with start of RT, while 27 (42.2%) received the first dose of nivolumab > 1 month post RT. Median radiation dose was 40 Gy (range: 30-50 Gy) with 44 (68.8%) patients being treated with SBRT<b>.</b> Median PFS was 3.8 months (95% confidence interval: 2.3–5.4). Median OS was 9.6 months (95% confidence interval: 5.2–14.0). On log-rank analysis, median OS and PFS did not differ between patients receiving therapy for a <b>de novo</b> diagnosis vs. previous therapy (OS: 12.9 vs 8.7 months, <i>P</i> = 0.46; PFS: 4.9 vs 2.9 months, <i>P</i> = 0.99), between patients with VP1-2 vs. VP3+ PVT (OS: 18.3 vs 9.4 months, <i>P</i> = 0.53; PFS: 3.3 vs 3.8 months, <i>P</i> = 0.44), between patients receiving SBRT vs. fractionated RT (OS: 9.2 vs 14.5 months, <i>P</i> = 0.69; PFS: 4.2 vs 3.2 months, <i>P</i> = 0.30), and between patients receiving nivolumab before/concurrent with RT vs. patients receiving nivolumab after RT (OS: 10.7 vs 9.6 months <i>P</i> = 0.41; PFS: 4.2 vs 2.9 months, <i>P</i> = 0.73). Patients with HCV trended for better OS than those with other etiologies but PFS was not improved (OS: 33.3 vs 8.7 months, <i>P</i> = 0.064; PFS: 4.8 vs 2.8 months, <i>P</i> = 0.16). 8 (12.5%) of the patients had OS times > 2 years. <h3>Conclusion</h3> In this retrospective series, combination nivolumab and radiation produced promising OS and PFS for HCC patients with PVT. Prospective studies are needed to know when this approach might be beneficial in the evolving landscape of immunotherapy in HCC.

COVID-19 pandemic: Impact on the management of patients with hepatocellular carcinoma at a tertiary care hospital.

BackgroundPatients with hepatocellular carcinoma (HCC) represent a vulnerable population potentially negatively affected by COVID-19-associated reallocation of healthcare resources. Here, we report the impact of COVID-19 on the management of HCC patients in a large tertiary care hospital.MethodsWe retrospectively analyzed clinical data of HCC patients who presented at the Vienna General Hospital, between 01/DEC/2019 and 30/JUN/2020. We compared patient care before (period 1) and after (period 2) implementation of COVID-19-associated healthcare restrictions on 16/MAR/2020.ResultsOf 126 patients, majority was male (n = 104, 83%) with a mean age of 66±11 years. Half of patients (n = 57, 45%) had impaired liver function (Child-Pugh stage B/C) and 91 (72%) had intermediate-advanced stage HCC (BCLC B-D). New treatment, was initiated in 68 (54%) patients. Number of new HCC diagnoses did not differ between the two periods (n = 14 vs. 14). While personal visits were reduced, an increase in teleconsultation was observed (period 2). Number of patients with visit delays (n = 31 (30%) vs. n = 10 (10%); p = 0.001) and imaging delays (n = 25 (25%) vs. n = 7 (7%); p = 0.001) was higher in period 2. Accordingly, a reduced number of patients was discussed in interdisciplinary tumor boards (lowest number in April (n = 24), compared to a median number of 57 patients during period 1). Median number of elective/non-elective admissions was not different between the periods. One patient contracted COVID-19 with lethal outcome.ConclusionsChanges in patient care included reduced personal contacts but increased telephone visits, and delays in diagnostic procedures. The effects on long-term outcome need to be determined.

Hepatocellular Carcinoma with Macroscopic Fat Metamorphosis: A Case Series

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related deaths in the world, with hepatitis B and C as its main causes. HCC can have fat metamorphosis which leads to a better prognosis, though this is more commonly found in lesions smaller than 3 cm in diameter, and usually contains intravoxel fat. In this case series, we present three cases of HCC with macroscopic fat metamorphosis as examined using CT scan and MRI. Macroscopic fat is seen using CT as a hypodense mass with attenuation of −10 to −100 HU, or MRI using fat-saturation technique. Intravoxel fat can be seen on MRI using fat saturation chemical shift technique, appearing as signal loss during opposed phase and increased signal during in-phase. The differential diagnoses of HCC with fat metamorphosis are angiomyolipoma, hepatic adenoma, nodular steatosis, focal nodular hyperplasia, dysplastic nodule, liposarcoma, and hepatic metastasis. Enhancement patterns of the fat and non-fat component; intra-tumoral fat distribution; the presence of cirrhosis; the presence of atoll sign; and history of viral hepatitis are useful clues for differentiation of HCC with other differential diagnoses.