Key clinical point: Cirrhosis is often unrecognized in patients diagnosed with hepatocellular carcinoma (HCC). Unrecognized cirrhosis is associated with more advanced HCC at diagnosis and a worse prognosis.

Major finding: Patients with unrecognized cirrhosis vs those with known cirrhosis diagnosed with HCC under surveillance had a significantly shorter median survival (0.89 years [95% CI 0.78-1.01] vs 3.79 years [95% CI 3.19-4.39]) and a higher mortality rate (adjusted hazard ratio 2.36; 95% CI 2.09-2.66).

Study details: This retrospective cohort study included 2670 adult patients with HCC and liver cirrhosis, of which 1033 had unrecognized cirrhosis at HCC diagnosis and 901 had known cirrhosis with HCC diagnosed under surveillance.

Disclosures: No source of funding was disclosed. The authors declared no conflicts of interest.

Source: Vaz J et al. Unrecognized liver cirrhosis is common and associated with worse survival in hepatocellular carcinoma: A nationwide cohort study of 3473 patients. J Intern Med. 2022 (Sep 27). Doi: 10.1111/joim.13570

Key clinical point: Cirrhosis is often unrecognized in patients diagnosed with hepatocellular carcinoma (HCC). Unrecognized cirrhosis is associated with more advanced HCC at diagnosis and a worse prognosis.

Major finding: Patients with unrecognized cirrhosis vs those with known cirrhosis diagnosed with HCC under surveillance had a significantly shorter median survival (0.89 years [95% CI 0.78-1.01] vs 3.79 years [95% CI 3.19-4.39]) and a higher mortality rate (adjusted hazard ratio 2.36; 95% CI 2.09-2.66).

Study details: This retrospective cohort study included 2670 adult patients with HCC and liver cirrhosis, of which 1033 had unrecognized cirrhosis at HCC diagnosis and 901 had known cirrhosis with HCC diagnosed under surveillance.

Disclosures: No source of funding was disclosed. The authors declared no conflicts of interest.

Source: Vaz J et al. Unrecognized liver cirrhosis is common and associated with worse survival in hepatocellular carcinoma: A nationwide cohort study of 3473 patients. J Intern Med. 2022 (Sep 27). Doi: 10.1111/joim.13570

Key clinical point: Cirrhosis is often unrecognized in patients diagnosed with hepatocellular carcinoma (HCC). Unrecognized cirrhosis is associated with more advanced HCC at diagnosis and a worse prognosis.

Major finding: Patients with unrecognized cirrhosis vs those with known cirrhosis diagnosed with HCC under surveillance had a significantly shorter median survival (0.89 years [95% CI 0.78-1.01] vs 3.79 years [95% CI 3.19-4.39]) and a higher mortality rate (adjusted hazard ratio 2.36; 95% CI 2.09-2.66).

Study details: This retrospective cohort study included 2670 adult patients with HCC and liver cirrhosis, of which 1033 had unrecognized cirrhosis at HCC diagnosis and 901 had known cirrhosis with HCC diagnosed under surveillance.

Disclosures: No source of funding was disclosed. The authors declared no conflicts of interest.

Source: Vaz J et al. Unrecognized liver cirrhosis is common and associated with worse survival in hepatocellular carcinoma: A nationwide cohort study of 3473 patients. J Intern Med. 2022 (Sep 27). Doi: 10.1111/joim.13570

Updated long-term safety data suggest that tofacitinib (Xeljanz, Pfizer) is generally safe for long-term use in the treatment of moderate to severe ulcerative colitis (UC), with adverse events (AE) consistent with previous studies and showed stability over time in the incidence of adverse events of special interest.

“Findings from these integrated safety analyses are reassuring for patients with UC. The incidence rates of most key events that led to the black box warning are lower in these cohorts, compared with results observed in the ORAL Surveillance study of older patients with RA [rheumatoid arthritis],” said Siddharth Singh, MD, who was asked to comment on the study.

The results support the current clinical approach, in which tofacitinib is typically employed following infliximab (Remicade, Janssen) failure, though the paradigm may change. “These findings on safety reassure our approach, though there will still be hesitation to use 10-mg twice-daily dosing in older patients. However, with the recent approval of upadacitinib (Rinvoq, AbbVie), a selective JAK1 inhibitor that seems to be more effective than tofacitinib, positioning of tofacitinib may evolve,” said Dr. Singh, who is an associate professor of medicine at University of California, San Diego, and director of the UCSD IBD Center.

There has been evidence to support safety concerns with tofacitinib. The prospective ORAL Surveillance study compared two doses of tofacitinib (5 or 10 mg, twice daily) to tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis. The researchers selected patients aged 50 and older and with at least one additional cardiovascular risk factor. The study found higher rates of major adverse cardiovascular events and malignancies in the tofacitinib groups, as well as higher rates of mortality, serious infection, and venous thromboembolism. The findings prompted a Food and Drug Administration “black box” warning for tofacitinib in July 2019, which was extended to two other JAK inhibitors in September 2021.

However, patients in the UC clinical program are generally younger than participants in the ORAL Surveillance study and were less likely to have a smoking history.

The new study, published in the Journal of Crohn’s and Colitis, represents an update of a pooled analysis from phase 2, phase 3, and open-label extension studies with up to 4.4 years of exposure. Analysis of the earlier cohort showed that tofacitinib had a generally similar safety profile to other UC therapies, with the exception of a higher incidence of herpes zoster infection. Since that publication, the researchers have compiled additional person-years of tofacitinib exposure from the open-label extension OCTAVE Open study and the 6-month interim analysis of the phase 3b/4 RIVETING study.

The new study included 1,157 patients who received at least one dose of tofacitinib. Overall, 35.6% had received treatment for longer than 4 years. The mean age was 41.3 years, 58.7% were male, and 80.1% were White; 64.0% had never smoked, and 30.9% were ex-smokers. The mean disease duration was 8.2 years. In all, 83% of patients were on a 10 mg dose, and 17% were on 5 mg.

In the 2016 analysis, 82.1% of patients had an adverse event and 14.6% had a serious adverse event. In the overall cohort, the percentages were 85.7% and 21%, respectively.

In the updated analysis, 11.6% discontinued medication use because of an adverse event. For all doses, incidence rates (IRs) for adverse events were defined as unique patients with events per 100 person-years of exposure. The IRs for death and adverse events of special interest were similar between the original cohort and the updated cohort. For example, the IR for death was 0.24 for death in the earlier cohort (95% confidence interval, 0.07-0.61) and 0.23 in the combined cohort (95% CI, 0.09-0.46); it was 1.99 for serious infections in the earlier cohort (95% CI 1.37–2.79) and 1.69 in the combined cohort for serious infections (95% CI, 1.26-2.21); it was 4.07 for serious and nonserious herpes zoster infection in the earlier cohort (95% CI, 3.14-5.19), 3.30 for serious and nonserious herpes zoster infection in the combined cohort (95% CI, 2.67-4.04); and it was 1.28 for opportunistic infections in the earlier cohort (95% CI, 0.79-1.96) and 1.03 in the combined cohort for opportunistic infections (95% CI, 0.70-1.46).

The updated cohort included 3.4 more years of observation and an additional 1,386.9 person-years of exposure. That resulted in a final tally of up to 7.8 years of exposure and a combined 2,999.7 person-years of exposure, “thus demonstrating that the safety profile of tofacitinib remained consistent with increased extent and length of exposure,” the authors wrote.

Despite the promising findings, Dr. Singh called for more research. “We need a dedicated safety registry of tofacitinib and other JAK inhibitors in patients with IBD, who do not share the characteristics of those studied in the ORAL Surveillance study,” he said.

The authors disclose ties to various pharmaceutical companies, including Pfizer, which manufactures tofacitinib. Dr. Singh has received personal fees from Pfizer for ad hoc grant review.
 

Updated long-term safety data suggest that tofacitinib (Xeljanz, Pfizer) is generally safe for long-term use in the treatment of moderate to severe ulcerative colitis (UC), with adverse events (AE) consistent with previous studies and showed stability over time in the incidence of adverse events of special interest.

“Findings from these integrated safety analyses are reassuring for patients with UC. The incidence rates of most key events that led to the black box warning are lower in these cohorts, compared with results observed in the ORAL Surveillance study of older patients with RA [rheumatoid arthritis],” said Siddharth Singh, MD, who was asked to comment on the study.

The results support the current clinical approach, in which tofacitinib is typically employed following infliximab (Remicade, Janssen) failure, though the paradigm may change. “These findings on safety reassure our approach, though there will still be hesitation to use 10-mg twice-daily dosing in older patients. However, with the recent approval of upadacitinib (Rinvoq, AbbVie), a selective JAK1 inhibitor that seems to be more effective than tofacitinib, positioning of tofacitinib may evolve,” said Dr. Singh, who is an associate professor of medicine at University of California, San Diego, and director of the UCSD IBD Center.

There has been evidence to support safety concerns with tofacitinib. The prospective ORAL Surveillance study compared two doses of tofacitinib (5 or 10 mg, twice daily) to tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis. The researchers selected patients aged 50 and older and with at least one additional cardiovascular risk factor. The study found higher rates of major adverse cardiovascular events and malignancies in the tofacitinib groups, as well as higher rates of mortality, serious infection, and venous thromboembolism. The findings prompted a Food and Drug Administration “black box” warning for tofacitinib in July 2019, which was extended to two other JAK inhibitors in September 2021.

However, patients in the UC clinical program are generally younger than participants in the ORAL Surveillance study and were less likely to have a smoking history.

The new study, published in the Journal of Crohn’s and Colitis, represents an update of a pooled analysis from phase 2, phase 3, and open-label extension studies with up to 4.4 years of exposure. Analysis of the earlier cohort showed that tofacitinib had a generally similar safety profile to other UC therapies, with the exception of a higher incidence of herpes zoster infection. Since that publication, the researchers have compiled additional person-years of tofacitinib exposure from the open-label extension OCTAVE Open study and the 6-month interim analysis of the phase 3b/4 RIVETING study.

The new study included 1,157 patients who received at least one dose of tofacitinib. Overall, 35.6% had received treatment for longer than 4 years. The mean age was 41.3 years, 58.7% were male, and 80.1% were White; 64.0% had never smoked, and 30.9% were ex-smokers. The mean disease duration was 8.2 years. In all, 83% of patients were on a 10 mg dose, and 17% were on 5 mg.

In the 2016 analysis, 82.1% of patients had an adverse event and 14.6% had a serious adverse event. In the overall cohort, the percentages were 85.7% and 21%, respectively.

In the updated analysis, 11.6% discontinued medication use because of an adverse event. For all doses, incidence rates (IRs) for adverse events were defined as unique patients with events per 100 person-years of exposure. The IRs for death and adverse events of special interest were similar between the original cohort and the updated cohort. For example, the IR for death was 0.24 for death in the earlier cohort (95% confidence interval, 0.07-0.61) and 0.23 in the combined cohort (95% CI, 0.09-0.46); it was 1.99 for serious infections in the earlier cohort (95% CI 1.37–2.79) and 1.69 in the combined cohort for serious infections (95% CI, 1.26-2.21); it was 4.07 for serious and nonserious herpes zoster infection in the earlier cohort (95% CI, 3.14-5.19), 3.30 for serious and nonserious herpes zoster infection in the combined cohort (95% CI, 2.67-4.04); and it was 1.28 for opportunistic infections in the earlier cohort (95% CI, 0.79-1.96) and 1.03 in the combined cohort for opportunistic infections (95% CI, 0.70-1.46).

The updated cohort included 3.4 more years of observation and an additional 1,386.9 person-years of exposure. That resulted in a final tally of up to 7.8 years of exposure and a combined 2,999.7 person-years of exposure, “thus demonstrating that the safety profile of tofacitinib remained consistent with increased extent and length of exposure,” the authors wrote.

Despite the promising findings, Dr. Singh called for more research. “We need a dedicated safety registry of tofacitinib and other JAK inhibitors in patients with IBD, who do not share the characteristics of those studied in the ORAL Surveillance study,” he said.

The authors disclose ties to various pharmaceutical companies, including Pfizer, which manufactures tofacitinib. Dr. Singh has received personal fees from Pfizer for ad hoc grant review.
 

Updated long-term safety data suggest that tofacitinib (Xeljanz, Pfizer) is generally safe for long-term use in the treatment of moderate to severe ulcerative colitis (UC), with adverse events (AE) consistent with previous studies and showed stability over time in the incidence of adverse events of special interest.

“Findings from these integrated safety analyses are reassuring for patients with UC. The incidence rates of most key events that led to the black box warning are lower in these cohorts, compared with results observed in the ORAL Surveillance study of older patients with RA [rheumatoid arthritis],” said Siddharth Singh, MD, who was asked to comment on the study.

The results support the current clinical approach, in which tofacitinib is typically employed following infliximab (Remicade, Janssen) failure, though the paradigm may change. “These findings on safety reassure our approach, though there will still be hesitation to use 10-mg twice-daily dosing in older patients. However, with the recent approval of upadacitinib (Rinvoq, AbbVie), a selective JAK1 inhibitor that seems to be more effective than tofacitinib, positioning of tofacitinib may evolve,” said Dr. Singh, who is an associate professor of medicine at University of California, San Diego, and director of the UCSD IBD Center.

There has been evidence to support safety concerns with tofacitinib. The prospective ORAL Surveillance study compared two doses of tofacitinib (5 or 10 mg, twice daily) to tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis. The researchers selected patients aged 50 and older and with at least one additional cardiovascular risk factor. The study found higher rates of major adverse cardiovascular events and malignancies in the tofacitinib groups, as well as higher rates of mortality, serious infection, and venous thromboembolism. The findings prompted a Food and Drug Administration “black box” warning for tofacitinib in July 2019, which was extended to two other JAK inhibitors in September 2021.

However, patients in the UC clinical program are generally younger than participants in the ORAL Surveillance study and were less likely to have a smoking history.

The new study, published in the Journal of Crohn’s and Colitis, represents an update of a pooled analysis from phase 2, phase 3, and open-label extension studies with up to 4.4 years of exposure. Analysis of the earlier cohort showed that tofacitinib had a generally similar safety profile to other UC therapies, with the exception of a higher incidence of herpes zoster infection. Since that publication, the researchers have compiled additional person-years of tofacitinib exposure from the open-label extension OCTAVE Open study and the 6-month interim analysis of the phase 3b/4 RIVETING study.

The new study included 1,157 patients who received at least one dose of tofacitinib. Overall, 35.6% had received treatment for longer than 4 years. The mean age was 41.3 years, 58.7% were male, and 80.1% were White; 64.0% had never smoked, and 30.9% were ex-smokers. The mean disease duration was 8.2 years. In all, 83% of patients were on a 10 mg dose, and 17% were on 5 mg.

In the 2016 analysis, 82.1% of patients had an adverse event and 14.6% had a serious adverse event. In the overall cohort, the percentages were 85.7% and 21%, respectively.

In the updated analysis, 11.6% discontinued medication use because of an adverse event. For all doses, incidence rates (IRs) for adverse events were defined as unique patients with events per 100 person-years of exposure. The IRs for death and adverse events of special interest were similar between the original cohort and the updated cohort. For example, the IR for death was 0.24 for death in the earlier cohort (95% confidence interval, 0.07-0.61) and 0.23 in the combined cohort (95% CI, 0.09-0.46); it was 1.99 for serious infections in the earlier cohort (95% CI 1.37–2.79) and 1.69 in the combined cohort for serious infections (95% CI, 1.26-2.21); it was 4.07 for serious and nonserious herpes zoster infection in the earlier cohort (95% CI, 3.14-5.19), 3.30 for serious and nonserious herpes zoster infection in the combined cohort (95% CI, 2.67-4.04); and it was 1.28 for opportunistic infections in the earlier cohort (95% CI, 0.79-1.96) and 1.03 in the combined cohort for opportunistic infections (95% CI, 0.70-1.46).

The updated cohort included 3.4 more years of observation and an additional 1,386.9 person-years of exposure. That resulted in a final tally of up to 7.8 years of exposure and a combined 2,999.7 person-years of exposure, “thus demonstrating that the safety profile of tofacitinib remained consistent with increased extent and length of exposure,” the authors wrote.

Despite the promising findings, Dr. Singh called for more research. “We need a dedicated safety registry of tofacitinib and other JAK inhibitors in patients with IBD, who do not share the characteristics of those studied in the ORAL Surveillance study,” he said.

The authors disclose ties to various pharmaceutical companies, including Pfizer, which manufactures tofacitinib. Dr. Singh has received personal fees from Pfizer for ad hoc grant review.
 

Key clinical point: In patients with chronic hepatitis B virus (HBV) infection who have undergone curative liver resection for hepatocellular carcinoma (HCC), concurrent metabolic syndrome is associated with poorer long-term oncological outcomes.

Major finding: Patients with vs without metabolic syndrome had significantly lower 5-year overall survival (OS; P  =  .010) and recurrence-free survival (RFS; P  =  .003) rates and higher 5-year overall recurrence rate (P  =  .024). Concurrent metabolic syndrome was independently associated with poorer OS (adjusted hazard ratio [aHR] 1.300; P  =  .036) and RFS (aHR 1.314; P  =  .012) rates and increased late recurrence rate (aHR 1.470; P  =  .047).

Study details: Findings are from a multicenter cohort study including 1753 patients who underwent liver resection for HBV-related HCC, of which 163 patients had concurrent metabolic syndrome.

Disclosures: This study was funded by the National Natural Science Foundation of China, among others. No information on conflicts of interest was available.

Source: Wang MD et al. Association of concurrent metabolic syndrome with long-term oncological prognosis following liver resection for hepatocellular carcinoma among patients with chronic hepatitis B virus infection: A multicenter study of 1753 patients. Ann Surg Oncol. 2022 (Sep 16). Doi: 10.1245/s10434-022-12529-6

Key clinical point: In patients with chronic hepatitis B virus (HBV) infection who have undergone curative liver resection for hepatocellular carcinoma (HCC), concurrent metabolic syndrome is associated with poorer long-term oncological outcomes.

Major finding: Patients with vs without metabolic syndrome had significantly lower 5-year overall survival (OS; P  =  .010) and recurrence-free survival (RFS; P  =  .003) rates and higher 5-year overall recurrence rate (P  =  .024). Concurrent metabolic syndrome was independently associated with poorer OS (adjusted hazard ratio [aHR] 1.300; P  =  .036) and RFS (aHR 1.314; P  =  .012) rates and increased late recurrence rate (aHR 1.470; P  =  .047).

Study details: Findings are from a multicenter cohort study including 1753 patients who underwent liver resection for HBV-related HCC, of which 163 patients had concurrent metabolic syndrome.

Disclosures: This study was funded by the National Natural Science Foundation of China, among others. No information on conflicts of interest was available.

Source: Wang MD et al. Association of concurrent metabolic syndrome with long-term oncological prognosis following liver resection for hepatocellular carcinoma among patients with chronic hepatitis B virus infection: A multicenter study of 1753 patients. Ann Surg Oncol. 2022 (Sep 16). Doi: 10.1245/s10434-022-12529-6

Key clinical point: In patients with chronic hepatitis B virus (HBV) infection who have undergone curative liver resection for hepatocellular carcinoma (HCC), concurrent metabolic syndrome is associated with poorer long-term oncological outcomes.

Major finding: Patients with vs without metabolic syndrome had significantly lower 5-year overall survival (OS; P  =  .010) and recurrence-free survival (RFS; P  =  .003) rates and higher 5-year overall recurrence rate (P  =  .024). Concurrent metabolic syndrome was independently associated with poorer OS (adjusted hazard ratio [aHR] 1.300; P  =  .036) and RFS (aHR 1.314; P  =  .012) rates and increased late recurrence rate (aHR 1.470; P  =  .047).

Study details: Findings are from a multicenter cohort study including 1753 patients who underwent liver resection for HBV-related HCC, of which 163 patients had concurrent metabolic syndrome.

Disclosures: This study was funded by the National Natural Science Foundation of China, among others. No information on conflicts of interest was available.

Source: Wang MD et al. Association of concurrent metabolic syndrome with long-term oncological prognosis following liver resection for hepatocellular carcinoma among patients with chronic hepatitis B virus infection: A multicenter study of 1753 patients. Ann Surg Oncol. 2022 (Sep 16). Doi: 10.1245/s10434-022-12529-6

Key clinical point: Abdominal ultrasonography (US) blind spots affect the initially detected hepatocellular carcinoma (HCC) tumor size, treatment strategy, and overall survival (OS) in patients with HCC who undergo regular surveillance.

Major finding: A significantly higher proportion of HCC tumors >2 cm were detected in blind vs non-blind spots (60.3% vs 47.1%; P  =  .001), with most being treated with hepatectomy (P < .001) vs radiofrequency ablation, respectively. Patients with HCC located in a blind spot in the US-detected vs US-missed group had a significantly better OS (P  =  .008).

Study details: This retrospective study included 1289 patients who underwent 6-month interval surveillance using US and serum alpha-fetoprotein and were eventually diagnosed with single-nodular Barcelona Clinic Liver Cancer stage 0-A HCC that was detected (n = 1062) or missed (n = 227) by US.

Disclosures: This study was supported by a grant from the Medical Science Research Institute, Kyung Hee University Hospital at Gangdong, South Korea. The authors declared no conflicts of interest.

Source: Lee J, Park SB, et al. Impact of ultrasonographic blind spots for early-stage hepatocellular carcinoma during surveillance. PLoS One. 2022;17(9):e0274747 (Sep 16). Doi: 10.1371/journal.pone.0274747

Key clinical point: Abdominal ultrasonography (US) blind spots affect the initially detected hepatocellular carcinoma (HCC) tumor size, treatment strategy, and overall survival (OS) in patients with HCC who undergo regular surveillance.

Major finding: A significantly higher proportion of HCC tumors >2 cm were detected in blind vs non-blind spots (60.3% vs 47.1%; P  =  .001), with most being treated with hepatectomy (P < .001) vs radiofrequency ablation, respectively. Patients with HCC located in a blind spot in the US-detected vs US-missed group had a significantly better OS (P  =  .008).

Study details: This retrospective study included 1289 patients who underwent 6-month interval surveillance using US and serum alpha-fetoprotein and were eventually diagnosed with single-nodular Barcelona Clinic Liver Cancer stage 0-A HCC that was detected (n = 1062) or missed (n = 227) by US.

Disclosures: This study was supported by a grant from the Medical Science Research Institute, Kyung Hee University Hospital at Gangdong, South Korea. The authors declared no conflicts of interest.

Source: Lee J, Park SB, et al. Impact of ultrasonographic blind spots for early-stage hepatocellular carcinoma during surveillance. PLoS One. 2022;17(9):e0274747 (Sep 16). Doi: 10.1371/journal.pone.0274747

Key clinical point: Abdominal ultrasonography (US) blind spots affect the initially detected hepatocellular carcinoma (HCC) tumor size, treatment strategy, and overall survival (OS) in patients with HCC who undergo regular surveillance.

Major finding: A significantly higher proportion of HCC tumors >2 cm were detected in blind vs non-blind spots (60.3% vs 47.1%; P  =  .001), with most being treated with hepatectomy (P < .001) vs radiofrequency ablation, respectively. Patients with HCC located in a blind spot in the US-detected vs US-missed group had a significantly better OS (P  =  .008).

Study details: This retrospective study included 1289 patients who underwent 6-month interval surveillance using US and serum alpha-fetoprotein and were eventually diagnosed with single-nodular Barcelona Clinic Liver Cancer stage 0-A HCC that was detected (n = 1062) or missed (n = 227) by US.

Disclosures: This study was supported by a grant from the Medical Science Research Institute, Kyung Hee University Hospital at Gangdong, South Korea. The authors declared no conflicts of interest.

Source: Lee J, Park SB, et al. Impact of ultrasonographic blind spots for early-stage hepatocellular carcinoma during surveillance. PLoS One. 2022;17(9):e0274747 (Sep 16). Doi: 10.1371/journal.pone.0274747

Key clinical point: Survival outcomes are unaffected by postoperative opioid use in patients who have undergone hepatectomy or liver transplantation for hepatocellular carcinoma (HCC).

Major finding: Patients who did vs did not receive opioids had no significant difference in overall survival (adjusted hazard ratio [aHR] 1.10; P  =  .478) or recurrence-free survival (aHR 1.15; P  =  .229).

Study details: This retrospective cohort study included 812 patients aged >20 years with HCC who underwent hepatectomy and did (n = 530) or did not (n = 282) receive opioids during the postoperative period.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Yeh PH et al. No association of postoperative opioid usage with long-term surgery outcomes in patients with liver cancer: A population-based retrospective cohort study. Pain. 2022 (Sep 8). Doi: 10.1097/j.pain.0000000000002776

Key clinical point: Survival outcomes are unaffected by postoperative opioid use in patients who have undergone hepatectomy or liver transplantation for hepatocellular carcinoma (HCC).

Major finding: Patients who did vs did not receive opioids had no significant difference in overall survival (adjusted hazard ratio [aHR] 1.10; P  =  .478) or recurrence-free survival (aHR 1.15; P  =  .229).

Study details: This retrospective cohort study included 812 patients aged >20 years with HCC who underwent hepatectomy and did (n = 530) or did not (n = 282) receive opioids during the postoperative period.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Yeh PH et al. No association of postoperative opioid usage with long-term surgery outcomes in patients with liver cancer: A population-based retrospective cohort study. Pain. 2022 (Sep 8). Doi: 10.1097/j.pain.0000000000002776

Key clinical point: Survival outcomes are unaffected by postoperative opioid use in patients who have undergone hepatectomy or liver transplantation for hepatocellular carcinoma (HCC).

Major finding: Patients who did vs did not receive opioids had no significant difference in overall survival (adjusted hazard ratio [aHR] 1.10; P  =  .478) or recurrence-free survival (aHR 1.15; P  =  .229).

Study details: This retrospective cohort study included 812 patients aged >20 years with HCC who underwent hepatectomy and did (n = 530) or did not (n = 282) receive opioids during the postoperative period.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Yeh PH et al. No association of postoperative opioid usage with long-term surgery outcomes in patients with liver cancer: A population-based retrospective cohort study. Pain. 2022 (Sep 8). Doi: 10.1097/j.pain.0000000000002776

Key clinical point: The long-term therapeutic outcomes of microwave ablation (MWA) are comparable to those of surgical resection (SR) in patients with subcapsular hepatocellular carcinoma (HCC).

Major finding: The MWA vs SR group had significantly lower complication rates (51.2% vs 70.2%; P  =  .011), with no significant difference in the 5-year cumulative local tumor progression (16.4% vs 10.6%; P  =  .31), 5-year overall survival (73.0% vs 72.1%; P  =  .89), or 5-year disease-free survival (38.1% vs 32.3%; P  =  .43) rate.

Study details: This multicenter retrospective study included 84 patients with subcapsular HCC meeting the Milan criteria who underwent MWA and 84 propensity score-matched patients who underwent SR.

Disclosures: This study was sponsored by the Natural Science Foundation of Shandong Province, China. The authors declared no conflicts of interest.

Source: Liu K et al. Microwave ablation versus surgical resection for subcapsular hepatocellular carcinoma: A propensity score-matched study of long-term therapeutic outcomes. Eur Radiol. 2022 (Sep 17). Doi: 10.1007/s00330-022-09135-1

Key clinical point: The long-term therapeutic outcomes of microwave ablation (MWA) are comparable to those of surgical resection (SR) in patients with subcapsular hepatocellular carcinoma (HCC).

Major finding: The MWA vs SR group had significantly lower complication rates (51.2% vs 70.2%; P  =  .011), with no significant difference in the 5-year cumulative local tumor progression (16.4% vs 10.6%; P  =  .31), 5-year overall survival (73.0% vs 72.1%; P  =  .89), or 5-year disease-free survival (38.1% vs 32.3%; P  =  .43) rate.

Study details: This multicenter retrospective study included 84 patients with subcapsular HCC meeting the Milan criteria who underwent MWA and 84 propensity score-matched patients who underwent SR.

Disclosures: This study was sponsored by the Natural Science Foundation of Shandong Province, China. The authors declared no conflicts of interest.

Source: Liu K et al. Microwave ablation versus surgical resection for subcapsular hepatocellular carcinoma: A propensity score-matched study of long-term therapeutic outcomes. Eur Radiol. 2022 (Sep 17). Doi: 10.1007/s00330-022-09135-1

Key clinical point: The long-term therapeutic outcomes of microwave ablation (MWA) are comparable to those of surgical resection (SR) in patients with subcapsular hepatocellular carcinoma (HCC).

Major finding: The MWA vs SR group had significantly lower complication rates (51.2% vs 70.2%; P  =  .011), with no significant difference in the 5-year cumulative local tumor progression (16.4% vs 10.6%; P  =  .31), 5-year overall survival (73.0% vs 72.1%; P  =  .89), or 5-year disease-free survival (38.1% vs 32.3%; P  =  .43) rate.

Study details: This multicenter retrospective study included 84 patients with subcapsular HCC meeting the Milan criteria who underwent MWA and 84 propensity score-matched patients who underwent SR.

Disclosures: This study was sponsored by the Natural Science Foundation of Shandong Province, China. The authors declared no conflicts of interest.

Source: Liu K et al. Microwave ablation versus surgical resection for subcapsular hepatocellular carcinoma: A propensity score-matched study of long-term therapeutic outcomes. Eur Radiol. 2022 (Sep 17). Doi: 10.1007/s00330-022-09135-1

Key clinical point: Antiplatelet therapy (APT) reduces the risk for hepatocellular carcinoma (HCC) incidence by 40% and for all-cause mortality by 50% in patients with HCC treated with curative or palliative strategies.

Major finding: APT was associated with a significant reduction in the risk for HCC incidence (odds ratio [OR] 0.63; P < .0001) and post-treatment mortality (OR 0.54; P  =  .006).

Study details: This study was a meta-analysis of 15 studies that investigated the impact of APT on HCC incidence in 2,685,009 individuals and five studies that investigated post-treatment mortality in 3281 patients with HCC, both with respect to APT use.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Lai Q et al and the Associazione Italiana per lo Studio del Fegato (AISF) HCC Special Interest Group. The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma. Eur J Clin Invest. 2022:e13870 (Sep 8). Doi: 10.1111/eci.13870

Key clinical point: Antiplatelet therapy (APT) reduces the risk for hepatocellular carcinoma (HCC) incidence by 40% and for all-cause mortality by 50% in patients with HCC treated with curative or palliative strategies.

Major finding: APT was associated with a significant reduction in the risk for HCC incidence (odds ratio [OR] 0.63; P < .0001) and post-treatment mortality (OR 0.54; P  =  .006).

Study details: This study was a meta-analysis of 15 studies that investigated the impact of APT on HCC incidence in 2,685,009 individuals and five studies that investigated post-treatment mortality in 3281 patients with HCC, both with respect to APT use.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Lai Q et al and the Associazione Italiana per lo Studio del Fegato (AISF) HCC Special Interest Group. The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma. Eur J Clin Invest. 2022:e13870 (Sep 8). Doi: 10.1111/eci.13870

Key clinical point: Antiplatelet therapy (APT) reduces the risk for hepatocellular carcinoma (HCC) incidence by 40% and for all-cause mortality by 50% in patients with HCC treated with curative or palliative strategies.

Major finding: APT was associated with a significant reduction in the risk for HCC incidence (odds ratio [OR] 0.63; P < .0001) and post-treatment mortality (OR 0.54; P  =  .006).

Study details: This study was a meta-analysis of 15 studies that investigated the impact of APT on HCC incidence in 2,685,009 individuals and five studies that investigated post-treatment mortality in 3281 patients with HCC, both with respect to APT use.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Lai Q et al and the Associazione Italiana per lo Studio del Fegato (AISF) HCC Special Interest Group. The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma. Eur J Clin Invest. 2022:e13870 (Sep 8). Doi: 10.1111/eci.13870

Key clinical point: Hepatectomy is beneficial in patients with ≤3 hepatocellular carcinomas (HCC) and no or Child-Pugh (CP) class A cirrhosis, with the long-term results being comparable to those in patients with single HCC.

Major finding: The overall survival was significantly different between patients with Barcelona Clinic Liver Cancer (BCLC) stages A1 and A2 (P  =  .0118), A2 and A3 (P  =  .0013), and B1 and B2 (P  =  .0050) but not between stages A3 and B1 (P  =  .4742). CP class B cirrhosis was an independent prognostic factor for overall survival.

Study details: This single-center retrospective study included 1088 patients who underwent hepatectomy for BCLC stage 0 (n = 88), A (n = 750), or B (n = 250) HCC, with stages A and B categorized into A1 (single nodule 2-5 cm or ≤3 nodules ≤3 cm), A2 (single nodule 5-10 cm), A3 (single nodule ≥10 cm), B1 (2-3 nodules >3 cm), and B2 (≥4 nodules).

Disclosures: No information on funding source was available. The authors declared no conflicts of interest.

Source: Orimo T et al. Hepatectomy is beneficial in select patients with multiple hepatocellular carcinomas. Ann Surg Oncol. 2022 (Sep 13). Doi: 10.1245/s10434-022-12495-z

Key clinical point: Hepatectomy is beneficial in patients with ≤3 hepatocellular carcinomas (HCC) and no or Child-Pugh (CP) class A cirrhosis, with the long-term results being comparable to those in patients with single HCC.

Major finding: The overall survival was significantly different between patients with Barcelona Clinic Liver Cancer (BCLC) stages A1 and A2 (P  =  .0118), A2 and A3 (P  =  .0013), and B1 and B2 (P  =  .0050) but not between stages A3 and B1 (P  =  .4742). CP class B cirrhosis was an independent prognostic factor for overall survival.

Study details: This single-center retrospective study included 1088 patients who underwent hepatectomy for BCLC stage 0 (n = 88), A (n = 750), or B (n = 250) HCC, with stages A and B categorized into A1 (single nodule 2-5 cm or ≤3 nodules ≤3 cm), A2 (single nodule 5-10 cm), A3 (single nodule ≥10 cm), B1 (2-3 nodules >3 cm), and B2 (≥4 nodules).

Disclosures: No information on funding source was available. The authors declared no conflicts of interest.

Source: Orimo T et al. Hepatectomy is beneficial in select patients with multiple hepatocellular carcinomas. Ann Surg Oncol. 2022 (Sep 13). Doi: 10.1245/s10434-022-12495-z

Key clinical point: Hepatectomy is beneficial in patients with ≤3 hepatocellular carcinomas (HCC) and no or Child-Pugh (CP) class A cirrhosis, with the long-term results being comparable to those in patients with single HCC.

Major finding: The overall survival was significantly different between patients with Barcelona Clinic Liver Cancer (BCLC) stages A1 and A2 (P  =  .0118), A2 and A3 (P  =  .0013), and B1 and B2 (P  =  .0050) but not between stages A3 and B1 (P  =  .4742). CP class B cirrhosis was an independent prognostic factor for overall survival.

Study details: This single-center retrospective study included 1088 patients who underwent hepatectomy for BCLC stage 0 (n = 88), A (n = 750), or B (n = 250) HCC, with stages A and B categorized into A1 (single nodule 2-5 cm or ≤3 nodules ≤3 cm), A2 (single nodule 5-10 cm), A3 (single nodule ≥10 cm), B1 (2-3 nodules >3 cm), and B2 (≥4 nodules).

Disclosures: No information on funding source was available. The authors declared no conflicts of interest.

Source: Orimo T et al. Hepatectomy is beneficial in select patients with multiple hepatocellular carcinomas. Ann Surg Oncol. 2022 (Sep 13). Doi: 10.1245/s10434-022-12495-z

Key clinical point: Ramucirumab offers clinically significant efficacy with no new safety signals after non-sorafenib systemic therapies in patients with advanced hepatocellular carcinoma (HCC) and alpha-fetoprotein (AFP) ≥400 ng/mL.

Major finding: Median overall and progression-free survival were 8.7 (95% CI 4.6-12.2) months and 1.7 (95% CI 1.5-4.1) months, respectively. The objective response rate was 10.6% (95% CI 1.8%-19.5%), and the disease control rate was 46.8% (95% CI 32.5%-61.1%). The grade ≥3 adverse event (AE) rate was 57%, with hypertension (11%) being the most frequent AE.

Study details: This open-label, non-comparative cohort of the REACH-2 study included 47 patients with advanced HCC and baseline AFP ≥400 ng/mL who had received non-sorafenib-based systemic therapies.

Disclosures: This study was funded by Eli Lilly and Company, U.S. Some authors declared serving as consultants or advisors for or receiving research funding or honoraria from various sources, including Eli Lilly. Four authors declared being employees of Eli Lilly.

Source: Finn RS et al. Ramucirumab for patients with advanced hepatocellular carcinoma and elevated alpha fetoprotein following non-sorafenib systemic therapy: An expansion cohort of REACH-2. Oncologist. 2022 (Oct 3). Doi: 10.1093/oncolo/oyac183

Key clinical point: Ramucirumab offers clinically significant efficacy with no new safety signals after non-sorafenib systemic therapies in patients with advanced hepatocellular carcinoma (HCC) and alpha-fetoprotein (AFP) ≥400 ng/mL.

Major finding: Median overall and progression-free survival were 8.7 (95% CI 4.6-12.2) months and 1.7 (95% CI 1.5-4.1) months, respectively. The objective response rate was 10.6% (95% CI 1.8%-19.5%), and the disease control rate was 46.8% (95% CI 32.5%-61.1%). The grade ≥3 adverse event (AE) rate was 57%, with hypertension (11%) being the most frequent AE.

Study details: This open-label, non-comparative cohort of the REACH-2 study included 47 patients with advanced HCC and baseline AFP ≥400 ng/mL who had received non-sorafenib-based systemic therapies.

Disclosures: This study was funded by Eli Lilly and Company, U.S. Some authors declared serving as consultants or advisors for or receiving research funding or honoraria from various sources, including Eli Lilly. Four authors declared being employees of Eli Lilly.

Source: Finn RS et al. Ramucirumab for patients with advanced hepatocellular carcinoma and elevated alpha fetoprotein following non-sorafenib systemic therapy: An expansion cohort of REACH-2. Oncologist. 2022 (Oct 3). Doi: 10.1093/oncolo/oyac183

Key clinical point: Ramucirumab offers clinically significant efficacy with no new safety signals after non-sorafenib systemic therapies in patients with advanced hepatocellular carcinoma (HCC) and alpha-fetoprotein (AFP) ≥400 ng/mL.

Major finding: Median overall and progression-free survival were 8.7 (95% CI 4.6-12.2) months and 1.7 (95% CI 1.5-4.1) months, respectively. The objective response rate was 10.6% (95% CI 1.8%-19.5%), and the disease control rate was 46.8% (95% CI 32.5%-61.1%). The grade ≥3 adverse event (AE) rate was 57%, with hypertension (11%) being the most frequent AE.

Study details: This open-label, non-comparative cohort of the REACH-2 study included 47 patients with advanced HCC and baseline AFP ≥400 ng/mL who had received non-sorafenib-based systemic therapies.

Disclosures: This study was funded by Eli Lilly and Company, U.S. Some authors declared serving as consultants or advisors for or receiving research funding or honoraria from various sources, including Eli Lilly. Four authors declared being employees of Eli Lilly.

Source: Finn RS et al. Ramucirumab for patients with advanced hepatocellular carcinoma and elevated alpha fetoprotein following non-sorafenib systemic therapy: An expansion cohort of REACH-2. Oncologist. 2022 (Oct 3). Doi: 10.1093/oncolo/oyac183

Key clinical point: The efficacy and safety profile of atezolizumab plus bevacizumab for unresectable hepatocellular carcinoma (HCC) in routine clinical practice is similar to that reported in the phase 3 IMbrave150 study.

Major finding: After a median follow-up of 10.0 months, the median overall survival was 15.7 months (95% CI 14.50-not estimated) and the progression-free survival was 6.9 months (95% CI 6.10-8.30). Among response-evaluable patients (n = 273), 30.8% achieved an objective response. Grade 3/4 treatment-related adverse events occurred in 23.6% of patients.

Study details: This multicenter prospective observational study, AB-Real, included 296 patients who received first-line atezolizumab plus bevacizumab for unresectable HCC.

Disclosures: This study received no specific funding. Some authors declared serving as consultants, advisors, or receiving lecture fees, advisory board honoraria, research grants, or travel or accommodation expenses from various sources.

Source: Fulgenzi CAM et al. Reproducible safety and efficacy of atezolizumab plus bevacizumab for HCC in clinical practice: Results of the AB-real study. Eur J Cancer. 2022;175:204-213 (Sep 20). Doi: 10.1016/j.ejca.2022.08.024

Key clinical point: The efficacy and safety profile of atezolizumab plus bevacizumab for unresectable hepatocellular carcinoma (HCC) in routine clinical practice is similar to that reported in the phase 3 IMbrave150 study.

Major finding: After a median follow-up of 10.0 months, the median overall survival was 15.7 months (95% CI 14.50-not estimated) and the progression-free survival was 6.9 months (95% CI 6.10-8.30). Among response-evaluable patients (n = 273), 30.8% achieved an objective response. Grade 3/4 treatment-related adverse events occurred in 23.6% of patients.

Study details: This multicenter prospective observational study, AB-Real, included 296 patients who received first-line atezolizumab plus bevacizumab for unresectable HCC.

Disclosures: This study received no specific funding. Some authors declared serving as consultants, advisors, or receiving lecture fees, advisory board honoraria, research grants, or travel or accommodation expenses from various sources.

Source: Fulgenzi CAM et al. Reproducible safety and efficacy of atezolizumab plus bevacizumab for HCC in clinical practice: Results of the AB-real study. Eur J Cancer. 2022;175:204-213 (Sep 20). Doi: 10.1016/j.ejca.2022.08.024

Key clinical point: The efficacy and safety profile of atezolizumab plus bevacizumab for unresectable hepatocellular carcinoma (HCC) in routine clinical practice is similar to that reported in the phase 3 IMbrave150 study.

Major finding: After a median follow-up of 10.0 months, the median overall survival was 15.7 months (95% CI 14.50-not estimated) and the progression-free survival was 6.9 months (95% CI 6.10-8.30). Among response-evaluable patients (n = 273), 30.8% achieved an objective response. Grade 3/4 treatment-related adverse events occurred in 23.6% of patients.

Study details: This multicenter prospective observational study, AB-Real, included 296 patients who received first-line atezolizumab plus bevacizumab for unresectable HCC.

Disclosures: This study received no specific funding. Some authors declared serving as consultants, advisors, or receiving lecture fees, advisory board honoraria, research grants, or travel or accommodation expenses from various sources.

Source: Fulgenzi CAM et al. Reproducible safety and efficacy of atezolizumab plus bevacizumab for HCC in clinical practice: Results of the AB-real study. Eur J Cancer. 2022;175:204-213 (Sep 20). Doi: 10.1016/j.ejca.2022.08.024