10 reports from 2017 on liver cancer incidence rates, major risk factors

Liver cancer rates continue to increase, prompting researchers to focus on leading causes such as hepatitis C and identifying major risk factors. Recent studies have identified some of these factors to include age, comorbidities and ethnicity.

The following reports focus on the incidence of hepatocellular carcinoma among specific demographics and after HCV therapy with direct-acting antivirals, and the efforts made to improve treatment and aftercare.

Liver cancer incidence after HCV therapy linked to risk factors, not treatment

Direct-acting antiviral treatment for hepatitis C did not correlate with an increased risk for hepatocellular carcinoma in a large cohort study of both treated and untreated patients with or without cirrhosis. Those with incident HCC after DAA treatment had higher risk factors at baseline.

“There was no increased risk for HCC as a result of having received DAA therapy whatsoever,” Raymond T. Chung, MD, director of Hepatology and Liver Center at Massachusetts General Hospital, told Healio.com/Hepatology. “The risk was related to their preexisting likelihood of developing HCC. The fact that HCC developed post-DAA, we think, is more likely to be an accident of timing than the idea that it’s related to receipt of DAA — these persons were at risk for HCC whether they received DAAs or not.” Read more

Liver tumor program launched to ‘work in a fashion of teamwork’

The Perlmutter Cancer Center at NYU Langone Health launched a new liver tumor program, designed to provide multidisciplinary care for patients with primary and secondary liver and bile duct cancers, according to a press release.

“What we’ve seen in the past — because these are patients with tough problems and care depends on familiarity with these diseases — and what we don’t want to see is a patient bouncing around for 6 weeks, waiting on various studies and biopsies and things of that nature,” Theodore H. Welling, MD, from the director of the liver tumor program at Perlmutter Cancer Center, told Healio.com/Hepatology. “Our experts can get to a disease-management plan much more quickly and I think that saves a lot of angst for the patient.” Read more

Moderate coffee intake reduces risk for liver cancer, cirrhosis, fibrosis

In a roundtable format, experts gathered to discuss the latest research on coffee and liver disease, which indicate that drinking approximately three to five cups per day is associated with a reduced risk for hepatocellular carcinoma, cirrhosis and fibrosis.

“I’ve been in the field for 30-odd years and it’s not a topic that’s come up until very recently. I would imagine patients will always ask, ‘What can I do, to help myself?’ And the advice is always lose weight, don’t drink too much alcohol and don’t smoke at all — a lot of advice that is somewhat negative,” Graeme Alexander, MD, senior advisor to the British Liver Trust, told Healio.com/Hepatology. “But to be told something positive, rather than negative, is a good message. If people ask, ‘Should I drink coffee?’ the answer would be yes.” Read more

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Fewer HCC cases from HCV clearance improves quality of life, cost savings

Through treatment of hepatitis C genotype 1 with direct-acting antivirals, significant direct and indirect cost savings may arise due to fewer cases of hepatocellular carcinoma and decompensated cirrhosis, according to results of a simulated model presented at The Liver Meeting 2017.

“As you know, chronic hepatitis C is a systemic infection that’s associated with adverse clinical outcomes, both hepatic as well as extrahepatic,” Zobair M. Younossi, MD, MPH, chairman of the department of medicine at Inova Fairfax Hospital and vice president for research at Inova Health System in Falls Church, Virginia, said in his presentation. “There is a significant burden associated hepatic infection and there’s also a number of, as studies have shown, that hepatitis C impairs patient-reported outcome such as health-related quality of life.” Read more

Age, comorbidities greater impact on HCC rates than DAA therapy

Researchers found no evidence of increased rates of de novo or recurrent hepatocellular carcinoma following treatment with direct-acting antivirals compared with patients treated with interferon therapy, according to a presentation at the World Congress of Gastroenterology at ACG 2017.

Stephanie Rutledge, MBBCh, BAO, MRCPI, presented results of a systematic review and meta-analysis designed to compare rates of HCC after hepatitis C treatment. According to Rutledge and colleagues, recent studies have revealed unexpectedly high rates of HCC after DAA therapy. Read more

Liver cancer remains a leading cause of cancer-related mortality worldwide

Primary liver cancer incidence increased by 75% between 1990 and 2015, and the disease remains one of the leading causes of cancer death in the world, according to a report from the Global Burden of Diseases Study 2015. Further, hepatitis B virus was the leading cause of new cases of liver cancer in 2015, the research showed.

“The Global Burden of Disease study provides the most current overview of the burden and etiology of liver cancer and can guide investments in targeted liver cancer prevention efforts,” Christina Fitzmaurice, MD, MPH, assistant professor in the department of medicine of Institute for Health Metrics at University of Washington, and colleagues from the Global Burden of Disease Liver Cancer Collaboration wrote. Read more

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Disparity in ethnicity, sex persists among increasing liver cancer rates

Liver cancer mortality rates are expected to increase in the coming decades and disparities in occurrence by race, ethnicity, sex and state location in the U.S. continue to persist, according to a recently published study.

“Liver cancer death rates are increasing at a faster pace than any other cancer. A major factor contributing to this increase is the comparatively high prevalence of hepatitis C virus (HCV) infection among those born during 1945 through 1965, also called ‘baby boomers.’ The sustained rise in obesity and type 2 diabetes over the past several decades has also likely contributed to the increasing liver cancer trend,” Farhad Islami, MD, PhD, from the American Cancer Society, Georgia, and colleagues wrote. “The incidence of liver cancer varies by race/ethnicity and state, mainly because of differences in the prevalence of major risk factors and, to some degree, because of disparities in access to high-quality care.” Read more

Risk for HCC in chronic HBV higher in men, older women

Following HBsAg seroclearance, women aged older than 50 years and men with chronic hepatitis B had significant risk for developing hepatocellular carcinoma, whereas women aged 50 years or younger had no risk for HCC up to 5 years, according to results of a recently published study.

“The results of this study have laid down some guidance on HCC surveillance for [chronic HBV] patients [who] achieved HBsAg seroclearance,” the researchers wrote. “Risk of HCC may still persist in [chronic HBV] patients with HBsAg seroclearance. HCC surveillance may not be necessary for female patients with HBsAg seroclearance at 50 years or younger, but may still be cost-effective for other patients.” Read more

HCC rates vary by race in US, highest among Asian-Pacific Islanders

Among U.S. veterans with hepatitis B, researchers found that the risk for hepatocellular carcinoma was higher among Asian-Pacific Islanders than Caucasians and African-Americans, increased with the presence of cirrhosis, and significantly increased among those without cirrhosis after age 40 regardless of race.

“Our results have important implications for HCC surveillance in HBV in the U.S.,” Sahil Mittal, MD, MS, from Baylor College of Medicine, Houston, and colleagues wrote. “We found that the annual risk of HCC was high in all patients with cirrhosis, ranging from 0.94% in [African-Americans] to as high as 3.4% in [Asian-Pacific Islanders]. These data provide support to the guidelines recommending HCC surveillance in all HBV infected individuals with underlying cirrhosis.” Read more