Hepatocellular Carcinoma

Key clinical point: In patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) who had undergone radiofrequency ablation (RFA), tenofovir disoproxil fumarate (TDF) performed better at protecting liver function and reducing HBV DNA loads than entecavir (ETV), without significant difference in recurrence or overall survival.

Major finding: Patients receiving TDF vs. ETV showed significantly faster serum HBV DNA reduction (2.75 vs. 9.13 months; P = .015) and a higher stabilization/improvement rate of the albumin-bilirubin grade (64% vs. 41%; P < .001), but similar 5-year recurrence (40.3% vs. 40.8%; P = .35) and overall survival (93.5% vs. 96.9%; P = .12) rates.

Study details: This single-center retrospective cohort study propensity score-matched patients receiving ETV (n = 130) with those receiving TDF (n = 77) for chronic HBV infection after undergoing RFA as a curative treatment for HCC.

Disclosures: The study was funded by the National Natural Science Foundation of China and Sun Yat-sen University Cancer Center physician scientist funding. No conflicts of interest were reported.

Source: Hu Z et al. Tenofovir vs. entecavir on outcomes of hepatitis B virus-related hepatocellular carcinoma after radiofrequency ablation. Viruses. 2022;14(4):656 (Mar 22). Doi: 10.3390/v14040656

Key clinical point: In patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) who had undergone radiofrequency ablation (RFA), tenofovir disoproxil fumarate (TDF) performed better at protecting liver function and reducing HBV DNA loads than entecavir (ETV), without significant difference in recurrence or overall survival.

Major finding: Patients receiving TDF vs. ETV showed significantly faster serum HBV DNA reduction (2.75 vs. 9.13 months; P = .015) and a higher stabilization/improvement rate of the albumin-bilirubin grade (64% vs. 41%; P < .001), but similar 5-year recurrence (40.3% vs. 40.8%; P = .35) and overall survival (93.5% vs. 96.9%; P = .12) rates.

Study details: This single-center retrospective cohort study propensity score-matched patients receiving ETV (n = 130) with those receiving TDF (n = 77) for chronic HBV infection after undergoing RFA as a curative treatment for HCC.

Disclosures: The study was funded by the National Natural Science Foundation of China and Sun Yat-sen University Cancer Center physician scientist funding. No conflicts of interest were reported.

Source: Hu Z et al. Tenofovir vs. entecavir on outcomes of hepatitis B virus-related hepatocellular carcinoma after radiofrequency ablation. Viruses. 2022;14(4):656 (Mar 22). Doi: 10.3390/v14040656

Key clinical point: In patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) who had undergone radiofrequency ablation (RFA), tenofovir disoproxil fumarate (TDF) performed better at protecting liver function and reducing HBV DNA loads than entecavir (ETV), without significant difference in recurrence or overall survival.

Major finding: Patients receiving TDF vs. ETV showed significantly faster serum HBV DNA reduction (2.75 vs. 9.13 months; P = .015) and a higher stabilization/improvement rate of the albumin-bilirubin grade (64% vs. 41%; P < .001), but similar 5-year recurrence (40.3% vs. 40.8%; P = .35) and overall survival (93.5% vs. 96.9%; P = .12) rates.

Study details: This single-center retrospective cohort study propensity score-matched patients receiving ETV (n = 130) with those receiving TDF (n = 77) for chronic HBV infection after undergoing RFA as a curative treatment for HCC.

Disclosures: The study was funded by the National Natural Science Foundation of China and Sun Yat-sen University Cancer Center physician scientist funding. No conflicts of interest were reported.

Source: Hu Z et al. Tenofovir vs. entecavir on outcomes of hepatitis B virus-related hepatocellular carcinoma after radiofrequency ablation. Viruses. 2022;14(4):656 (Mar 22). Doi: 10.3390/v14040656

Key clinical point: Although lenvatinib plus pembrolizumab exhibits similar tolerability between systemic therapy-naive and -experienced patients with unresectable hepatocellular carcinoma (uHCC), the progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) may be compromised in patients with prior systemic therapy.

Major finding: After a 9.3-month median follow-up, therapy-naive vs. -experienced patients showed numerically greater median PFS (9.2 vs. 4.9 months; P = .092), ORR (34.1% vs. 18.5%; P = .157), and DCR (84.1% vs. 70.4%; P = .169), but similar incidence rates of treatment-emergent adverse events (96.4% vs. 97.7%).

Study details: Findings are from a prospective study that enrolled 71 patients with uHCC who were systemic therapy-naive (n = 44) or -experienced (n =2 7) and received lenvatinib plus pembrolizumab.

Disclosures: The study received financial support from Taipei Veteran General Hospital, Taiwan. The authors declared no conflicts of interest.

Source: Wu C-J et al. Lenvatinib plus pembrolizumab for systemic therapy-naïve and -experienced unresectable hepatocellular carcinoma. Cancer Immunol Immunother. 2022 (Mar 28). Doi: 10.1007/s00262-022-03185-6

Key clinical point: Although lenvatinib plus pembrolizumab exhibits similar tolerability between systemic therapy-naive and -experienced patients with unresectable hepatocellular carcinoma (uHCC), the progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) may be compromised in patients with prior systemic therapy.

Major finding: After a 9.3-month median follow-up, therapy-naive vs. -experienced patients showed numerically greater median PFS (9.2 vs. 4.9 months; P = .092), ORR (34.1% vs. 18.5%; P = .157), and DCR (84.1% vs. 70.4%; P = .169), but similar incidence rates of treatment-emergent adverse events (96.4% vs. 97.7%).

Study details: Findings are from a prospective study that enrolled 71 patients with uHCC who were systemic therapy-naive (n = 44) or -experienced (n =2 7) and received lenvatinib plus pembrolizumab.

Disclosures: The study received financial support from Taipei Veteran General Hospital, Taiwan. The authors declared no conflicts of interest.

Source: Wu C-J et al. Lenvatinib plus pembrolizumab for systemic therapy-naïve and -experienced unresectable hepatocellular carcinoma. Cancer Immunol Immunother. 2022 (Mar 28). Doi: 10.1007/s00262-022-03185-6

Key clinical point: Although lenvatinib plus pembrolizumab exhibits similar tolerability between systemic therapy-naive and -experienced patients with unresectable hepatocellular carcinoma (uHCC), the progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) may be compromised in patients with prior systemic therapy.

Major finding: After a 9.3-month median follow-up, therapy-naive vs. -experienced patients showed numerically greater median PFS (9.2 vs. 4.9 months; P = .092), ORR (34.1% vs. 18.5%; P = .157), and DCR (84.1% vs. 70.4%; P = .169), but similar incidence rates of treatment-emergent adverse events (96.4% vs. 97.7%).

Study details: Findings are from a prospective study that enrolled 71 patients with uHCC who were systemic therapy-naive (n = 44) or -experienced (n =2 7) and received lenvatinib plus pembrolizumab.

Disclosures: The study received financial support from Taipei Veteran General Hospital, Taiwan. The authors declared no conflicts of interest.

Source: Wu C-J et al. Lenvatinib plus pembrolizumab for systemic therapy-naïve and -experienced unresectable hepatocellular carcinoma. Cancer Immunol Immunother. 2022 (Mar 28). Doi: 10.1007/s00262-022-03185-6

Key clinical point: Atezolizumab plus bevacizumab (AtezoBev) is an effective therapeutic option for unresectable hepatocellular carcinoma (uHCC) in routine clinical practice and is safe even in patients with Child-Pugh (CP)-B grade liver function.

Major finding: After a 9-month median follow-up, median overall survival was 14.9 months (95% CI 13.6-16.3 months) and median progression-free survival was 6.8 months (95% CI 5.2-8.5 months). Tolerability was similar across CP classes, with comparable bevacizumab-related (CP-A, 48%; CP-B, 46%) and atezolizumab-related (CP-A, 53%; CP-B, 40%) adverse event rates of any grade.

Study details: This was a multicenter retrospective study that included 202 adult patients with uHCC and CP-A (76%) or CP-B (24%) cirrhosis who received AtezoBev as the first-line systemic treatment.

Disclosures: The study was funded by the National Institute of Health Research Imperial Biomedical Research Centre, among others. Some authors declared serving as consultants or advisors for or receiving advisory board honoraria, lecture/speaker fees, research grants, or travel/accommodation expenses from various sources.

Source: D'Alessio A et al. Preliminary evidence of safety and tolerability of atezolizumab plus bevacizumab in patients with hepatocellular carcinoma and Child-Pugh A and B cirrhosis: A real-world study. Hepatology. 2022 (Mar 21). Doi: 10.1002/hep.32468

Key clinical point: Atezolizumab plus bevacizumab (AtezoBev) is an effective therapeutic option for unresectable hepatocellular carcinoma (uHCC) in routine clinical practice and is safe even in patients with Child-Pugh (CP)-B grade liver function.

Major finding: After a 9-month median follow-up, median overall survival was 14.9 months (95% CI 13.6-16.3 months) and median progression-free survival was 6.8 months (95% CI 5.2-8.5 months). Tolerability was similar across CP classes, with comparable bevacizumab-related (CP-A, 48%; CP-B, 46%) and atezolizumab-related (CP-A, 53%; CP-B, 40%) adverse event rates of any grade.

Study details: This was a multicenter retrospective study that included 202 adult patients with uHCC and CP-A (76%) or CP-B (24%) cirrhosis who received AtezoBev as the first-line systemic treatment.

Disclosures: The study was funded by the National Institute of Health Research Imperial Biomedical Research Centre, among others. Some authors declared serving as consultants or advisors for or receiving advisory board honoraria, lecture/speaker fees, research grants, or travel/accommodation expenses from various sources.

Source: D'Alessio A et al. Preliminary evidence of safety and tolerability of atezolizumab plus bevacizumab in patients with hepatocellular carcinoma and Child-Pugh A and B cirrhosis: A real-world study. Hepatology. 2022 (Mar 21). Doi: 10.1002/hep.32468

Key clinical point: Atezolizumab plus bevacizumab (AtezoBev) is an effective therapeutic option for unresectable hepatocellular carcinoma (uHCC) in routine clinical practice and is safe even in patients with Child-Pugh (CP)-B grade liver function.

Major finding: After a 9-month median follow-up, median overall survival was 14.9 months (95% CI 13.6-16.3 months) and median progression-free survival was 6.8 months (95% CI 5.2-8.5 months). Tolerability was similar across CP classes, with comparable bevacizumab-related (CP-A, 48%; CP-B, 46%) and atezolizumab-related (CP-A, 53%; CP-B, 40%) adverse event rates of any grade.

Study details: This was a multicenter retrospective study that included 202 adult patients with uHCC and CP-A (76%) or CP-B (24%) cirrhosis who received AtezoBev as the first-line systemic treatment.

Disclosures: The study was funded by the National Institute of Health Research Imperial Biomedical Research Centre, among others. Some authors declared serving as consultants or advisors for or receiving advisory board honoraria, lecture/speaker fees, research grants, or travel/accommodation expenses from various sources.

Source: D'Alessio A et al. Preliminary evidence of safety and tolerability of atezolizumab plus bevacizumab in patients with hepatocellular carcinoma and Child-Pugh A and B cirrhosis: A real-world study. Hepatology. 2022 (Mar 21). Doi: 10.1002/hep.32468

Key clinical point: Postoperative adjuvant stereotactic body radiotherapy (SBRT) on suboptimal resection margin safely and effectively improves disease-free survival (DFS) and prevents local recurrence in microvascular invasion (MVI)-positive hepatocellular carcinoma (HCC).

Major finding: SBRT vs. surgery alone led to significantly higher 1-year (92.1% vs. 76.3%) and 5-year (56.1% vs. 26.3%) DFS rates (P = .005) and similar local recurrence (P = .236) rates. No grade ≥3 adverse events were noted.

Study details: This randomized controlled trial included 76 adult patients with MVI-positive HCC who underwent marginal resection and were randomly assigned to receive postoperative adjuvant SBRT or surgery alone.

Disclosures: The study was funded by the Clinical Science and Technology Innovation Project of Shenkang Hospital Development Center, Shanghai Jiading District Fund, and Shanghai Municipal Health Commission Program, China. No conflicts of interest were reported.

Source: Shi C et al. Adjuvant stereotactic body radiotherapy after marginal resection for hepatocellular carcinoma with microvascular invasion: A randomised controlled trial. Eur J Cancer. 2022;166:176-184 (Mar 16). Doi: 10.1016/j.ejca.2022.02.012

Key clinical point: Postoperative adjuvant stereotactic body radiotherapy (SBRT) on suboptimal resection margin safely and effectively improves disease-free survival (DFS) and prevents local recurrence in microvascular invasion (MVI)-positive hepatocellular carcinoma (HCC).

Major finding: SBRT vs. surgery alone led to significantly higher 1-year (92.1% vs. 76.3%) and 5-year (56.1% vs. 26.3%) DFS rates (P = .005) and similar local recurrence (P = .236) rates. No grade ≥3 adverse events were noted.

Study details: This randomized controlled trial included 76 adult patients with MVI-positive HCC who underwent marginal resection and were randomly assigned to receive postoperative adjuvant SBRT or surgery alone.

Disclosures: The study was funded by the Clinical Science and Technology Innovation Project of Shenkang Hospital Development Center, Shanghai Jiading District Fund, and Shanghai Municipal Health Commission Program, China. No conflicts of interest were reported.

Source: Shi C et al. Adjuvant stereotactic body radiotherapy after marginal resection for hepatocellular carcinoma with microvascular invasion: A randomised controlled trial. Eur J Cancer. 2022;166:176-184 (Mar 16). Doi: 10.1016/j.ejca.2022.02.012

Key clinical point: Postoperative adjuvant stereotactic body radiotherapy (SBRT) on suboptimal resection margin safely and effectively improves disease-free survival (DFS) and prevents local recurrence in microvascular invasion (MVI)-positive hepatocellular carcinoma (HCC).

Major finding: SBRT vs. surgery alone led to significantly higher 1-year (92.1% vs. 76.3%) and 5-year (56.1% vs. 26.3%) DFS rates (P = .005) and similar local recurrence (P = .236) rates. No grade ≥3 adverse events were noted.

Study details: This randomized controlled trial included 76 adult patients with MVI-positive HCC who underwent marginal resection and were randomly assigned to receive postoperative adjuvant SBRT or surgery alone.

Disclosures: The study was funded by the Clinical Science and Technology Innovation Project of Shenkang Hospital Development Center, Shanghai Jiading District Fund, and Shanghai Municipal Health Commission Program, China. No conflicts of interest were reported.

Source: Shi C et al. Adjuvant stereotactic body radiotherapy after marginal resection for hepatocellular carcinoma with microvascular invasion: A randomised controlled trial. Eur J Cancer. 2022;166:176-184 (Mar 16). Doi: 10.1016/j.ejca.2022.02.012

Key clinical point: Compared with other liver disease etiologies, nonalcoholic fatty liver disease (NAFLD) was associated with lower hepatocellular carcinoma (HCC) surveillance receipt and early-stage detection, thus calling for interventions for increased surveillance implementation and improved prognosis of patients with NAFLD-related HCC.

Major finding: NAFLD vs. hepatitis C virus etiology was associated with a lower likelihood of consistent or inconsistent HCC surveillance receipt (adjusted odds ratio [aOR] 0.37; 95% CI 0.32-0.44) and detection of early-stage HCC (aOR 0.49; 95% CI 0.40-0.60) and worse overall survival (adjusted hazard ratio 1.20; 95% CI 1.09-1.32).

Study details: This was a population-based cohort study of US Medicare beneficiaries including 5098 patients aged ≥68 years with HCC, which was attributable to NAFLD in most patients (35.6%).

Disclosures: The study was funded by the American College of Gastroenterology, US Department of Defense, and US National Institute of Health. Some authors reported being consultants, advisory board members, or shareholders of and receiving research grants from various organizations.

Source: Karim MA et al. Clinical characteristics and outcomes of nonalcoholic fatty liver disease–associated hepatocellular carcinoma in the United States. Clin Gastroenterol Hepatol. 2022 (Mar 17). Doi: 10.1016/j.cgh.2022.03.010

Key clinical point: Compared with other liver disease etiologies, nonalcoholic fatty liver disease (NAFLD) was associated with lower hepatocellular carcinoma (HCC) surveillance receipt and early-stage detection, thus calling for interventions for increased surveillance implementation and improved prognosis of patients with NAFLD-related HCC.

Major finding: NAFLD vs. hepatitis C virus etiology was associated with a lower likelihood of consistent or inconsistent HCC surveillance receipt (adjusted odds ratio [aOR] 0.37; 95% CI 0.32-0.44) and detection of early-stage HCC (aOR 0.49; 95% CI 0.40-0.60) and worse overall survival (adjusted hazard ratio 1.20; 95% CI 1.09-1.32).

Study details: This was a population-based cohort study of US Medicare beneficiaries including 5098 patients aged ≥68 years with HCC, which was attributable to NAFLD in most patients (35.6%).

Disclosures: The study was funded by the American College of Gastroenterology, US Department of Defense, and US National Institute of Health. Some authors reported being consultants, advisory board members, or shareholders of and receiving research grants from various organizations.

Source: Karim MA et al. Clinical characteristics and outcomes of nonalcoholic fatty liver disease–associated hepatocellular carcinoma in the United States. Clin Gastroenterol Hepatol. 2022 (Mar 17). Doi: 10.1016/j.cgh.2022.03.010

Key clinical point: Compared with other liver disease etiologies, nonalcoholic fatty liver disease (NAFLD) was associated with lower hepatocellular carcinoma (HCC) surveillance receipt and early-stage detection, thus calling for interventions for increased surveillance implementation and improved prognosis of patients with NAFLD-related HCC.

Major finding: NAFLD vs. hepatitis C virus etiology was associated with a lower likelihood of consistent or inconsistent HCC surveillance receipt (adjusted odds ratio [aOR] 0.37; 95% CI 0.32-0.44) and detection of early-stage HCC (aOR 0.49; 95% CI 0.40-0.60) and worse overall survival (adjusted hazard ratio 1.20; 95% CI 1.09-1.32).

Study details: This was a population-based cohort study of US Medicare beneficiaries including 5098 patients aged ≥68 years with HCC, which was attributable to NAFLD in most patients (35.6%).

Disclosures: The study was funded by the American College of Gastroenterology, US Department of Defense, and US National Institute of Health. Some authors reported being consultants, advisory board members, or shareholders of and receiving research grants from various organizations.

Source: Karim MA et al. Clinical characteristics and outcomes of nonalcoholic fatty liver disease–associated hepatocellular carcinoma in the United States. Clin Gastroenterol Hepatol. 2022 (Mar 17). Doi: 10.1016/j.cgh.2022.03.010

Key clinical point: In hepatitis B e-antigen (HBeAg)-positive, non-cirrhotic, adult patients with chronic hepatitis B (CHB) and baseline hepatitis B virus (HBV) DNA levels of ≥5.00 log₁₀ IU/mL, pretreatment baseline serum HBV DNA levels were inversely associated with the on-treatment risk for hepatocellular carcinoma (HCC).

Major finding: Relative to that at HBV DNA levels of ≥8.00 log₁₀ IU/mL, HCC risk increased incrementally with a decrease in baseline HBV DNA levels, with the adjusted hazard ratios for 7.00-7.99, 6.00-6.99, and 5.00-5.99 log₁₀ IU/mL of HBV DNA being 2.48 (P = .03), 3.69 (P = .002), and 6.10 (P < .001), respectively.

Study details: The findings are from a multicenter cohort study involving 2073 HBeAg-positive, non-cirrhotic, treatment-naive, adult patients with CHB who had baseline HBV DNA levels of ≥5.00 log₁₀ IU/mL and had initiated treatment with entecavir or tenofovir disoproxil fumarate.

Disclosures: The study was sponsored by the Ministry of Health & Welfare, Republic of Korea. Y-S Lim declared being an advisory board member of and receiving research funds from Gilead Sciences.

Source: Choi W-M et al. Increasing on-treatment hepatocellular carcinoma risk with decreasing baseline viral load in HBeAg-positive chronic hepatitis B. J Clin Invest. 2022 (Mar 31). Doi: 10.1172/JCI154833

Key clinical point: In hepatitis B e-antigen (HBeAg)-positive, non-cirrhotic, adult patients with chronic hepatitis B (CHB) and baseline hepatitis B virus (HBV) DNA levels of ≥5.00 log₁₀ IU/mL, pretreatment baseline serum HBV DNA levels were inversely associated with the on-treatment risk for hepatocellular carcinoma (HCC).

Major finding: Relative to that at HBV DNA levels of ≥8.00 log₁₀ IU/mL, HCC risk increased incrementally with a decrease in baseline HBV DNA levels, with the adjusted hazard ratios for 7.00-7.99, 6.00-6.99, and 5.00-5.99 log₁₀ IU/mL of HBV DNA being 2.48 (P = .03), 3.69 (P = .002), and 6.10 (P < .001), respectively.

Study details: The findings are from a multicenter cohort study involving 2073 HBeAg-positive, non-cirrhotic, treatment-naive, adult patients with CHB who had baseline HBV DNA levels of ≥5.00 log₁₀ IU/mL and had initiated treatment with entecavir or tenofovir disoproxil fumarate.

Disclosures: The study was sponsored by the Ministry of Health & Welfare, Republic of Korea. Y-S Lim declared being an advisory board member of and receiving research funds from Gilead Sciences.

Source: Choi W-M et al. Increasing on-treatment hepatocellular carcinoma risk with decreasing baseline viral load in HBeAg-positive chronic hepatitis B. J Clin Invest. 2022 (Mar 31). Doi: 10.1172/JCI154833

Key clinical point: In hepatitis B e-antigen (HBeAg)-positive, non-cirrhotic, adult patients with chronic hepatitis B (CHB) and baseline hepatitis B virus (HBV) DNA levels of ≥5.00 log₁₀ IU/mL, pretreatment baseline serum HBV DNA levels were inversely associated with the on-treatment risk for hepatocellular carcinoma (HCC).

Major finding: Relative to that at HBV DNA levels of ≥8.00 log₁₀ IU/mL, HCC risk increased incrementally with a decrease in baseline HBV DNA levels, with the adjusted hazard ratios for 7.00-7.99, 6.00-6.99, and 5.00-5.99 log₁₀ IU/mL of HBV DNA being 2.48 (P = .03), 3.69 (P = .002), and 6.10 (P < .001), respectively.

Study details: The findings are from a multicenter cohort study involving 2073 HBeAg-positive, non-cirrhotic, treatment-naive, adult patients with CHB who had baseline HBV DNA levels of ≥5.00 log₁₀ IU/mL and had initiated treatment with entecavir or tenofovir disoproxil fumarate.

Disclosures: The study was sponsored by the Ministry of Health & Welfare, Republic of Korea. Y-S Lim declared being an advisory board member of and receiving research funds from Gilead Sciences.

Source: Choi W-M et al. Increasing on-treatment hepatocellular carcinoma risk with decreasing baseline viral load in HBeAg-positive chronic hepatitis B. J Clin Invest. 2022 (Mar 31). Doi: 10.1172/JCI154833

Key clinical point: Long-term aspirin use may reduce the risk for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection.

Major finding: After adjusting for confounding factors, aspirin use was associated with a decreased likelihood of HCC in the entire population (adjusted hazard ratio [aHR] 0.84; P = .002) and in the matched cohort (aHR 0.87; P = .01).

Study details: The data come from a cohort study including 161,673 patients aged ≥40 years with chronic HBV infection and no history of HCC, of which 9837 patients were aspirin users (for ≥3 years). A 1:4 propensity score matching yielded 9837 matched pairs of users and nonusers.

Disclosures: The study was sponsored by the Korea Health Industry Development Institute through “Social and Environmental Risk Research” funded by the Ministry of Health & Welfare. The authors declared no conflicts of interest.

Source: Yun B et al. Clinical indication of aspirin associated with reduced risk of liver cancer in chronic hepatitis B: A nationwide cohort study. Am J Gastroenterol. 2022 (Mar 14). Doi: 10.14309/ajg.0000000000001725

Key clinical point: Long-term aspirin use may reduce the risk for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection.

Major finding: After adjusting for confounding factors, aspirin use was associated with a decreased likelihood of HCC in the entire population (adjusted hazard ratio [aHR] 0.84; P = .002) and in the matched cohort (aHR 0.87; P = .01).

Study details: The data come from a cohort study including 161,673 patients aged ≥40 years with chronic HBV infection and no history of HCC, of which 9837 patients were aspirin users (for ≥3 years). A 1:4 propensity score matching yielded 9837 matched pairs of users and nonusers.

Disclosures: The study was sponsored by the Korea Health Industry Development Institute through “Social and Environmental Risk Research” funded by the Ministry of Health & Welfare. The authors declared no conflicts of interest.

Source: Yun B et al. Clinical indication of aspirin associated with reduced risk of liver cancer in chronic hepatitis B: A nationwide cohort study. Am J Gastroenterol. 2022 (Mar 14). Doi: 10.14309/ajg.0000000000001725

Key clinical point: Long-term aspirin use may reduce the risk for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection.

Major finding: After adjusting for confounding factors, aspirin use was associated with a decreased likelihood of HCC in the entire population (adjusted hazard ratio [aHR] 0.84; P = .002) and in the matched cohort (aHR 0.87; P = .01).

Study details: The data come from a cohort study including 161,673 patients aged ≥40 years with chronic HBV infection and no history of HCC, of which 9837 patients were aspirin users (for ≥3 years). A 1:4 propensity score matching yielded 9837 matched pairs of users and nonusers.

Disclosures: The study was sponsored by the Korea Health Industry Development Institute through “Social and Environmental Risk Research” funded by the Ministry of Health & Welfare. The authors declared no conflicts of interest.

Source: Yun B et al. Clinical indication of aspirin associated with reduced risk of liver cancer in chronic hepatitis B: A nationwide cohort study. Am J Gastroenterol. 2022 (Mar 14). Doi: 10.14309/ajg.0000000000001725

Yao and colleagues confirmed that there are well-known risk factors for recurrence of HCC after surgical resection. They retrospectively analyzed 1424 patients who underwent resection with curative intent for Barcelona Clinical Liver Cancer (BCLC) stage 0/A HCC in several centers in China. Of those patients, 679 (47.7%) developed recurrence at a median follow-up of 54.8 months, including 408 (60.1%) with an early recurrence (≤ 2 years after surgery) and 271 (39.9%) with a late recurrence (> 2 years). Cirrhosis (adjusted hazard ratio [aHR] 1.49; P < .001), preoperative alpha-fetoprotein (AFP) level > 400 µg/L (aHR 1.28; P = .004), tumor size > 5 cm (aHR 1.74; P < .001), the presence of satellite nodules (aHR 1.35; P = .040), multiple tumors (aHR 1.63; P = .015), microvascular invasion (aHR 1.51; P < .001), and intraoperative blood transfusion (aHR 1.50; P = .013) were identified as independent risk factors associated with postoperative HCC recurrence. The authors concluded that those patients with risk factors for recurrence would benefit from more intensive surveillance and potentially additional liver-directed therapy with curative intent.

Not all patients with hepatitis C virus (HCV) infection and HCC are offered antiviral therapy. Takaura and colleagues confirmed that active HCV infection worsens the prognosis of patients with very early-stage HCC who undergo treatment with radiofrequency ablation (RFA). In this single-center retrospective study, 302 patients with BCLC stage 0 HCC who underwent RFA were analyzed. Of those patients, 195 had evidence of HCV, and 132 had an active infection. The authors concluded that active HCV infection was a significant risk factor for shorter overall survival (aHR 2.17; P = .003) and early recurrence of HCC (aHR 1.47; P = .022). Patients with active HCV infection had a shorter median overall survival (66 months vs 145 months) and recurrence-free survival (20 months vs 31 months) (both P < .001). Therefore, treatment of active HCV should be offered to patients even after the development of HCC.

Kuroda and colleagues retrospectively analyzed a multicenter cohort of 247 patients with unresectable HCC treated with lenvatinib between 2018 and 2020. Out of those, 63 patients who received lenvatinib and transarterial chemoembolization (TACE) sequential therapy were propensity-score matched to those receiving lenvatinib monotherapy. The overall survival and progression-free survival in the sequential group were significantly higher than those in the lenvatinib monotherapy group, 31.2 (26.4-34.3) vs 15.7 (13.1-19.4) months and 12.2 (8.5-17.3) vs 6.7 (5.3-10.2) months (P = .002 and P = .037), respectively. Multivariate analysis showed that the deep response was independently associated with the initial response to levatinib; the partial response showed an odds ratio of 13.75 (95% CI 0.41-1.32; P < .001). The authors concluded that sequential therapy might provide more clinical benefits than lenvatinib monotherapy in patients who responded to initial lenvatinib treatment, with objective response to initial lenvatinib being an independent factor predicting sequential therapy deep response.

Yao and colleagues confirmed that there are well-known risk factors for recurrence of HCC after surgical resection. They retrospectively analyzed 1424 patients who underwent resection with curative intent for Barcelona Clinical Liver Cancer (BCLC) stage 0/A HCC in several centers in China. Of those patients, 679 (47.7%) developed recurrence at a median follow-up of 54.8 months, including 408 (60.1%) with an early recurrence (≤ 2 years after surgery) and 271 (39.9%) with a late recurrence (> 2 years). Cirrhosis (adjusted hazard ratio [aHR] 1.49; P < .001), preoperative alpha-fetoprotein (AFP) level > 400 µg/L (aHR 1.28; P = .004), tumor size > 5 cm (aHR 1.74; P < .001), the presence of satellite nodules (aHR 1.35; P = .040), multiple tumors (aHR 1.63; P = .015), microvascular invasion (aHR 1.51; P < .001), and intraoperative blood transfusion (aHR 1.50; P = .013) were identified as independent risk factors associated with postoperative HCC recurrence. The authors concluded that those patients with risk factors for recurrence would benefit from more intensive surveillance and potentially additional liver-directed therapy with curative intent.

Not all patients with hepatitis C virus (HCV) infection and HCC are offered antiviral therapy. Takaura and colleagues confirmed that active HCV infection worsens the prognosis of patients with very early-stage HCC who undergo treatment with radiofrequency ablation (RFA). In this single-center retrospective study, 302 patients with BCLC stage 0 HCC who underwent RFA were analyzed. Of those patients, 195 had evidence of HCV, and 132 had an active infection. The authors concluded that active HCV infection was a significant risk factor for shorter overall survival (aHR 2.17; P = .003) and early recurrence of HCC (aHR 1.47; P = .022). Patients with active HCV infection had a shorter median overall survival (66 months vs 145 months) and recurrence-free survival (20 months vs 31 months) (both P < .001). Therefore, treatment of active HCV should be offered to patients even after the development of HCC.

Kuroda and colleagues retrospectively analyzed a multicenter cohort of 247 patients with unresectable HCC treated with lenvatinib between 2018 and 2020. Out of those, 63 patients who received lenvatinib and transarterial chemoembolization (TACE) sequential therapy were propensity-score matched to those receiving lenvatinib monotherapy. The overall survival and progression-free survival in the sequential group were significantly higher than those in the lenvatinib monotherapy group, 31.2 (26.4-34.3) vs 15.7 (13.1-19.4) months and 12.2 (8.5-17.3) vs 6.7 (5.3-10.2) months (P = .002 and P = .037), respectively. Multivariate analysis showed that the deep response was independently associated with the initial response to levatinib; the partial response showed an odds ratio of 13.75 (95% CI 0.41-1.32; P < .001). The authors concluded that sequential therapy might provide more clinical benefits than lenvatinib monotherapy in patients who responded to initial lenvatinib treatment, with objective response to initial lenvatinib being an independent factor predicting sequential therapy deep response.

Yao and colleagues confirmed that there are well-known risk factors for recurrence of HCC after surgical resection. They retrospectively analyzed 1424 patients who underwent resection with curative intent for Barcelona Clinical Liver Cancer (BCLC) stage 0/A HCC in several centers in China. Of those patients, 679 (47.7%) developed recurrence at a median follow-up of 54.8 months, including 408 (60.1%) with an early recurrence (≤ 2 years after surgery) and 271 (39.9%) with a late recurrence (> 2 years). Cirrhosis (adjusted hazard ratio [aHR] 1.49; P < .001), preoperative alpha-fetoprotein (AFP) level > 400 µg/L (aHR 1.28; P = .004), tumor size > 5 cm (aHR 1.74; P < .001), the presence of satellite nodules (aHR 1.35; P = .040), multiple tumors (aHR 1.63; P = .015), microvascular invasion (aHR 1.51; P < .001), and intraoperative blood transfusion (aHR 1.50; P = .013) were identified as independent risk factors associated with postoperative HCC recurrence. The authors concluded that those patients with risk factors for recurrence would benefit from more intensive surveillance and potentially additional liver-directed therapy with curative intent.

Not all patients with hepatitis C virus (HCV) infection and HCC are offered antiviral therapy. Takaura and colleagues confirmed that active HCV infection worsens the prognosis of patients with very early-stage HCC who undergo treatment with radiofrequency ablation (RFA). In this single-center retrospective study, 302 patients with BCLC stage 0 HCC who underwent RFA were analyzed. Of those patients, 195 had evidence of HCV, and 132 had an active infection. The authors concluded that active HCV infection was a significant risk factor for shorter overall survival (aHR 2.17; P = .003) and early recurrence of HCC (aHR 1.47; P = .022). Patients with active HCV infection had a shorter median overall survival (66 months vs 145 months) and recurrence-free survival (20 months vs 31 months) (both P < .001). Therefore, treatment of active HCV should be offered to patients even after the development of HCC.

Kuroda and colleagues retrospectively analyzed a multicenter cohort of 247 patients with unresectable HCC treated with lenvatinib between 2018 and 2020. Out of those, 63 patients who received lenvatinib and transarterial chemoembolization (TACE) sequential therapy were propensity-score matched to those receiving lenvatinib monotherapy. The overall survival and progression-free survival in the sequential group were significantly higher than those in the lenvatinib monotherapy group, 31.2 (26.4-34.3) vs 15.7 (13.1-19.4) months and 12.2 (8.5-17.3) vs 6.7 (5.3-10.2) months (P = .002 and P = .037), respectively. Multivariate analysis showed that the deep response was independently associated with the initial response to levatinib; the partial response showed an odds ratio of 13.75 (95% CI 0.41-1.32; P < .001). The authors concluded that sequential therapy might provide more clinical benefits than lenvatinib monotherapy in patients who responded to initial lenvatinib treatment, with objective response to initial lenvatinib being an independent factor predicting sequential therapy deep response.

Yao and colleagues confirmed that there are well-known risk factors for recurrence of HCC after surgical resection. They retrospectively analyzed 1424 patients who underwent resection with curative intent for Barcelona Clinical Liver Cancer (BCLC) stage 0/A HCC in several centers in China. Of those patients, 679 (47.7%) developed recurrence at a median follow-up of 54.8 months, including 408 (60.1%) with an early recurrence (≤ 2 years after surgery) and 271 (39.9%) with a late recurrence (> 2 years). Cirrhosis (adjusted hazard ratio [aHR] 1.49; P < .001), preoperative alpha-fetoprotein (AFP) level > 400 µg/L (aHR 1.28; P = .004), tumor size > 5 cm (aHR 1.74; P < .001), the presence of satellite nodules (aHR 1.35; P = .040), multiple tumors (aHR 1.63; P = .015), microvascular invasion (aHR 1.51; P < .001), and intraoperative blood transfusion (aHR 1.50; P = .013) were identified as independent risk factors associated with postoperative HCC recurrence. The authors concluded that those patients with risk factors for recurrence would benefit from more intensive surveillance and potentially additional liver-directed therapy with curative intent.

Not all patients with hepatitis C virus (HCV) infection and HCC are offered antiviral therapy. Takaura and colleagues confirmed that active HCV infection worsens the prognosis of patients with very early-stage HCC who undergo treatment with radiofrequency ablation (RFA). In this single-center retrospective study, 302 patients with BCLC stage 0 HCC who underwent RFA were analyzed. Of those patients, 195 had evidence of HCV, and 132 had an active infection. The authors concluded that active HCV infection was a significant risk factor for shorter overall survival (aHR 2.17; P = .003) and early recurrence of HCC (aHR 1.47; P = .022). Patients with active HCV infection had a shorter median overall survival (66 months vs 145 months) and recurrence-free survival (20 months vs 31 months) (both P < .001). Therefore, treatment of active HCV should be offered to patients even after the development of HCC.

Kuroda and colleagues retrospectively analyzed a multicenter cohort of 247 patients with unresectable HCC treated with lenvatinib between 2018 and 2020. Out of those, 63 patients who received lenvatinib and transarterial chemoembolization (TACE) sequential therapy were propensity-score matched to those receiving lenvatinib monotherapy. The overall survival and progression-free survival in the sequential group were significantly higher than those in the lenvatinib monotherapy group, 31.2 (26.4-34.3) vs 15.7 (13.1-19.4) months and 12.2 (8.5-17.3) vs 6.7 (5.3-10.2) months (P = .002 and P = .037), respectively. Multivariate analysis showed that the deep response was independently associated with the initial response to levatinib; the partial response showed an odds ratio of 13.75 (95% CI 0.41-1.32; P < .001). The authors concluded that sequential therapy might provide more clinical benefits than lenvatinib monotherapy in patients who responded to initial lenvatinib treatment, with objective response to initial lenvatinib being an independent factor predicting sequential therapy deep response.

Yao and colleagues confirmed that there are well-known risk factors for recurrence of HCC after surgical resection. They retrospectively analyzed 1424 patients who underwent resection with curative intent for Barcelona Clinical Liver Cancer (BCLC) stage 0/A HCC in several centers in China. Of those patients, 679 (47.7%) developed recurrence at a median follow-up of 54.8 months, including 408 (60.1%) with an early recurrence (≤ 2 years after surgery) and 271 (39.9%) with a late recurrence (> 2 years). Cirrhosis (adjusted hazard ratio [aHR] 1.49; P < .001), preoperative alpha-fetoprotein (AFP) level > 400 µg/L (aHR 1.28; P = .004), tumor size > 5 cm (aHR 1.74; P < .001), the presence of satellite nodules (aHR 1.35; P = .040), multiple tumors (aHR 1.63; P = .015), microvascular invasion (aHR 1.51; P < .001), and intraoperative blood transfusion (aHR 1.50; P = .013) were identified as independent risk factors associated with postoperative HCC recurrence. The authors concluded that those patients with risk factors for recurrence would benefit from more intensive surveillance and potentially additional liver-directed therapy with curative intent.

Not all patients with hepatitis C virus (HCV) infection and HCC are offered antiviral therapy. Takaura and colleagues confirmed that active HCV infection worsens the prognosis of patients with very early-stage HCC who undergo treatment with radiofrequency ablation (RFA). In this single-center retrospective study, 302 patients with BCLC stage 0 HCC who underwent RFA were analyzed. Of those patients, 195 had evidence of HCV, and 132 had an active infection. The authors concluded that active HCV infection was a significant risk factor for shorter overall survival (aHR 2.17; P = .003) and early recurrence of HCC (aHR 1.47; P = .022). Patients with active HCV infection had a shorter median overall survival (66 months vs 145 months) and recurrence-free survival (20 months vs 31 months) (both P < .001). Therefore, treatment of active HCV should be offered to patients even after the development of HCC.

Kuroda and colleagues retrospectively analyzed a multicenter cohort of 247 patients with unresectable HCC treated with lenvatinib between 2018 and 2020. Out of those, 63 patients who received lenvatinib and transarterial chemoembolization (TACE) sequential therapy were propensity-score matched to those receiving lenvatinib monotherapy. The overall survival and progression-free survival in the sequential group were significantly higher than those in the lenvatinib monotherapy group, 31.2 (26.4-34.3) vs 15.7 (13.1-19.4) months and 12.2 (8.5-17.3) vs 6.7 (5.3-10.2) months (P = .002 and P = .037), respectively. Multivariate analysis showed that the deep response was independently associated with the initial response to levatinib; the partial response showed an odds ratio of 13.75 (95% CI 0.41-1.32; P < .001). The authors concluded that sequential therapy might provide more clinical benefits than lenvatinib monotherapy in patients who responded to initial lenvatinib treatment, with objective response to initial lenvatinib being an independent factor predicting sequential therapy deep response.

Yao and colleagues confirmed that there are well-known risk factors for recurrence of HCC after surgical resection. They retrospectively analyzed 1424 patients who underwent resection with curative intent for Barcelona Clinical Liver Cancer (BCLC) stage 0/A HCC in several centers in China. Of those patients, 679 (47.7%) developed recurrence at a median follow-up of 54.8 months, including 408 (60.1%) with an early recurrence (≤ 2 years after surgery) and 271 (39.9%) with a late recurrence (> 2 years). Cirrhosis (adjusted hazard ratio [aHR] 1.49; P < .001), preoperative alpha-fetoprotein (AFP) level > 400 µg/L (aHR 1.28; P = .004), tumor size > 5 cm (aHR 1.74; P < .001), the presence of satellite nodules (aHR 1.35; P = .040), multiple tumors (aHR 1.63; P = .015), microvascular invasion (aHR 1.51; P < .001), and intraoperative blood transfusion (aHR 1.50; P = .013) were identified as independent risk factors associated with postoperative HCC recurrence. The authors concluded that those patients with risk factors for recurrence would benefit from more intensive surveillance and potentially additional liver-directed therapy with curative intent.

Not all patients with hepatitis C virus (HCV) infection and HCC are offered antiviral therapy. Takaura and colleagues confirmed that active HCV infection worsens the prognosis of patients with very early-stage HCC who undergo treatment with radiofrequency ablation (RFA). In this single-center retrospective study, 302 patients with BCLC stage 0 HCC who underwent RFA were analyzed. Of those patients, 195 had evidence of HCV, and 132 had an active infection. The authors concluded that active HCV infection was a significant risk factor for shorter overall survival (aHR 2.17; P = .003) and early recurrence of HCC (aHR 1.47; P = .022). Patients with active HCV infection had a shorter median overall survival (66 months vs 145 months) and recurrence-free survival (20 months vs 31 months) (both P < .001). Therefore, treatment of active HCV should be offered to patients even after the development of HCC.

Kuroda and colleagues retrospectively analyzed a multicenter cohort of 247 patients with unresectable HCC treated with lenvatinib between 2018 and 2020. Out of those, 63 patients who received lenvatinib and transarterial chemoembolization (TACE) sequential therapy were propensity-score matched to those receiving lenvatinib monotherapy. The overall survival and progression-free survival in the sequential group were significantly higher than those in the lenvatinib monotherapy group, 31.2 (26.4-34.3) vs 15.7 (13.1-19.4) months and 12.2 (8.5-17.3) vs 6.7 (5.3-10.2) months (P = .002 and P = .037), respectively. Multivariate analysis showed that the deep response was independently associated with the initial response to levatinib; the partial response showed an odds ratio of 13.75 (95% CI 0.41-1.32; P < .001). The authors concluded that sequential therapy might provide more clinical benefits than lenvatinib monotherapy in patients who responded to initial lenvatinib treatment, with objective response to initial lenvatinib being an independent factor predicting sequential therapy deep response.

Key clinical point: The risk for hepatocellular carcinoma (HCC) varies with underlying etiologies, with active hepatitis C virus (HCV) cirrhosis posing the highest and alcoholic or nonalcoholic fatty liver disease (NAFLD) cirrhosis posing the lowest risk of developing HCC.

Major finding: Patients with active HCV (3.36%) showed the highest annual HCC incidence rate, followed by those with cured HCV (1.71%), alcoholic liver disease (1.32%), and NAFLD cirrhosis (1.24%). Patients with active HCV vs. NAFLD were at a 2.1-fold higher risk for HCC (adjusted hazard ratio 2.16; 95% CI, 1.16-4.04).

Study details: This multicenter, prospective cohort study analyzed data from two multiethnic cohorts enrolling a total of 2,733 patients with cirrhosis.

Disclosures: The study received financial support from the National Cancer Institute; Cancer Prevention & Research Institute of Texas grant; and Center for Gastrointestinal Development, Infection, and Injury. No conflicts of interest were reported.

Source: Kanwal F et al. Risk factors for hepatocellular cancer in contemporary cohorts of patients with cirrhosis. Hepatology. 2022 (Mar 1). Doi: 10.1002/hep.32434

Key clinical point: The risk for hepatocellular carcinoma (HCC) varies with underlying etiologies, with active hepatitis C virus (HCV) cirrhosis posing the highest and alcoholic or nonalcoholic fatty liver disease (NAFLD) cirrhosis posing the lowest risk of developing HCC.

Major finding: Patients with active HCV (3.36%) showed the highest annual HCC incidence rate, followed by those with cured HCV (1.71%), alcoholic liver disease (1.32%), and NAFLD cirrhosis (1.24%). Patients with active HCV vs. NAFLD were at a 2.1-fold higher risk for HCC (adjusted hazard ratio 2.16; 95% CI, 1.16-4.04).

Study details: This multicenter, prospective cohort study analyzed data from two multiethnic cohorts enrolling a total of 2,733 patients with cirrhosis.

Disclosures: The study received financial support from the National Cancer Institute; Cancer Prevention & Research Institute of Texas grant; and Center for Gastrointestinal Development, Infection, and Injury. No conflicts of interest were reported.

Source: Kanwal F et al. Risk factors for hepatocellular cancer in contemporary cohorts of patients with cirrhosis. Hepatology. 2022 (Mar 1). Doi: 10.1002/hep.32434

Key clinical point: The risk for hepatocellular carcinoma (HCC) varies with underlying etiologies, with active hepatitis C virus (HCV) cirrhosis posing the highest and alcoholic or nonalcoholic fatty liver disease (NAFLD) cirrhosis posing the lowest risk of developing HCC.

Major finding: Patients with active HCV (3.36%) showed the highest annual HCC incidence rate, followed by those with cured HCV (1.71%), alcoholic liver disease (1.32%), and NAFLD cirrhosis (1.24%). Patients with active HCV vs. NAFLD were at a 2.1-fold higher risk for HCC (adjusted hazard ratio 2.16; 95% CI, 1.16-4.04).

Study details: This multicenter, prospective cohort study analyzed data from two multiethnic cohorts enrolling a total of 2,733 patients with cirrhosis.

Disclosures: The study received financial support from the National Cancer Institute; Cancer Prevention & Research Institute of Texas grant; and Center for Gastrointestinal Development, Infection, and Injury. No conflicts of interest were reported.

Source: Kanwal F et al. Risk factors for hepatocellular cancer in contemporary cohorts of patients with cirrhosis. Hepatology. 2022 (Mar 1). Doi: 10.1002/hep.32434