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.

Sorafenib in hepatocellular carcinoma: prospective study on adverse events, quality of life, and related feasibility under daily conditions.

Sorafenib is an oral multikinase inhibitor approved for the treatment of hepatocellular carcinoma (HCC). In two randomized trials, sorafenib was reported to be safe without a significant impact on quality of life (QoL). The aim of this study was to evaluate the occurrence of adverse events, QoL variations, and treatment discontinuations in HCC patients treated with sorafenib. Between November 2009 and March 2011, all patients evaluated as suitable for sorafenib treatment were enrolled. Every patient was invited to complete the Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire before starting therapy, at week 1, and at months 1 and 2. QoL scores were analyzed by the Wilcoxon matched-pairs test. Side effects were classified according to the Common Terminology Criteria for Adverse Events v.3.0. Thirty-six patients were enrolled. The cumulative incidence of therapy discontinuation for drug-related adverse events was 33 % (95 % confidence interval, 20.2-49.7). The most common adverse event was fatigue (66.7 %). The worst score decrease was detected from baseline to week 1 in physical well-being, with a median reduction of -8.3 (range -60.1 to 17.9; P = 0.0003). Treatment withdrawal from adverse events was higher than previously reported, significant QoL decrease occurred, and estimated feasibility was 66.7 %.

Non-orthopaedic causes of shoulder pain: what the shoulder expert must remember.

Aim of this review is to underline some specific patterns of shoulder pain that are not related to musculoskeletal diseases but are manifestations of gastrointestinal, neurological, cardiological or rheumatological diseases. The most important pathologies (like gallstones, myocardial ischaemia and Parsonage-Turner syndrome...) that can manifest with shoulder pain will be presented by specialty doctors and elements for differential diagnosis will be discussed. Orthopaedic shoulder surgeons should always suspect other causes of pain, different from those related to bone, tendons and joint. If there is something unfair, patients should be referred to family doctor for further investigations in order to exclude major systemic diseases.

Local Tumor Progression of Hepatocellular Carcinoma After Microwave Percutaneous Ablation: A Preliminary Report.

BACKGROUND: Microwaves (MW) technology is an ablative treatment alternative to radiofrequency (RF) for early stages of hepatocellular carcinoma (HCC) in cirrhotic patients not suitable for surgical resection. It is well known that HCC lesions ≥ 30 mm treated by RF show a high rate of local tumor progression because of residual of unablated neoplastic tissue. METHODS: Aim of this study was to describe a limited experience of MW ablation (9 cirrhotic patients with medium size HCC: 11 lesions, 31 - 50 mm in diameter) treated from June 2009 to May 2010 by one of currently marketed western MW ablation systems and followed up for 2 years. Primary end-point was the probability of local tumor progression at 24 months; secondary end-point was the safety of the procedure. RESULTS: Radiological response after a single session and re-evaluation of local tumor progression along the time were performed by contrast enhanced computed-tomography at months 1-8-12-24. Early effectiveness rate was 90.1 %. The cumulative incidence of local tumor progression at 1 and 2 years were 36.4% (95% CI 11.2 - 62.7) and 57.6% (95% CI 23.6 - 81.0). We observed a single minor complication of the procedure. CONCLUSIONS: In conclusion, MW ablation system "Amica" has a high rate of primary effectiveness rate but residual of unablated neoplastic tissue induce local tumor progression in about half of the cases during the following 2 years.