http://jama.jamanetwork.com/ en-us Mon, 17 Dec 2012 00:00:00 GMT Tue, 01 Jan 2013 00:47:42 GMT Silverchair editor@jama.jamanetwork.com webmaster@jama.jamanetwork.com http://jama.jamanetwork.com/article.aspx?articleID=1391401 Wed, 14 Nov 2012 00:00:00 GMT Wu C, Chen Y, Ho HJ, et al. <span class="paragraphSection"><div class="boxTitle">Context</div>Tumor recurrence is a major issue for patients with hepatocellular carcinoma (HCC) following curative liver resection.<div class="boxTitle">Objective</div>To investigate the association between nucleoside analogue use and risk of tumor recurrence in patients with hepatitis B virus (HBV)−related HCC after curative surgery.<div class="boxTitle">Design, Setting, and Participants</div>A nationwide cohort study between October 2003 and September 2010. Data from the Taiwan National Health Insurance Research Database. Among 100 938 newly diagnosed HCC patients, we identified 4569 HBV-related HCC patients who received curative liver resection for HCC between October 2003 and September 2010.<div class="boxTitle">Main Outcome Measures</div>The risk of first tumor recurrence was compared between patients not taking nucleoside analogues (untreated cohort, n = 4051) and patients taking nucleoside analogues (treated cohort, n = 518). Cumulative incidences and hazard ratios (HRs) were calculated after adjusting for competing mortality.<div class="boxTitle">Results</div>The treated cohort had a higher prevalence of liver cirrhosis when compared with the untreated cohort (48.6% vs 38.7%; P < .001), but lower risk of HCC recurrence (n = 106 [20.5%] vs n = 1765 [43.6%]; P < .001), and lower overall death (n = 55 [10.6%] vs n = 1145 [28.3%]; P < .001). After adjusting for competing mortality, the treated cohort had a significantly lower 6-year HCC recurrence rate (45.6%; 95% CI, 36.5%-54.6% vs untreated, 54.6%; 95% CI, 52.5%-56.6%; P < .001). Six-year overall mortalities for treated cohorts were 29.0% (95% CI, 20.0%-38.0%) and for untreated 42.4% (95% CI, 40.0%-44.7%; P < .001). On modified Cox regression analysis, nucleoside analogue use (HR, 0.67; 95% CI, 0.55-0.81; P < .001), statin use (HR, 0.68; 95% CI, 0.53-0.87; P = .002), and nonsteroidal anti-inflammatory drugs or aspirin use (HR, 0.80; 95% CI, 0.73-0.88; P < .001) were independently associated with a reduced risk of HCC recurrence. Multivariable stratified analyses verified the association in all subgroups of patients, including those who were noncirrhotic (HR, 0.56; 95% CI, 0.42-0.76) and diabetic (HR, 0.52; 95% CI, 0.31-0.89).<div class="boxTitle">Conclusion</div>Nucleoside analogue use was associated with a lower risk of HCC recurrence among patients with HBV-related HCC after liver resection.</span> 308 18 1906 1913 10.1001/2012.jama.11975 http://jama.jamanetwork.com/article.aspx?articleID=1391401 http://jama.jamanetwork.com/article.aspx?articleID=1391402 Wed, 14 Nov 2012 00:00:00 GMT Lok AF. <span class="paragraphSection">Surgical resection and liver transplantation are the only curative therapies for hepatocellular carcinoma (HCC); however, fewer than 20% of patients are eligible for these therapies. Surgical resection is the treatment of choice for HCC in patients with a solitary tumor and no evidence of cirrhosis; this disease pattern accounts for roughly 5% of HCC in western countries and 40% in Asia. The higher percentage of HCC patients in Asia who are amenable to surgical resection is related to the predominance of hepatitis B virus (HBV)–related HCC, which can occur in the absence of cirrhosis. Improvement in early diagnosis of HCC and more accurate evaluation of underlying liver function have resulted in 5-year survival after resection for HCC exceeding 50%. Nevertheless, despite careful selection, HCC recurrence rate after surgical resection is high: 50% to 70% at 5 years. None of the adjuvant therapies prior to or immediately following resection have been shown to reduce the rate of HCC recurrence.</span> 308 18 1922 1924 10.1001/jama.2012.12971 http://jama.jamanetwork.com/article.aspx?articleID=1391402