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Background and Aims: The prevalence of HDV infection in HBsAg carriers is about 9.9% in Italy. However, the real prevalence is underestimated because the anti‐HDV test is not performed routinely in all HBsAg carriers. The aim of this study was to compare the prevalence and the absolute number of HDV infection identified in HBsAg‐positive subjects tested at University Hospital Federico II before and after the introduction of anti‐HDV reflex testing. Methods: From January to December 2022, reflex test for the detection of total HDV antibodies was performed in all HBsAg‐positive subjects tested at University Hospital Federico II. The control group consisted of all the HBsAg‐positive subjects tested at the same laboratory in 2019, before the implementation of anti‐HDV reflex testing. Sera were evaluated with ADVIA Centaur HBsAgII Qualitative, Liaison Murex HBsAg Quantitative and Liaison Murex Total Anti‐HDV Qualitative. Results: Before reflex testing, anti‐HDV had been tested in 16.4% (84/512) of HBsAg‐positive subjects, while after its implementation, 100% (484/484) of HBsAg‐positive patients was tested for anti‐HDV. The anti‐HDV positive prevalence was lower than before the introduction of reflex test (10.7% vs. 16.6%) but the absolute number of anti‐HDV positive patients increased (14 vs. 52 subjects). HDV‐RNA was detectable in 26 (53%) of 49 tested subjects. Conclusions: Our data showed that the implementation of anti‐HDV reflex testing increased the diagnoses of HDV infection. In this setting, due to the approval of specific anti‐HDV drugs, a reflex test for anti‐HDV should be implemented to early identify patients with HBV/HDV infection. [ABSTRACT FROM AUTHOR]

Background and aims: Coeliac disease (CD) is considered a high‐risk condition for developing non‐alcoholic fatty liver disease (NAFLD) and other related metabolic disorders, particularly after commencing gluten‐free diet (GFD). Recently, a new concept of metabolic‐associated fatty liver disease (MAFLD) has been proposed to overcome the limitations of NAFLD definition. This study aimed at exploring the prevalence of NAFLD and MAFLD in CD patients at the time of CD diagnosis and after 2 years of GFD. Furthermore, we evaluated the role of PNPLA3 rs738409 in the development of NAFLD and MAFLD in the same population. Methods: We retrospectively enrolled all newly diagnosed CD patients who underwent clinical, laboratory and ultrasonography investigations both at diagnosis and after 2 years of follow‐up. Moreover, a PNPLA3 rs738409 genotyping assay was performed. Results: Of 221 newly diagnosed CD patients, 65 (29.4%) presented NAFLD at CD diagnosis, while 32 (14.5%) met the criteria for MAFLD (k = 0.57). There were no significant differences between NAFLD and MAFLD, except for the higher rate of insulin resistance (IR) of MAFLD patients (75% vs 33.8%, P <.001). At 2 years of follow‐up, 46.6% of patients developed NAFLD while 32.6% had MAFLD (k = 0.71). MAFLD subjects had higher transaminases (P =.03), LDL‐cholesterol (P =.04), BMI and waist circumference and higher IR than NAFLD patients. MAFLD patients showed higher non‐invasive liver fibrosis scores than NAFLD subjects (APRI = 1.43 ± 0.56 vs 0.91 ± 0.62, P <.001; NFS=−1.72 ± 1.31 vs −2.18 ± 1.41, P =.03; FIB‐4 = 1.27 ± 0.77 vs 1.04 ± 0.74, P =.04). About PNPLA3 polymorphisms, at 2 years follow‐up, NAFLD subjects presented a higher rate of heterozygosis (40.8%) and homozygosis (18.4%) polymorphisms than non‐NAFLD (26.3% and 7.6%, respectively, P =.03 and 0.02), while no correlation between PNPLA3 polymorphisms and MAFLD was seen. Conclusions: The new MAFLD definition better reflects the metabolic alterations following GFD in CD population. This new classification could be able to identify patients at higher risk of worse metabolic outcome, who need a close multidisciplinary approach for their multisystemic disease. [ABSTRACT FROM AUTHOR]

Background and aims: Epidemiology of hepatocellular carcinoma (HCC) is changing in most areas of the world. This study aimed at updating the changing scenario of aetiology, clinical presentation, management and prognosis of HCC in Italy during the last 15 years. Methods: Retrospective analysis of the Italian Liver Cancer (ITA.LI.CA) database included 6034 HCC patients managed in 23 centres from 2004 to 2018. Patients were divided into three groups according to the date of cancer diagnosis (2004‐2008, 2009‐2013 and 2014‐2018). Results: The main results were: (i) a progressive patient ageing; (ii) a progressive increase of non‐viral cases and, particularly, of 'metabolic' and 'metabolic + alcohol' HCCs; (iii) a slightly decline of cases diagnosed under surveillance, but with an incremental use of the semiannual schedule; (iv) a favourable cancer stage migration; (v) an increased use of radiofrequency ablation to the detriment of percutaneous ethanol injection; (vi) improved outcomes of ablative and transarterial treatments; (vii) an improved overall survival (adjusted for the lead time in surveyed patients) in the last calendar period, particularly in viral patients; (viii) a large gap between the number of potential candidates (according to oncologic criteria and age) to liver transplant and that of transplanted patients. Conclusions: During the last 15 years several aspects of HCC scenario have changed, as well as its management. The improvement in patient survival observed in the last period was likely because of a larger use of thermal ablation with respect to the less effective alcohol injection and to an improved management of intermediate stage patients. [ABSTRACT FROM AUTHOR]

Background & Aims: According to the Barcelona Clinic Liver Cancer (BCLC) staging system, monofocal hepatocellular carcinoma (HCC) is classified as early (BCLC A) irrespective of its size, even though controversies still exist regarding staging and treatment of large tumours. We aimed at evaluating the appropriate staging and treatment for large (>5 cm) monofocal (HCC). Methods: From the Italian Liver Cancer database, we selected 924 patients with small early monofocal HCC (2‐5 cm; SEM‐HCC), 163 patients with larger tumours (>5 cm; LEM‐HCC) and 1048 intermediate stage patients (BCLC B). Results: LEM‐HCC patients had a worse overall survival (OS) than SEM‐HCC (31.0 vs 49.0 months; P <.0001), and this was confirmed at multivariate analysis (HR 1.63, 95% CI 1.29‐2.05; P <.0001). The small difference in OS between LEM‐HCC and BCLC B patients (31.0 vs 27.0 months; P =.03) disappeared in the multivariate model (HR 0.98, 95% CI 0.77‐1.25; P =.89). In all monofocal tumours, treatment was the strongest independent predictor of survival, with a progressively decreasing survival benefit moving from "curative" to "palliative" therapies. The survival of resected patients with LEM‐HCC was significantly shorter than that of SEM‐HCC (44.0 vs 78.0 months; P =.002), but liver resection provided the highest survival benefit in both groups compared to other treatments. Conclusions: Monofocal HCC larger than 5 cm should not be staged as BCLC A and either a different staging system or a different subgrouping of patients (e.g. BCLC AB) should be used. Liver resection, if feasible, remains the recommended treatment for all these patients. [ABSTRACT FROM AUTHOR]

Background: Metabolic disorders are well‐known risk factors for HCC. Conversely, their impact on the natural history of HCC is not established. This study aimed at evaluating the impact of metabolic disorders on clinical features, treatment and survival of HCC patients regardless of its aetiology. Methods: We analysed the ITA.LI.CA database regarding 839 HCC patients prospectively collected. The following metabolic features were analysed: BMI, diabetes, arterial hypertension, hypercholesterolaemia and hypertriglyceridaemia. According to these features, patients were divided into 3 groups: 0‐1, 2 and 3‐5 metabolic features. Results: As compared with patients with 0‐1 metabolic features, patients with 3‐5 features showed lower percentage of HCC diagnosis on surveillance (P = .021), larger tumours (P = .038), better liver function (higher percentage of Child‐Pugh class A [P = .007] and MELD < 10 [P = .003]), higher percentage of metastasis (P = .024) and lower percentage of portal vein thrombosis (P = .010). The BCLC stage and treatment options were similar among the 3 groups, with the exception of a less frequent access to loco‐regional therapies for BCLC stage B patients with 3‐5 features (P = .012). Overall survival and survival according to BCLC stage and/or treatment did not significantly differ among the 3 groups. Only using a probabilistic sensitivity analysis, diabetic patients showed a lower survival (P = .046). MELD score, HCC morphology, nodule size, BCLC stage, portal vein thrombosis and metastasis were independent predictors of lead‐time adjusted survival. Conclusions: Our "real world" study suggests that metabolic disorders shape the clinical presentation of HCC but do not seem to play a major role in setting patient survival. [ABSTRACT FROM AUTHOR]

Background & Aims Determining risk for recurrence or survival after curative resection or ablation in patients with hepatitis C virus ( HCV)-related hepatocellular carcinoma ( HCC) is important for stratifying patients according to expected outcomes in future studies of adjuvant therapy in the era of direct-acting antivirals ( DAAs). The aims of this meta-analysis were to estimate the recurrence and survival probabilities of HCV-related early HCC following complete response after potentially curative treatment and to identify predictors of recurrence and survival. Methods Studies reporting time-dependent outcomes ( HCC recurrence or death) after potentially curative treatment of HCV-related early HCC were identified in MEDLINE through May 2016. Data on patient populations and outcomes were extracted from each study by three independent observers and combined using a distribution-free summary survival curve. Primary outcomes were actuarial probabilities of recurrence and survival. Results Eleven studies met the inclusion criteria. Pooled estimates of actuarial recurrence rates were 7.4% at 6 months and 47.0% at 2 years. Pooled estimates of actuarial survival rates were 79.8% at 3 years and 58.6% at 5 years. Heterogeneity among studies was highly significant for all outcomes. By univariate meta-regression analyses, lower serum albumin, randomized controlled trial study design and follow-up were independently associated with higher recurrence risk, whereas tumour size and alpha-foetoprotein levels were associated with higher mortality. Conclusions This meta-analysis showed that recurrence risk and survival are extremely variable in patients with successfully treated HCV-related HCC, providing a useful benchmark for indirect comparisons of the benefits of DAAs and for a correct design of randomized controlled trials in the adjuvant setting. [ABSTRACT FROM AUTHOR]