Giovan Giuseppe Di Costanzo

Background and Aims: Patients with liver cirrhosis (LC) often have malnutrition (MN), which can be associated with decompensation, infection, and death. The aims were to determine: the prevalence of MN in patients with LC and ascites, its impact on mortality, and the relationship between MN and spontaneous bacterial peritonitis (SBP). Methods: Nutritional status (NS) was analysed in cirrhotic patients, experiencing their first episode of ascites, who were consecutively admitted at two clinical liver centres between November 2014 and October 2016. The participants underwent diagnostic paracentesis and were followed up to assess their outcomes. Results: 110 participants underwent NS assessment in addition to routine clinical procedures. The prevalence of MN was 30.9% according to corrected body mass index, 67.3% according to upper mid-arm muscle area (UMA) and 40% according to upper mid-arm fat area (UFA). The percentages of the participants remaining alive were 68.1% at 3 months, 59.3% at 6 months, 45.1% at 12 months and 24.2% at the end of the study. Univariate analysis showed that SBP, model for end-stage liver disease (MELD), UFA, UMA and age were significantly associated with mortality. Multivariate analysis showed that only SBP, MELD and UFA (hazard ratio 2.2) were independently associated with mortality. There was a correlation between adipopenia, but not sarcopenia, and SBP. Conclusions: Adipopenia, as assessed by UFA, was present in 40% of the cirrhotic patients, and it was independently associated with mortality.

Predictive scores for hepatocellular carcinoma: a race with no winners?

Background and aim: The present real‐life multicentre, prospective study aims to investigate the effects of direct‐acting antivirals (DAAs) in HCV patients with a previous successfully treated hepatocellular carcinoma (HCC), in terms of neoplastic recurrence and sustained virological response (SVR) rates.Methods: From March 2015 to March 2017, all consecutive HCV patients with a previous successfully treated HCC who underwent DAA therapy were enrolled. Neoplastic recurrence was used as the primary outcome, whereas the secondary outcomes were patient characteristics predicting HCC recurrence. Cumulative probabilities of recurrence were extracted from time‐to‐event curves based on the Kaplan‐Meier method. Hazard ratios with 95% confidence intervals were estimated using univariate and multivariate Cox regressions.Results: A total of 101 patients were enrolled: 83% of them were in Child‐Pugh class A, 88% had a history of HCC BCLC stage 0/A and 91.1% achieved SVR. The median time from the last successful HCC treatment to DAA start was 10.1 months [IQR: 5.6‐16.7]. Thirty‐one HCC recurrences were observed from DAA start (median follow‐up: 31.7 months). The incidence rate of recurrence was 20.5/100 person‐years. The 6‐, 12‐ and 24‐months HCC recurrence rates from the last HCC treatment were 1%, 8.9% and 25.6% respectively. DAA treatment failure, higher level of total bilirubin, higher BMI and higher level of AFP were significantly associated with higher risk of HCC recurrence in both univariate and Cox multivariate analysis.Conclusions: Our data suggest that the achievement of SVR and the absence of well‐known HCC risk factors reduce recurrence in patients who have taken DAAs.

Prostate cancer (PCa) is a disease affecting an increasing number of men worldwide. Several efforts have been made to identify imaging biomarkers to non-invasively detect and characterize PCa, with substantial improvements thanks to multiparametric Magnetic Resonance Imaging (mpMRI). In recent years, diffusion kurtosis imaging (DKI) was proposed to be directly related to tissue physiological and pathological characteristic, while the radiomic approach was proven to be a key method to study cancer imaging phenotypes. Our aim was to compare a standard radiomic model for PCa detection, built using T2-weighted (T2W) and Apparent Diffusion Coefficient (ADC), with an advanced one, including DKI and quantitative Dynamic Contrast Enhanced (DCE), while also evaluating differences in prediction performance when using 2D or 3D lesion segmentation. The obtained results in terms of diagnostic accuracy were high for all of the performed comparisons, reaching values up to 0.99 for the area under a receiver operating characteristic curve (AUC), and 0.98 for both sensitivity and specificity. In comparison, the radiomic model based on standard features led to prediction performances higher than those of the advanced model, while greater accuracy was achieved by the model extracted from 3D segmentation. These results provide new insights into active topics of discussion, such as choosing the most convenient acquisition protocol and the most appropriate postprocessing pipeline to accurately detect and characterize PCa.

Hepatoma Research is an open access journal and focuses on all topics related to hepatoma. The following articles are especially welcome: pathogenesis, clinical examination and early diagnosis of hepatoma, complications of hepatoma, and their preventions and treatments, etc.

Background and Aim: The Barcelona Clinic Liver Cancer (BCLC) algorithm is the standard system for clinical management of hepatocellular carcinoma (HCC). Data on adherence to this therapeutic paradigm are scarce. This field practice study aimed to provide a description of HCC cirrhotic patients in Southern Italy, to evaluate the adherence to BCLC guidelines and its impact on patients' survival.Methods: We analyzed the region‐wide Italian database of Progetto Epatocarcinoma Campania, which includes data of HCC cirrhotic patients, prospectively collected from January 2013 to December 2015 in 16 regional centers.Results: Overall, 1008 HCC patients were enrolled: 70.6% patients received therapies recommended by BCLC algorithm, while 29.4% underwent different treatments. Among patients who were treated in adherence to guidelines, a higher rate of diagnosis on surveillance programs, better liver function, lower rate of alpha‐fetoprotein > 200 ng/mL, more early‐stage and monofocal HCC, lower frequency of nodules > 5 cm, portal vein thrombosis and metastases were observed. The overall survival was evaluated according to HCC stage and no differences between groups and patients managed differently were found. The multivariate analysis showed that non‐adherence to treatment guidelines was independently associated to the BCLC stage B, Child–Pugh classes B and C, and the presence of neoplastic thrombosis and metastases.Conclusion: Adherence to BCLC algorithm in field practice was high in early and end‐stage HCC patients, but it was poor in intermediate and advanced patients.

Sorafenib is recommended for the treatment of advanced-stage hepatocellular carcinoma (HCC). Nonetheless, it is expensive, effective in few patients, and may cause significant adverse effects. Therefore, accurate selection of patients is needed. In a previous study, we constructed a simple scoring system to predict patients’ outcomes based on the occurrence of sorafenib adverse effects.

Hepatocellular carcinoma (HCC) develops in about 3-4% of cirrhotic patients every year. The squamous cell carcinoma antigen (SCCA) has been found elevated in liver cancer specimens by immunohistochemistry, and detected in complex with IgM (SCCA-IgM) in the serum of patients with HCC. The aim of this study was to evaluate the ability of serological SCCA-IgM levels to predict the efficacy of HCC therapy. From April 2012 to April 2014, 131 patients with a new diagnosis of HCC were enrolled. The HCC diagnosis was made according to the EASL guidelines. The patients were staged and treated according to the BCLC Staging System: BCLC stages A and B were treated with locoregional therapy, and BCLC stage C was treated with Sorafenib. Response to therapy was evaluated according to the mRECIST criteria. Serum SCCA-IgM levels were determined by a commercially available ELISA kit at basal time (T0) and after one month of treatment (T1). At baseline and one month into therapy, SCCA-IgM levels were significantly lower (p value <.05) in patients who responded to therapy compared to those who did not respond (median SCCA-IgM level [25th + 75th percentile] at T0:115.1 AU/mL [50.0 + 174.4] vs. 149.1 AU/mL [111.3 + 198.8]; median SCCA-IgM level [25th + 75th percentile] at T1: 113.4 AU/mL [50.0 + 194.2] vs. 170.6 AU/mL [111.7 + 344.2]). Our study suggests that the SCCA-IgM determination could be helpful in predicting the response to therapy in patients with HCC.

Patients with diabetes are at increased risk of developing hepatocellular carcinoma (HCC) and have a poorer prognosis as compared to non-diabetics when HCC occurs. Diabetics with non-HCC cancers are at higher risk of toxicity related to systemic therapy, but data on HCC are lacking.

The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastroenterological disorders seen most often in patients. Published with practicing clinicians in mind, the journal aims to be easily accessible, organizing its content by topic, both online and in print. www.amjgastro.com, *2007 Journal Citation Report (Thomson Reuters, 2008)