Impact of body mass index on hepatocellular carcinoma recurrence after liver transplantation through long-term follow-up

BackgroundObesity is associated with increased oncological risk and outcomes but the evidence surrounding the effect of body mass index (BMI) on increased risk of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) is still questionable. The purpose of this retrospective study of a large cohort of adult patients transplanted for HCC was to investigate the effect of BMI on the incidence of HCC recurrence and outcome.MethodsData from 427 adult recipients transplanted for HCC between 2000 and 2017 were collected. Patients were classified at time of LT according to the World Health Organization BMI classification into 3 groups; group 1: BMI <25 (n=166), group 2: BMI 25–29.9 (n=150) and group 3: BMI ≥30 (n=111).ResultsThere were no significant changes of mean BMI overtime 26.8±5.0 kg/m2 at time of LT and 28.8±23.1 at 5 years. The recurrence rates of HCC after LT in the three groups were 19%, 16% and 17% respectively. The 5, 10 and 15-year recurrence free survival (RFS) rates were respectively 68.6%, 47.3% and 40.8% in group 1, 73.3%, 66.2% and 49.5% in group 2 and 68.8%, 57.5% and 47.7% in group 3 (log rank P=0.47).ConclusionsRecipient BMI at time of transplant and during follow-up didn’t impact the incidence of HCC recurrence nor long-term patient survival, irrespective to the status of the patients and their tumor characteristic at time of LT. The present study clearly confirms that obesity should not be considered, when selecting patients with HCC to LT, as a predictive factor of recurrence.     

A population‐based competing‐risks analysis of the survival of patients treated with radical cystectomy for bladder cancer

BACKGROUND.

Patients treated with radical cystectomy represent a very heterogeneous group with respect to cancer‐specific and other‐cause mortality. Comorbidities and comorbidity‐associated events represent very important causes of mortality in those individuals. The authors examined the rates of cancer‐specific and other‐cause mortality in a population‐based radical cystectomy cohort.

METHODS.

The authors identified 11,260 patients treated with radical cystectomy for urothelial carcinoma of the urinary bladder between 1988 and 2006 within 17 Surveillance, Epidemiology, and End Results registries. Patients were stratified into 20 strata according to patient age and tumor stage at radical cystectomy. Smoothed Poisson regression models were fitted to obtain estimates of cancer‐specific and other‐cause mortality rates at specific time points after radical cystectomy.

RESULTS.

After stratification according to disease stage and patient age, cancer‐specific mortality emerged as the main cause of mortality in all patient strata. Nonetheless, at 5 years after radical cystectomy, between 8.5% and 27.1% of deaths were attributable to other‐cause mortality. The 3 most common causes of other‐cause mortality were other malignancies, heart disease, and chronic obstructive pulmonary disease. The most prominent effect on cancer‐specific mortality was exerted by locally advanced bladder cancer stages. Conversely, age was the main determinant of other‐cause mortality. Interestingly, even after adjusting for bladder cancer pathologic stage, cancer‐specific mortality was higher in older individuals than their younger counterparts.

CONCLUSIONS.

The current study provides a valuable graphical aid for prediction of cancer‐specific and other‐cause mortality according to disease stage and patient age. It can help clinicians to better stratify the risk‐benefit ratio of radical cystectomy. Hopefully, these findings will be considered in treatment decision making and during informed consent before radical cystectomy. Cancer 2011. © 2010 American Cancer Society.     

CMV plasma DNAemia and risk of cancer among HIV-infected patients: A case–control study nested in the ANRS CO3 Aquitaine Cohort,France, 2002–2007

BackgroundCMV reactivation, which enhances immune senescence, could be associated with a higher risk of cancer.ObjectivesWe compared the prevalence of positive CMV DNAemia in HIV-infected patients with and without cancer.Study designThis case–control study, nested in the ANRS-CO3 Aquitaine Cohort, included patients with a first diagnosis of cancer (2002–2007) as cases. Two controls were matched per case.Cancer risk was estimated using conditional logistic regression models, an Odds Ratio (OR) of 2 could be detected with 80% power. The variables considered were: ≥1 positive CMV DNAemia, CD4+ and CD8+ counts, HIV plasma load. Plasma CMV DNA was retrospectively quantified within the 3-year period preceding the endpoint.ResultsThe 143 cases (93 non-AIDS-related and 50 AIDS-related cancers) and 284 controls had a median age of 47 years (IQR: 41–56). At the time of diagnosis or censorship, for cases and controls, median values were respectively, for CD4+ count: 327 cells/mm³ (IQR: 164–514) and 416 (IQR: 275–582), and for HIV plasma load: 2.6 log₁₀ copies/mL (IQR: 1.7–4.7) and 1.7 log₁₀ copies/mL (IQR: 1.7–3.3). We performed 2056 CMV PCR; 14 cases (9.8% [95% CI: 4.9–14.7]) and 19 controls (6.7% [CI: 3.8–9.6]) presented ≥1 positive PCR. CMV DNAemia was not associated with the risk of cancer (unadjusted and adjusted p-values = 0.19 and 0.54, respectively). HIV load >500 copies/mL was independently associated with a higher risk of cancer (OR = 2.02; p = 0.002; 95% CI: 1.29–3.17).ConclusionThis large case–control study did not show any differential exposure to positive CMV plasma DNAemia between cancer cases and controls.