Aims Hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths worldwide and liver transplant (LT) prolongs survival. However, 15–20% will experience recurrent HCC, most occurring within 2 years of LT. HCC patients with late recurrences (>5 years after LT) may have distinctive clinical/biological characteristics. Methods A retrospective review was conducted of 88 patients who underwent LT for HCC between 1993–2015, analyzing demographics, clinical factors, explant pathology, and outcome. Results Median follow-up was 6.4 years. HCC recurred in 15 (17.0%) patients with mean time to recurrence of 3.96 +/− 3.99 years. Five patients recurred >5 years post-LT. All late recurrences involved males in their 50s, recurring at 8.5 years on average. Recurrences occurred in chest wall (2), liver (2), lung (2), bone (1) and pelvis (1), with multifocal involvement in 2 patients. Four patients died within 18 months of late recurrence. The fifth patient is alive after ablation of liver recurrence and treatment with sorafenib and everolimus. Conclusions One-third of post-LT patients with recurrent HCC experienced late recurrence. Although the sample size makes it difficult to identify significant risk factors, this study highlights the importance of long-term follow up and need for biomarkers to identify patients at risk for late recurrences.

ObjectiveTo investigate the role of intratympanic (IT) therapy in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL).MethodsThis study was a retrospective review. Patients were treated for ISSNHL from January 1, 2011 to April 12, 2015 with the following: pre/posttreatment audios, treatment initiated ≤90 days and idiopathic etiology. Fifty‐three ISSNHL patients were analyzed in the following subgroups: oral steroids (n = 8), combination oral+IT (n = 39), and IT (n = 6). Main outcomes measured were pre/posttreatment pure tone average (PTA) scores.ResultsThe PTA changes for all treatment groups improved by 8.0 ± 19.5 dB (P = .004); for 31 patients treated ≤2 weeks after onset, PTA improved by 13.8 ± 16.6 dB (P < .001). Multivariable generalized linear model for repeated measures was conducted to investigate the association between PTA changes for treatment groups adjusted for age, gender, time‐to‐treatment, and vertigo. Earlier time‐to‐treatment and older age were statistically correlated towards improved outcomes. As time‐to‐treatment increased by each day, change in PTA decreased by 0.324 (95% CI [0.12, 0.52], P = .002). As age increased by each year, PTA changes increased by 0.802 (95% CI [0.36, 1.24], P < .001). For the oral+IT group, PTA changes for concurrent oral+IT (n = 20, 7.10 dB) and delayed/salvage oral+IT (n = 19, 5.43 dB) were not statistically different (P = .79); earlier time‐to‐treatment (P = .001), and older age (P = .006) remained statistically correlated towards improved outcomes.ConclusionResults suggest outcomes can be improved with early identification and oral steroid therapy by primary care providers. Poorer prognosis for younger patients potentially suggests a need for more aggressive diagnostic and therapeutic management for this subgroup.Level of Evidence3b.

INTRODUCTION: Despite receiving cancer-directed therapies, there is a high rate of cancer recurrence among patients with hepatocellular carcinoma (HCC). Our study aims to focus on the subset of patients with HCC recurrence to evaluate sex- and ethnicity-specific disparities in receipt of treatment. METHODS: Adults with HCC who developed HCC recurrence were identified using 1973-2015 U.S. National Cancer Institute’s Surveillance, Epidemiology, and End Results cancer registry. HCC tumor stage was assessed with the SEER historic staging system (localized, regional, distant) and HCC treatment received was assessed with SEER’s site-specific surgery variable (no treatment, locoregional therapy, surgical resection, and liver transplantation (LT)). Comparisons of tumor stage at diagnosis and receipt of HCC treatment between groups were assessed using chi-square testing and multivariate logistic regression models. RESULTS: Among 275 patients with recurrence of HCC (76.7% male, 48.7% non-Hispanic Whites, 14.9% Hispanic, 27.6% Asian/Pacific Islanders), 24.6% did not receive any HCC-directed surgical treatment, 21.9% received locoregional therapies, 42.3% surgical resection, and 11.2% LT. Compared to women, men were significantly less likely to receive any HCC treatment after initial diagnosis of HCC (OR 0.33, 95% CI 0.14-0.76, P = 0.01), including surgical resection or LT (OR 0.53, 95% CI 0.29-0.96, P = 0.037). Compared to non-Hispanic Whites, significantly lower rates of any HCC treatment were observed in Hispanics (OR 0.40, 95% CI 0.19-0.84, P = 0.015) and higher rates of treatment were seen in Asian/Pacific Islanders (OR 2.28, 95% CI 1.02-5.12, P = 0.045). On multivariate analysis, there were significantly lower odds of receiving any therapy for the initial HCC diagnosis in men vs. women (OR 0.27, 95% CI 0.11-0.68, P < 0.01) and in Hispanics vs. non-Hispanic Whites (OR 0.32, 95% CI 0.15-0.72, P < 0.01). Asian/Pacific Islanders were more likely to receive treatment compared to non-Hispanic Whites (OR 2.72, 95% CI 1.15-6.44, P = 0.023). There were no significant differences in receipt of treatment for the HCC recurrence based on sex or ethnicity. CONCLUSION: Among U.S. adults with HCC who developed HCC recurrence, nearly one quarter did not receive any HCC-directed surgical therapies at initial diagnosis. Men and Hispanics were significantly less likely to receive any HCC-directed therapies for the initial HCC diagnosis.

INTRODUCTION: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality with high rates of recurrence despite treatment. The characteristics and outcomes of HCC recurrence are not well studied. We utilize a national cancer registry to evaluate predictors of overall survival in recurrent HCC. METHODS: Using National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer registry, we retrospectively evaluated U.S. adults with recurrence of HCC from 1973-2015. HCC tumor stage was assessed with the SEER historic staging system (localized, regional, distant) and HCC treatment was assessed using SEER's site-specific surgery variable (no treatment, locoregional therapy, surgical resection, and liver transplantation (LT)). Overall survival was evaluated using Kaplan Meier and Cox proportional hazards models. RESULTS: Among 275 patients with recurrence of HCC (76.7% male, mean age at initial HCC diagnosis 61 ± 11 years, 48.7% non-Hispanic white, 14.9% Hispanic, 7.6% African American, 27.6% Asian/Pacific Islanders), the majority of patients had localized stage at initial HCC diagnosis (76.4%). At time of HCC recurrence, the proportion of patients with distant/advanced stage was 4 times higher than at initial diagnosis (8.7% vs. 2.2%, P < 0.01). At initial HCC diagnosis, 24.6% did not receive any HCC-directed surgical therapies. At the time of recurrence, overall treatment rates were significantly lower, with 46.6% not receiving any HCC-directed surgical therapies and only 28.7% receiving surgical resection or LT. Median survival was 98 months (95% CI 85-118) after initial HCC diagnosis and 36 months (95% CI 31-48) after HCC recurrence. Significantly higher risk of death was associated with increasing age at time of HCC diagnosis (HR 1.02, 95% CI 1.01–1.04, P < 0.01) and distant stage at diagnosis of recurrence compared to localized stage (HR 2.11, 95% CI 1.26-3.53, P < 0.01). There was a trend towards lower risk of death in Asians compared to non-Hispanic whites (HR 0.67, 95% CI 0.44-1.03, P = 0.07). Receipt of any HCC-directed surgical therapy either for the initial HCC or HCC recurrence was associated with significantly lower risk of death. CONCLUSION: Among U.S. adults who developed recurrence of HCC, nearly half did not receive any HCC-directed surgical therapy at time of HCC recurrence. Older age and more advanced tumor stage at recurrence were associated with significantly higher risk of death despite HCC treatment.

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