Hepatitis C Virus Prevalence and Genotyping among Hepatocellular Carcinoma Patients in Baghdad

Hepatocellular carcinoma (HCC) is the third most common cause for cancer death in the world, now beingespecially linked to chronic hepatitis C virus (HCV) infection. This case-control study consisting of 65 HCCpatients and 82 patients with other malignant tumours as controls was conducted to determine the associationof HCV markers with HCC. Serum of each participant was obtained for detection of HCV Ab and RNA byDNA enzyme immunoassay (DEIA). Twenty six per cent (26.0%) of HCC patients had positive anti-HCV whichwas significantly greater than the control group (p=0.001). HCC patients significantly have a risk of exposure toHCV infection almost 3 times than the control group (OR=2.87, 95% C.I=1.1-7). Anti-HCV seropositive rate wassignificantly (p=0.03) higher among old age HCC patients and increases with age. Males with HCC significantlyshowed to have more than 9 times risk of exposure to HCV infection (OR=9.375, 95 % CI=1.299-67.647) thanfemales. HCV-RNA seropositive rate was (70.8%) significantly higher among HCC patients compared to (22.2%)the control group (p=0.019). The most prevalent genotype (as a single or mixed pattern of infection) was HCV-1b. This study detected a significantly higher HCV seropositive rate of antibodies and RNA in HCC patients.     

Increased Prevalence of HTLV-I Infection in Patients with Hepatocellular Carcinoma Associated with Hepatitis C Virus

The progression from chronic hepatitis C virus (HCV) infection to hepatocellular carcinoma (HCC) has been reported. We evaluated whether co-infection with the human T-lymphotropic virus type I (HTLV-I) might be associated with this transition in a cross-sectional analysis of 127 patients with HCV-chronic hepatitis (mean age=51.7) and 43 patients with HCV-associated HCC (mean age=62.4); the seroprevalence of anti-HTLV-I was 9.5% and 30.2%, respectively. For subjects 50 years or older, the seroprevalence of anti-HTLV-I in HCC patients was 13/41 (31.7%) which was significantly higher than that in chronic hepatitis patients (6/82, 7.3%) ( P =0.001). The relative risk (RR) of association was 12.8 ( P =0.0004) among the males, however, no association was evident among the females, RR=1.3 ( P =0.80). The increased prevalence of HTLV-I positivity among the HCC cases could not be attributed to a higher rate of prior transfusion. These data suggest that co-infection with HTLV-I may contribute to the development of HCC among patients with HCV-induced chronic liver diseases in a highly HTLV-I-endemic area.     

Fatal Acute Hepatitis C Virus Infection in Patients with Hematological Malignancies

Abstract

Patients in hematology units are at risk of hepatitis C virus infection. In these patients acute infection is reportedly mild, presents only moderately increased ALT levels, is characterized by a significant delay in anti-HCV seroconversion and does not influence the course of the underlying disease. We describe two fatal cases of acute HCV infection occurring in patients with hematologic malignancies and we hypothesize that, in a subset of immunocompromised patients, acute HCV infection may play a still unrecognized but not marginal role in contributing to death. Prospective studies are needed to define the frequency of fatal acute HCV infection among hematologic patients undergoing chemotherapy.     

原发性肝癌患者血清丙型肝炎病毒抗体测定及其临床意义

作者应用抗丙型肝炎病毒(HCV)酶联免疫分析(EIA)试剂盒,对50例原发性肝细胞癌(HCC)患者作了抗HCV检测;同时以40例健康成年献血员作为对照组。血清抗HCV罹患率在对照组为5％(2/40),而在HCC组为10％(5/50)。两组之间无明显差异(P>0.05),但HCC组5例抗HCV阳性者均伴有HBV感染。因此建议今后在对健康献血员作肝功能及HBV系列测定的同时,应作抗HCV测定;对抗HCV阳性者,应进一步作HCV的PCR检测,并应极治疗。     

Predictors of Long-Term Response With Pazopanib in Patients With Advanced Renal-Cell Carcinoma

Background

Pazopanib is among the current standards of care for first-line treatment of patients with unresectable advanced renal-cell carcinoma (aRCC) or metastatic renal-cell carcinoma. This real-world study aimed to characterize those with long-term response to pazopanib in the treatment of aRCC in a community oncology setting, and to identify predictors of long-term response.

Transition of Antibody to Hepatitis C Virus from Chronic Hepatitis to Hepatocellular Carcinoma

Fifty-eight patients with chronic hepatitis C were followed for more than 7 years. Of them, 10 patients were found to develop hepatocellular carcinoma, 14 to develop liver cirrhosis, 30 to sustain chronic hepatitis, and 4 to show subsidence of hepatitis. Antibody to hepatitis C virus (anti-HCV) disappeared from the 4 patients whose hepatitis subsided, but it persisted in the remaining 54 patients. The mean titer of anti-HCV was almost the same at the stages of chronic hepatitis and of cancer in the 10 patients who developed hepatocellular carcinoma. These results indicate that chronic infection of hepatitis C virus may lead to hepatocellular carcinoma.     

肝细胞癌组织中乙型肝炎病毒和丙型肝炎病毒的检测

目的检测肝细胞癌（hepatocellular carcinoma，HCC）组织中乙型病毒性肝炎（virus hepatitis type B）表面抗原（HB—sAg）和丙型病毒性肝炎（virus hepatitis type C）核心抗原（HCVAg）的表达。方法应用免疫组织化学法检测78例HCC及癌旁肝组织HBsAg和HCVAg的表达。同时比较患者的HBsAg和HCVAg血清学检测结果。结果HCC及癌旁肝组织中HBsAg和HCVAg阳性及HBsAg和HCVAg双重阳性表达率分别为9.1％、6．4％、2．6％和80．8％、44．9％、29．5％。HCC与癌旁肝组织HBsAg和HCVAg阳性及HBsAg和HCVAg双阳性表达率相互比较有非常显著性差异（P〈0．01）。合并肝硬化组和无肝硬HCC组中HCC与癌旁肝组织HBsAg和HCVAg阳性、HBsAg及HCVAg双阳性表达率相互比较也有非常显著性差异（P〈0．01）。HCC的HBsAg和HCVAg血清学检测的结果与手术标本HBsAg和HCVAg免疫组织化学检测的结果相吻合。结论HCC的发生与HBV和HCV的感染密切相关。     

Association Between Pretreatment Neutrophil-to-Lymphocyte Ratio and Outcome of Patients With Metastatic Renal-Cell Carcinoma Treated With Nivolumab

Background

Biomarkers to guide treatment in metastatic renal-cell carcinoma (mRCC) are lacking. We aimed to investigate the association between pretreatment neutrophil-to-lymphocyte ratio (NLR) and outcome of patients with mRCC receiving nivolumab.

Drug Holiday in Metastatic Renal-Cell Carcinoma Patients Treated With Vascular Endothelial Growth Factor Receptor Inhibitors

Introduction

Tyrosine kinase inhibitor (TKI) therapy in metastatic renal-cell carcinoma (mRCC) is noncurative and may be associated with significant toxicities. Some patients may receive treatment breaks as a result of TKI-related adverse effects or planned drug holidays.

Interferon Alpha Monotherapy for Chronic Hepatitis C Viral Infection in Thalassemics and Hemodialysis Patients

Abstract

We assessed the effectiveness of interferon (IFN) monotherapy in thalassemic or hemodialysis patients with chronic hepatitis C viral (HCV) infection. Ten thalassemic and four hemodialysis patients were included in the study. Chronic HCV was confirmed with both serum HCV-RNA and liver histopathology. IFN alpha-2a was administered three times a week for 24-48 weeks, at a dose of 5 MU/m² (maximum 6 million units). Sustained response was defined as negative HCV-RNA at least 24 weeks after termination of the treatment. All patients completed the study. Eight of 10 thalassemic (80%) and one of four hemodialysis patients (25%) showed a sustained response. IFN monotherapy proved to be an effective treatment, especially in thalassemic patients with chronic HCV. IFN monotherapy seems reasonable for patients with thalassemia and chronic hepatitis C virus in whom ribavirin cannot be used.     

High Prevalence of Hepatocellular Carcinoma in Patients with Chronic Hepatitis B Infection in Thailand

Background: Chronic hepatitis B (CHB) infection is one of the important causes of hepatocellular carcinoma (HCC) in Thailand, involved in the pathogenesis and leading to a development of HCC with or without cirrhotic changes of the liver. This study was aimed to investigate the predictive factors for HCC among CHB patients in a tertiary care center in Thailand. Materials and Methods: We conducted a retrospective study of CHB patients with or without HCC during the period of January 2009 and December 2014 at Thammasat University Hospital, Pathumthani, Thailand. Data on clinical characteristics, biochemical tests and radiologic findings were collected from review of medical records. Results: A total of 266 patients were diagnosed with CHB in Thammasat university hospital during the study period. However, clinical information of only 164/266 CHB patients (98 males, 66 females with mean age of 49.4 years) could be completely retrieved in this study. The prevalence of HCC in CHB infection in this study was 38/164 (23.2%). CHB patients with HCC had a mean age older than those without HCC (59.5 vs 47 years, P-value = 0.01). Furthermore, history of upper GI bleeding, tattooing, blood transfusion, and chronic alcoholism were significantly more common in CHB patients with HCC than patients without HCC (13.2% vs 3.2% P-value 0.03, OR = 4.6, 95%CI = 1.2-18.1, 20% vs 3.9%, P-value = 0.01, OR= 6.1, 95% CI= 1.6-23.6, 20% vs 6.3%, P-value = 0.03, OR = 3.8, 95%CI =1.1-12.7, 62.2% vs 30.3%, P-value <0.0001, OR = 3.7, 95%CI= 1.7-8.1 respectively). Interestingly, more CHB patients with HCC had evidence of cirrhosis than those without HCC (78.9% vs 20.4%, P-value <0.0001, OR = 14.6, 95%CI = 5.8-36.7). In CHB patients with HCC, surgical therapy provided longer survival than radiofrequency ablation (RFA) (72 vs 46.5 months, P-value= 0.04). The mean survival time after HCC diagnosis was 17.2 months. Conclusions: HCC remains a major problem among patients with CHB infection in Thailand. Possible risk factors are male gender, history of upper GI bleeding, chronic alcoholism, tattooing, blood transfusion and evidence of cirrhosis. For early stage HCC patients, surgical treatment provided longer survival time than RFA. Most HCC patients presented with advanced disease and had a grave prognosis. Appropriate screening of CHB patients at risk for HCC might be an appropriate approach for early detection and improvement of long-term outcomes.     

Prevalence of Antibody against Non-A, non-B Hepatitis Virus in Japanese Patients with Hepatocellular Carcinoma

Antibodies against a possible causative agent of non-A, non-B hepatitis, hepatitis C virus (HCV), in Japanese patients with hepatocellular carcinoma were analyzed using the enzyme-linked immunosorbent assay (ELISA) system from Ortho Diagnostic Systems, Japan. Fifty of 58 cases of hepatitis B virus surface antigen (HBsAg)-negative hepatocellular carcinoma were positive for the antibody (86%) and 8 of 42 cases of HBsAg-positive hepatocellular carcinoma were positive (19%). Among patients with HBsAg-negative hepatocellular carcinoma, the prevalence of the antibody was greater among those who had received a blood transfusion (97%) than among those with no history of transfusion (70%). Only 3 of 54 patients with cancers other than hepatocellular carcinoma were found to be antibody-positive (5.6%) and all three patients had a history of blood transfusion. These results show a close relationship between the presence of anti-HCV antibody and HBsAg-negative hepatocellular carcinoma in Japan.     

Detection of Occult Hepatitis C Virus Infection in Egyptian Patients Who Achieved a Sustained Virologic Response to Direct-Acting Antiviral Agents

Background: Occult hepatitis C virus (HCV) infection (OCI) is diagnosed based on the detection of HCV-RNA in non-serum reservoirs, such as peripheral blood mononuclear cells (PBMCs) and/or hepatocytes with undetectable HCV-RNA in the serum. The current study was designed to shed more light on the presence of occult HCV in a population of cases who achieved an SVR after receiving treatments for HCV-infection and its significance. Methods: This cross-sectional study evaluated 111 chronic HCV patients treated at Theodor Bilharz Research Institute, Egypt and achieved a sustained virological response (SVR) 12 -24 weeks after treatment with Direct acting antiviral drugs (DAAs). The treatment lasted 12 or 24 weeks using generic medications including Sofosbuvir (SOF) 400 mg/day and Daclatasvir (DCV) 60 mg/day ± weight-based Ribavirin (RBV) 600-1000 mg/day. After achieving the SVR 12 -24 weeks, all patients were subjected to clinical examination and full laboratory investigations. All the candidates were assessed for fibrosis pre/post-treatment by transient elastography (Fibroscan©). Eighty-seven patients (78.4%) received dual therapy (SOF/DCV) and 24 patients (21.6%) received triple therapy (SOF/DCV/RBV). One hundred and seven patients received the regimen for 12 weeks (96.4%) and only four patients received the regimen for 24 weeks (3.6%). All patients were examined in terms of HCV RNA in plasma and PBMCs. Results: Nine patients (8.1%) were positive for PBMCs HCV RNA. The presence of Occult HCV infection (OCI) was significantly correlated with age, level of AFP, and the degree of liver stiffness. Conclusion: The OCI was present in 8.1% of the patients who achieved an SVR 12 – 24 weeks. These patients were mostly aged and with elevated AFP and advanced fibrosis. Monitoring and follow-up of those patients may help to assess the outcomes.     

Safety and Efficacy of Pazopanib in First-Line Metastatic Renal-Cell Carcinoma With or Without Renal Failure: CORE-URO-01 Study

Background

Pazopanib has been approved for first-line treatment of patients with metastatic renal-cell carcinoma on the basis of clinical trials that enrolled only patients with adequate renal function. Few data are available on the safety and efficacy of pazopanib in patients with renal insufficiency. This study investigated the effect of kidney function on treatment outcomes in such patients.

Non-Hodgkin's Lymphoma and Hepatitis C Virus Infection

The hepatitis C virus (HCV) is a recently described and important cause of acute and chronic liver disease. A hallmark of HCV is its propensity to become chronic, some patients with chronic HCV progressing to cirrhosis and hepatocellular carcinoma (HCC). HCV is also lymphotrophic and we report 2 patients with HCV cirrhosis who developed non-Hodgkins lymphoma (NHL). These cases raise the possibility that chronic HCV infection of lymphocytes plays an aetiological role in this malignancy. However screening of a further 63 consecutive patients over the age of 50 years with NHL for HCV antibody by second generation enzyme linked immunoassay (ELISA) failed to identify any patients with evidence of HCV infection. This suggests that HCV is an uncommon contributory factor for the development of non-Hodgkins lymphoma in the United Kingdom.     

Factors Influencing Overall Survival for Patients With Metastatic Clear-Cell Renal-Cell Carcinoma in Daily Practice

Purpose

To describe factors associated with overall survival (OS) among patients with metastatic clear-cell renal-cell carcinoma (mccRCC) in regard to evolution of systemic therapies.

Clinical Outcomes in Patients With Metastatic Papillary Renal-Cell Carcinoma: A Multi-Institutional Study in Japan

Background

Standard treatments have not been established in metastatic papillary renal-cell carcinoma (PRCC). We aimed to investigate treatment outcomes in patients with mPRCC.