Abdulrahman Y. Hammad

Palliative interventions for hepatocellular carcinoma patients: Analysis of the National Cancer Database

BACKGROUND Palliative therapies are provided to a subset of hepatocellular carcinoma (HCC) patients with the aim of providing symptomatic relief, better quality of life and improved survival. The present study sought to assess and compare the efficacy of different palliative therapies for HCC. METHODS The National Cancer Database (NCDB), a retrospective national database that captures approximately 70% of all patients treated for cancer in the US, was queried for patients with HCC who were deemed unresectable from 1998-2011. Patients were stratified by receipt of palliative therapy. Survival analysis was examined by log-rank test and Kaplan Meier curves, and a multivariate proportional hazards model was utilized to identify the predictors of survival. RESULTS A total of 3,267 patients were identified; 287 (8.7%) received surgical palliation, 827 (25.3%) received radiotherapy (RT), 877 (26.8%) received chemotherapy, 1,067 (32.6%) received pain management therapy, while 209 (6.4%) received a combination of the previous three modalities. On multivariate analysis palliative RT was identified as a positive predictor of survival [hazards ratio (HR) 0.65; 95% CI, 0.50-0.83]. Stratifying by disease stage, palliative RT provided a significant survival benefit for patients with stage IV disease. CONCLUSIONS Palliative RT appears to extend survival and should be considered for patients presenting with late stage HCC.

Parathyroidectomy for primary hyperparathyroidism improves sleep quality: A prospective study

Background. This prospective survey study assessed changes in sleep quality in patients with primary hyperparathyroidism after parathyroidectomy. Methods. Patients undergoing parathyroidectomy for primary hyperparathyroidism (n = 110) or thyroidectomy for benign euthyroid disease (control group; n = 45) were recruited between June 2013 and June 2015 and completed the Pittsburgh Sleep Quality Index preoperatively and at 1‐ and 6 months postoperatively. “Poor” sleep quality was defined as a score >5; a clinically important and relevant improvement was a ≥3‐point decrease. Results. Preoperatively, parathyroid patients had worse sleep quality than thyroid patients (mean 8.1 vs 5.3; P < .001); 76 (69%) parathyroid and 23 (51%) thyroid patients reported poor sleep quality (P = .03). Postoperatively, only parathyroid patients demonstrated improvement in sleep quality; mean scores did not differ between the parathyroid and thyroid groups at 1 month (6.3 vs 5.3; P = .12) or 6 months (5.8 vs 4.6; P = .11). The proportion of patients with a clinically important improvement in sleep quality was greater in the parathyroid group at 1 month (37% vs 10%; P < .001) and 6 months (40% vs 17%; P = .01). Importantly, there was no difference in the proportion of patients with poor sleep quality between the 2 groups at 1 month (50% vs 40%; P = .32) and 6 months (40% vs 29%; P = .22). Conclusion. More than two‐thirds of patients with primary hyperparathyroidism report poor sleep quality. After parathyroidectomy, over one‐third experienced improvement, typically within the first month postoperatively.

External radiation or ablation for solitary hepatocellular carcinoma: A survival analysis of the SEER database

Hepatocellular carcinoma (HCC) patients are often not candidates for resection. This study hypothesized that external beam radiation (XRT) could be equally effective compared to ablation therapy (AT) for selected HCC patients.

Point-of-Care Clinical Guide: Gallbladder Cancer

Gallbladder cancer is an uncommon disease that carries a high mortality rate due to its often late presentation. The disease follows a slow steady asymptomatic growth, and may be discovered incidentally at an earlier stage during a cholecystectomy. Gallbladder cancer possesses an infiltrating growth pattern towards the neighboring portal vasculature. Nihilistic view of the disease stayed for years due to patients’ limited survival. Recent studies report a decline in mortality rates in several parts of the world, although survival remains dismal for advanced stages. Gallbladder cancer is more commonly seen in South American countries such as Chile, Bolivia, and Ecuador, followed by Eastern Asian Countries such as Japan and South Korea. Lower incidence of the disease is reported in Europe, and the North American continent is considered a low risk area. No clear factors are associated with the development of gallbladder cancer; yet some risk factors are frequently linked to it. In the next sections, possible risk factors are discussed followed by clinical presentation, investigations, and treatment considerations for patients with gallbladder cancer.

Point-of-Care Clinical Guide: Cholangiocarcinoma

Cholangiocarcinoma is a neoplasm arising from the epithelial lining of the biliary tree; the cholangiocytes. Cholangiocarcinoma encompasses three types based on anatomical location: intrahepatic (IHCC), extrahepatic (EHCC), and hilar (HiCC) type; with the hilar type being the most common. Although cholangiocarcinoma is a rare tumor, its incidence is rising worldwide. Late presentation of the disease contributes to the poor prognosis and occurs due to subtle symptoms that often initially go unrecognized. Although surgical resection remains the best available option for cholangiocarcinoma, late presentation can limit surgical resection as an option, stressing the need for alternative interventions. Current therapeutic options include resection, liver transplantation, systematic chemotherapy, radiotherapy, and liver directed therapies. Palliative care is a valuable tool for those entering a non-curative paradigm in order to potentially minimize symptoms and improve the patient’s quality of life. In this chapter, we discuss factors most commonly associated with disease development, available treatments, and anticipated outcomes for cholangiocarcinoma.

Conditional probability of survival in gallbladder carcinoma as a prognostic tool for long term survivors.

455 Background: Gallbladder carcinoma (GBC) often presents in an advanced stage and despite radical resection and nodal harvest, prognosis remains poor. Conventional survival statistics do not account for time elapsed from diagnosis and may not carry relevant prognostic information for long term survivors. This study sought to estimate the conditional probability of survival (CS) in patients of GBC. Methods: Patients with GBC were identified from the Surveillance, Epidemiology and End Results (SEER) database (1988-2012). Overall probability of survival (OS) was estimated using Kaplan-Meier method. Cumulative incidence method was employed to calculate CS. Results: Of 15,046 GBC patients identified, Stage IV disease was the most common presentation (n = 5625). Surgical intervention was reported in 9,720(65%) patients with cholecystectomies (n = 8254) outnumbering radical resections (n = 1116). 3-year OS for all stages was 18% and conditional probability of surviving additional 3 years (CS3) at 1, 2 and 3 ye...

Palliative care for hepatocellular carcinoma: Analysis of the National Cancer Data Base.

390 Background: Palliative care is provided to a subset of hepatocellular carcinoma (HCC) patients with the aim of symptomatic relief and improving quality of life. The present study sought to assess and compare the prevalence and efficacy of different palliative therapies for HCC from the National Cancer Database (NCDB). Methods: The NCDB, a retrospective national database that captures approximately 70% of all patients treated for cancer, was queried for patients with HCC who were deemed non-resectable from 1998-2011. Patients were stratified by receipt of palliative care. Descriptive analyses were performed. Survival analysis was examined by log-rank test and Kaplan Meier curves, and a multivariate proportional hazards model was utilized to identify the predictors of survival. Results: A total of 3,267 patients were identified; 287 (8.7%) received surgical palliation, 827 (25.3%) received radiotherapy, 877 (26.8%) received chemotherapy, 1,067 (32.6%) received pain therapy, while 209 (6.4%) received a c...

Overall survival and resection margin after hepatectomy for intrahepatic cholangiocarcinoma at academic cancer centers versus community cancer centers.

339 Background: Margin status is an important prognostic factor of survival following hepatectomy for intrahepatic cholangiocarcinoma (ICC). R0 resection for ICC correlates with improved recurrence-free survival and overall survival (OS). The present study hypothesized that surgical resection margins and survival rates vary between centers. Methods: Patients with ICC undergoing hepatectomy were identified from the National Cancer Database (1998-2011). Treating centers were categorized as Academic Cancer Centers (ACC), and Community Cancer Centers (CCC). Rates of R0 vs. R1/2 resection were examined. OS was analyzed by Kaplan-Meier method, and Cox multivariate modeling identified independent predictors of survival. Results: A total of 2,774 patients were identified. Hepatectomy was most often performed at ACC compared to CCC: 1,928 (69.5%) vs. 846 (30.5%). Hepatectomy at ACC was associated with higher rates of R0 resections compared to CCC (72.5% vs. 68.1%, p= 0.018). Higher 30-day readmission rates were se...

Laparoscopic Resection of Hepatic Angiomyolipoma - An Uncommon PrimaryLiver Tumor: A Case Report and Literature Review

PEComas are an uncommon group of mesenchymal neoplasms that exhibit perivascular epithelioid cell differentiation. The term PEComa includes a collection of different subcategories, such as lymphangioleimyomatosis, clear cell tumor of the lung, and angiomyolipoma (AML) which is the topic of discussion in this article. The main problem concerning the diagnosis of hepatic AML is the wide non-specific imaging findings, stressing the need for a tissue diagnosis. Histological examination of a hepatic AML shows different types of tissues such as smooth muscle cells, fat cells (adipocytes), and blood vessels. The ultimate method for diagnosing an AML case is through immunohistochemical examination. AML displays positive immunoreactivity to HMB-45 and Melan- A, and negative to CAM5.2 and AE1/AE3 as well as S100 of the melanoma. The management of hepatic AML has been a matter of debate between different groups, and in this article we discuss a hepatic AML case that presented to our group and was treated with a minimally invasive surgical procedure.