Comparative effectiveness of traditional chemoembolization with or without sorafenib for hepatocellular carcinoma.

AIM: To compare the overall survival (OS) and progression-free survival (PFS) with associated adverse events (AE) in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) + sorafenib vs TACE alone. METHODS: In this retrospective cohort study we collected data on all consecutive patients with a diagnosis of unresectable HCC between 2007 and 2011 who had been treated with TACE + sorafenib or TACE alone. We hypothesized that the combination therapy is superior to TACE alone in improving the survival in these patients. Data extracted included patient's demographics, etiology of liver disease, histology of HCC, stage of liver disease with respect to model of end stage liver disease score and Child-Turcotte-Pugh (CTP) classification and Barcelona Clinic Liver Cancer (BCLC) staging for HCC. Computed tomography scan findings, alpha fetoprotein levels, number of treatments and related AE were also recorded and analyzed. RESULTS: Of the 43 patients who met inclusion criteria, 13 were treated with TACE + sorafenib and 30 with TACE alone. There was no significant difference in median survival: 20.6 mo (95%CI: 13.4-38.4) for the TACE + sorafenib and 18.3 mo (95%CI: 11.8-32.9) for the TACE alone (P = 0.72). There were also no statistically significant differences between groups in OS (HR = 0.82, 95%CI: 0.38-1.77; P = 0.61), PFS (HR = 0.93, 95%CI: 0.45-1.89; P = 0.83), and treatment-related toxicities (P = 0.554). CTP classification and BCLC staging for HCC were statistically significant (P = 0.001, P = 0.04 respectively) in predicting the survival in patients with HCC. The common AE observed were abdominal pain, nausea, vomiting and mild elevation of liver enzymes. CONCLUSION: Combination therapy with TACE + sorafenib is safe and equally effective as TACE alone in patients with unresectable HCC. CTP classification and BCLC staging were the significant predictors of survival. Future trials with large number of patients are needed to further validate this observation.

Ethnicity and body mass index are associated with hepatitis C presentation and progression.

BACKGROUND & AIMS: Ethnicity and the metabolic syndrome are believed to affect progression of hepatitis C virus (HCV) infection, but the interaction between these factors is unknown. We evaluated the association between elements of the metabolic syndrome and ethnicity in the histologic progression of HCV in a large, diverse cohort. METHODS: We retrospectively evaluated clinical data and liver biopsy samples from 812 patients who had no cause of liver disease other than HCV infection. Liver biopsies were scored for steatosis, necroinflammatory activity, and fibrosis. For each patient with a known risk factor for viral acquisition, fibrosis index was calculated as an indicator of disease progression. RESULTS: Hispanics had significantly higher fibrosis index (0.13 +/- 0.09) than non-Hispanic whites (0.11 +/- 0.07) and African Americans (0.10 +/- 0.06; P = .001). Fibrosis index correlated with body mass index (BMI), older age at infection, ethnicity, and degree of steatosis. Cirrhosis was present in 50% of Hispanics, 38% of non-Hispanic whites, and 24% of African Americans (P < .001). The presence of cirrhosis was associated additionally with older age, longer duration of infection, BMI, alcohol consumption, and diabetes. In multivariate analysis, only BMI and ethnicity were associated with both fibrosis index and presentation with cirrhosis. Patients with higher BMIs, diabetes mellitus, and steatosis had higher degrees of necroinflammation. CONCLUSIONS: Ethnicity and BMI each were associated with the progression of fibrosis and the presence of cirrhosis. Hispanics had the highest fibrosis index and prevalence of cirrhosis, whereas African Americans had the lowest. Ethnic differences in fibrosis index and cirrhosis persisted after controlling for elements of metabolic syndrome.

Hepatitis B seroprevalence and disease characteristics in an urban Chinatown community.

BACKGROUND & AIMS: Chronic HBV infection is prevalent among Asian immigrants and is an important cause of cirrhosis and hepatocellular carcinoma. The aim of this study was to evaluate the HBsAg seroprevalence and to characterize hepatitis B in persons who presented to an urban Chinatown internal medicine practice. METHODS: Records were reviewed retrospectively from 4671 adult patients who had at least 1 office visit during a 2-year period. Demographic information and laboratory data were collected. An elevated ALT level was defined as >19 IU/mL for women and >30 IU/mL for men. RESULTS: All patients were ethnically Chinese, and 97% were born in Asia. HBsAg testing was available in 64% (3012/4671) of cases. The HBsAg seroprevalence rate was 11.1% (335/3012) overall and 14.9% in persons aged 30-39 years. HBeAg testing was available for 75% (250/335) of HBsAg+ cases. Seventy-five percent (188/250) were HBeAg-. Sixty percent (26/43) of HBeAg+ patients with available data had HBV DNA >10(5) copies/mL and an elevated ALT level. Sixteen percent (21/128) of HBeAg- patients with available data had HBV DNA >10(4) copies/mL and an elevated ALT level. CONCLUSIONS: The HBsAg seroprevalence was high (11.1%) in Chinese immigrants presenting for general medical care. A majority (75%) of HBsAg+ patients were HBeAg-. Sixty percent of HBeAg+ cases and 16% of HBeAg- patients with available data had both HBV DNA and ALT levels that would prompt consideration of antiviral therapy. These findings highlight the importance of testing and medical management of hepatitis B in Chinese Americans.