Background/Aims: Middle Eastern countries, including Saudi Arabia to some extent, are endemic for chronic hepatitis B (CHB) infection which could be associated with high mortality and comorbidities risk. However, limited data characterizing this CHB population exists. Our aim was to characterize and compare CHB patients in 2015 with those in 2010 and 2012 in Saudi Arabia. Patients and Methods: We conducted and compared three cross-sectional analyses of adult patients with CHB defined as either positive hepatitis B surface antigen or documented CHB history in 2010, 2012, and 2015. Data were accessed from the multicenter Systematic Observatory Liver Disease Registry (SOLID). Results: A total of 765 CHB patients were identified in 2010 ( n = 274), 2012 ( n = 256), and 2015 ( n = 235). Median age was significantly higher in 2015 (47 years) compared to 2010 and 2012 (42 years;P < 0.05). The proportions of patients with hepatocellular carcinoma (range 1–12%) and cirrhosis (range 5–23%) were significantly higher in 2015 compared to 2010 and 2012 ( P < 0.05). Compared to 2010, patients in 2015 had significantly ( P < 0.05) higher prevalence of coronary artery disease (10% vs. 4%) and hyperbilirubinemia (18% vs. 9%). Although not significant, there was a numerical increase in 2015 in chronic kidney disease (9% vs. 7% in 2010; P = 0.559) and hepatic steatosis (32% vs. 25% in 2010; P = 0.074). Significantly more patients in 2015 ( P < 0.05) were treatment experienced (23% vs. 5% in 2010/2012) and switched treatment (17% vs. 1–2% in 2010/2012). Conclusions: Between 2010 and 2015, the CHB population in Saudi Arabia had significantly aged and was more likely to develop liver disease sequelae and other comorbidities.

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Objectives: A previous analysis showed the economic sustainability of adding liquid biopsy, whenever possible, to tissue biopsy for the assessment of epidermal growth factor receptor-positive (EGFR+) mutation in patients with advanced non-small cell lung cancer (mNSCLC). The following analysis evaluated the clinical outcome (progression free survival, PFS) when adopting two different diagnostic strategies in the first-line treatment of patients with EGFR+ mNSCLC. Methods: A previous decisionanalytic model was adopted to compare the two diagnostic strategies: i) tissue strategy and ii) combined strategy (tissue biopsy and, were its outcome unknown, liquid biopsy). We only evaluated the PFS variation between the two diagnostic strategies considered. We assumed that mNSCLC EGFR+ patients were treated with 3 rd generation EGFR-TKI (PFS: 18.9 months), while mNSCLC EGFR Wilde Type (WT) patients were treated with chemotherapy (PFS: 5.7 months). Key variables were tested in the sensitivity analysis. Results: A total of 13,030 patients eligible for tissue biopsy in Italy were considered, of whom 2,463 were assumed to be EGFR+. The combined strategy showed an increase of the number of correctly identified EGFR+ patients (2,293 patients) compared to the tissue strategy (1,691 patients). When considering mNSCLC EGFR+ patients treated with 3 rd generation EGFR-TKI, the PFS would increase from 14.8 months per patient with the tissue strategy to 18.5 months per patient with the combined strategy. When considering mNSCLC EGFR+ patients treated with other 1 st /2 nd generation EGFR-TKI, the PFS would increase from 8.8 months per patient with the tissue strategy to 10.1 months per patient with the combined strategy. Conclusions: The choice of a correct diagnostic strategy is crucial in order to optimize cancer therapies in the first-line treatment of mNSCLC EGFR+. The addition to the diagnostic pathway of the liquid biopsy would correctly identify a greater number of cases, supporting the prescription of a more effective oncological therapy.

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