Due to ageing of the global population, hepatocellular carcinoma (HCC) is increasingly common among elderly patients, but outcomes after curative hepatic resection are unclear. Using a metanalytic approach, we aimed to estimate overall survival (OS), recurrence free survival (RFS) and complication rates in elderly HCC patients undergoing resection.We searched PubMed, Embase, and Cochrane databases from inception to Nov 10, 2020 for studies reporting outcomes in elderly (age ≥ 65 years) patients with HCC undergoing curative surgical resection. Pooled estimates were generated using a random-effects model.We screened 8,598 articles and included 42 studies (7,778 elderly patients). The mean age was 74.45 years (95% CI 72.89-76.02), 75.54% were male (95% CI 72.53-78.32) and 66.73% had cirrhosis (95% CI 43.93-83.96). The mean tumor size was 5.50 cm (95% CI 4.71-6.29) and 16.01% had multiple tumors (95% CI 10.74-23.19). The 1-year (86.02% versus 86.66%, p=0.84) and 5-year OS (51.60% versus 53.78%) between non-elderly versus elderly patients were similar. Likewise, there were no differences in the 1-year (67.32% versus 73.26%, p=0.11) and 5-year RFS (31.57% versus 30.25%, p=0.67) in non-elderly versus elderly patients. There was a higher rate of minor complications (21.95% versus 13.71%, p=0.03) among elderly patients compared with non-elderly patients, but no difference in major complications (p=0.43) Conclusion: This data shows that overall survival, recurrence and major complications after liver resection for HCC are comparable between elderly and non-elderly patients, and may inform clinical management of HCC in this population.
Introduction: Chronic liver disease (CLD) is associated with increased morbidity and mortality. Understanding health disparities can inform appropriate interventions. We aimed to study mortality outcomes of those with CLD by the income level (income-to-poverty ratio <5 as lower income and ≥5 as higher income). Methods: In this retrospective cohort study, we analyzed data of adults from the National Health and Nutrition Examination Survey, 1999–2018. CLD included viral hepatitis, nonalcoholic fatty liver disease (NAFLD), and alcohol-associated liver disease (ALD). Results: We analyzed 59,204 adults: 47,224 without CLD and 11,980 with CLD. The CLD group was older, more likely male, racial/ethnic minority groups or foreign-born, and had lower educational and income levels (p < 0.001). Most (80.02%) CLD participants did not have college degrees and had lower income (79.18%). Among CLD participants, similar differences were observed between lower and higher income groups. Lower income participants with CLD had significantly higher 10-year cumulative mortality compared to higher income CLD participants (15.26 vs. 8.00%, p < 0.001), with consistent findings in viral hepatitis and NAFLD subgroups (p < 0.001) but not ALD (p = 0.71). Adjusting for age, sex, race, birthplace, lower income CLD participants were 2.01 (hazard ratio [HR]: 2.01; 95% CI: 1.79–2.26) times more likely to die overall and in viral hepatitis (HR: 2.05; 95% CI: 1.31–3.24) and NAFLD subgroups (HR: 2.32; 95% CI: 1.69–3.18) but not ALD (HR: 1.17; 95% CI: 0.55–2.51). Conclusion: Lower income, foreign-born, and racial/ethnic minority groups were disproportionately represented among those with CLD, with lower income and CLD individuals having double the mortality risk compared to their higher income counterparts. Interventions should be culturally appropriate and address socioeconomic barriers.
The relationship between the use of anti-hypertensive drugs and cancer risk remains controversial.The main objective of this study was to assess the effects of beta-blocker use on cancer risk. Methods:In a cohort of 839 patients with cardiovascular disease, followed up prospectively for a mean of 10years, we compared the risk of cancer in subjects who had and had not received beta-blockers. We estimated therelative risk of cancer associated with beta-blocker use with a Cox model adjusted for sex and age. The use ofbeta-blockers and the duration of exposure to the drug were analyzed as time-dependent variables. We alsocalculated standardized incidence ratios (SIR) from the corresponding age- and sex-adjusted cancer incidencesin the French general population. Results: A total of 326 beta-blocker users and 513 subjects on other treatments were included in the cohort.During the follow-up period, corresponding to 8,466 person-years, 15 incident cancer cases occurred in beta-blocker users and 59 occurred in patients who had never used beta-blockers. The Cox model estimated theoverall relative risk of cancer at 0.51 (95% confidence interval [CI]: 0.29-0.90) in the beta-blocker users,compared with those who had never used beta-blockers (p= 0.02), with a 6% decrease per year of use (95% CI:1%-12%p= 0.03). The corresponding SIR ratio between these two groups was 0.44 (CI: 0.24-0.76) Conclusion: In this cohort, beta-blocker treatments appeared to decrease the risk of cancer significantly.However, this result should be interpreted with caution, as biases inherent in this type of epidemiologicalstudy cannot be totally excluded. Keywords: Beta-blockers, Cancer, Cohort Study
Background: HBV immunization is the cornerstone of the global HBV elimination strategy. Using a systematic review and meta-analytic approach, this study determined the durability of HBV immunity and the prevalence of anamnestic response to a booster HBV vaccine dose in individuals previously vaccinated with a 3-dose HBV vaccine series as children or adolescents.Methods: Two researchers independently searched PubMed, Embase, and Cochrane from inception to 6/1/2023 and performed data extraction. Studies that included individuals with significant comorbidities or <5 years of follow-up were excluded.Findings: We initially identified 2,517 potential studies and analyzed 91 eligible studies [193,359 individuals from 208 cohorts (some studies provided data for more than one cohort)]. The median age at vaccination was 0 years (range: 0-20.00). After a median follow-up of 10.15 years (range: 5-35), 63.2% (95% CI: 59.3-67.0) retained HBV immunity, lower with increasing age at follow-up and in higher-quality studies. HBV immunity declined by 6.62% per follow-up year (Ptrend<0.0001). In meta-regression adjusting for vaccine type, follow-up time, and geographic location, age at vaccination was significantly associated with retaining HBV immunity [adjusted odds ratio (aOR) 1.12 per year, P<0.0001]. The anamnestic response rate (44 studies, 66 cohorts, 29,040 patients) was 90.34% (95% CI: 86.84-92.98), with highest rates in Europe and Asia, but only study setting (clinical versus community-based: aOR 2.21, P=0.034) was an independent factor.Interpretation: HBV immunity prevalence was about 60% after 10 years following childhood vaccination. Anamnestic response rate was about 90% and varied by study setting. Testing for immunity should be considered in individuals with high exposure risk and distant vaccination history with booster as needed.Funding: HR was supported by the Karen T. Romer Undergraduate Teaching and Research Award through Brown UniversityDeclaration of Interest: MHN: Research grants via institution: Pfizer, Enanta, Astra Zeneca, GSK, Delfi, Innogen, Exact Science, CurveBio, Gilead, Vir Biotech, Helio Health, National Cancer Institute, Glycotest. Consulting/Advisory board: Intercept, Exact Science, Gilead, GSK. All other authors have no competing interest to declare.
Global data on the treatment rate with direct-acting antivirals (DAAs) for chronic hepatitis C (CHC) are sparse. We aimed to evaluate the CHC treatment rate and barriers to treatment in the DAA era.We searched PubMed, EMBASE and Cochrane from inception to 5 August 2021, for relevant articles. Patients treated with DAAs without interferon (IFN) therapy were categorized as IFN-free DAAs. Patients receiving DAA with IFN or unclear IFN status were categorized as DAA/IFN.We identified and analysed data from 146 studies (1 760 352 CHC patients). DAA/IFN treatment rate was 16.0% (95% CI: 9.9-23.3, 49 studies, 886 535 patients). IFN-free DAA treatment rate was 52.3% (95% CI: 46.2-58.4, 123 studies, 1 276 754 patients): 45.4% in North America, 64.2% in South America (1 study), 90.4% in Africa (most data from Egypt), 54.4% in Europe, 60.7% in Australia and 60.5% in Asia, (p < .0001); 49% with hepatitis B co-infection and 32.3% with hepatocellular carcinoma (HCC). Treatment was not a priority in 22.8% of patients in Europe and 16.7% in Australia, compared to only 4.8% in North America and 2.1% in Asia (p < .0001). Poor adherence to clinical follow-up was the cause of no treatment in 74.7% of patients in Australia, 37.0% in North America, 7.9% in Europe and 14.3% in Asia (p < .0001).Though a marked improvement from IFN/DAA, the treatment rate with IFN-free DAA remains suboptimal (52.3% overall, 32.3% in HCC patients). Non-adherence to clinical follow-up and lack of disease awareness were treatment barriers.
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