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398 PREDICTIVE FACTORS OF HCC FREE SURVIVAL IN 203 PATIENTS WITH CIRRHOSIS CLASSED CHILD PUGH A AND HCC (≤ 5CM) TREATED BY RADIOFREQUENCY ABLATION (RFA)
S154
POSTERS
carcinomas (10), germ cell tumors (6) and in undifferentiated childhood tumors: Wilms tumor (5), neuroblastoma (7), meduloblastoma (5), kidney rhabdoid tumor (1). Results: All the hepatoblastomas were positive for DLK. The staining was mostly focal covering 5−30% of the areas of tumors, the surrounding liver tissue remained negative. The reaction was present always in the epithelial component of the tumors but there was no preferential staining over the fetal or embryonic parts. The staining pattern was membranous and cytoplasmic. The differentiating cells of two ganglioneuroblastomas stained positively, no reaction was observed in any other tumors. Conclusions: DLK immunostaining seems to be a highly sensitive and specific marker for hepatoblastomas. If this primary observation can be confirmed DLK can be used as an immunohistochemical marker for hepatoblastomas. The biological function of DLK in hepatoblastomas requires further studies. However since DLK is a membrane receptor it can be considered a molecular target for therapeutical approaches. This study was supported by ETT 32/2006 and OTKA K67697 397 LONG-TERM RESULTS OF RADIOFREQUENCY ABLATION (RFA) IN PATIENTS WITH CIRRHOSIS AND HCC 5 CM IN DIAMETER G. Nkontchou1 , O. Seror2 , A. Mahamoudi1 , A. Mounir3 , N. Ganne Carrie1 , V. Grando Lemaire1 , E. Vicaut3 , J.C. Trinchet1 , M. Beaugrand1 . 1 Liver Unit, 2 Radiology Unit Hˆ opital Jean Verdier, Assistance PubliqueHˆopitaux de Paris, Bondy, France; 3 U, .URC Hˆopital Lariboisi`ere E-mail: [email protected] This study aims to assess the long-term prognosis of patients with cirrhosis and HCC 5cm treated by RFA. Patients and Methods: From January 2001 to June 2007, among 311 patients with cirrhosis and HCC non eligible for resection treated by RFA, we selected all naive patients with 3 or less HCC 5 cm. 235 patients (mean age 65±10 yrs; cirrhosis classed Child-Pugh A (205) or B (30) related to alcohol (89), viral C (115) or B (16), hemochromatosis (5) or others (10) with 307 HCCs (mean diameter of the large tumor: 29 mm (93 30 mm), 53 bi or trifocal forms). 76 patients were excluded due to tumour size >5 cm (48), recurrence after resection (16) or embolization (12). Efficacy of the treatment was evaluated by CT scan and serum AFP at 1 month, and every 3 months after complete ablation. In case of local recurrence or new lesions, treatment by RFA was performed when possible. Results: A complete ablation was obtained in 222 patients. Three major complications occurred: One death related to chock and renal failure 2 days after the procedure, one neoplastic seeding and one liver abscess. After a mean follow-up of 813±611 days, 82 patients died, including 61 death related to HCC progression, 29 patients were transplanted.124 patients were alive and non transplanted (103 without detectable tumour). In intention-to-treat, overall and HCC free survival rates at 3 and 5 yrs were 60% and 40% and 56% and 31% respectively. In multivariate analysis, factors associated with HCC free survival were: total bilirubin: OR 1.6 (1−2.6) p = 0.04, serum AFP: OR 1 (1−1) p < 0.0001, multifocal tumour: OR 1.8 (1.19−2.6) p = 0.004. In patients with unique HCC and bilirubin 15 Um (n = 82), survival rates at 3 and 5 years were 75% and 61% respectively. Conclusion: RFA of HCC 5cm in patients with cirrhosis non eligible for resection had a low morbidity and high survival rates particularly in patients with a unique HCC and bilirubin 15 uM
398 PREDICTIVE FACTORS OF HCC FREE SURVIVAL IN 203 PATIENTS WITH CIRRHOSIS CLASSED CHILD PUGH A AND HCC ( 5CM) TREATED BY RADIOFREQUENCY ABLATION (RFA) G. Nkontchou1 , O. Seror2 , A. Mahamoudi1 , A. Mounir3 , N. Ganne Carrie1 , V. Grando Lemaire1 , E. Vicaut3 , J.C. Trinchet1 , M. Beaugrand1 . 1 Liver Unit, 2 Radiology Unit, Hˆ opital Jean Verdier, Assistance PubliqueHˆopitaux de Paris, avenue du 14 Juillet, 93140 Bondy, France; 3 U, .URC Hˆopital Saint Louis Paris E-mail: [email protected] Long term prognosis of patients with cirrhosis Child Pugh A and small HCC ( 5cm) treated by RFA mostly depend of the occurrence of distant recurrence either intrahepatic metastasis or new lesions A better knowledge of factors associated with distant recurrence could help to improve the management of these patients This study aimed to assess factors associated with distant recurrence and survival free recurrence after RFA of HCC ( 5cm) in patients with cirrhosis Child-Pugh A. Patients and Methods: 203 naive patients non eligible for resection (mean age 66.2 years with cirrhosis related to alcohol (72), viral C (105) or B (15), hemochromatosis (5), or others (6) bearing 254 HCCs (mean diameter of 3 cm for the larger nodule (78 nodules 3 cm), 44 bifocal and 3 trifocal forms) were treated by RFA between January 2001 and Jun 2007.The efficacy of the treatment was evaluated by CT scan and serum AFP at 1 month, and every 3 months after complete ablation. In case of incomplete ablation or recurrence, treatment by RFA was performed when possible. Results: A complete ablation was obtained in 189 patients. After a mean follow-up of de 2, 4±1, 8 yrs, 65 patients died (38 related to HCC). 113 patients were alive including 96 without detectable tumor and 25 have been transplanted. Distant recurrence rate was 42% and 75% and overall survival rate 61% and 40% at 3 and 5 yrs respectively. In multivariate analysis, factors associated with distant recurrence were level of AFP OR 1 (1−1) p = 0.01 and multifocal HCC OR = 2.3 (1.4−3.6) p = 0.0003. In patients younger than 65 yrs (n = 82), HCC free survival rate at 3 and 5 yrs was 71% and 55% for patients with unifocal HCC and 50% and 20% for multifocal HCC respectively (p = 0.04) Conclusion: In patients with Child-Pugh A cirrhosis and HCC 5 cm, multifocality is an important prognostic factor of long term HCC free survival. This suggests that liver transplantation could be proposed for patients with cirrhosis Child Pugh A more than one tumor. 399 BONE MARROW STEM CELLS EXPRESSING CD34 ARE MOBILIZED IN DIFFERENT HISTOTYPES OF LIVER CANCER M. Novi1 , E. Rinninella1 , A.C. Piscaglia1 , E.C. Lauritano1 , M.A. Zocco1 , N. Saulnier1 , M.A. Puglisi1 , F. Giuliante2 , F. Barbaro1 , M.L. Serricchio1 , C. Rumi3 , G. Leone3 , G. Nuzzo2 , G. Ghirlanda1 , A. Gasbarrini1 . 1 Internal Medicine, 2 Surgical Sciences, 3 Hematology, Catholic University of Rome, Gemelli Hospital, Rome, Italy E-mail: [email protected] Background and Aim: Several studies have suggested that haemolymphopoietic and solid tumors harbour a population of cells that show typical stem cell properties, such as self-renewal and differentiation potential. These cells seem to sustain the tumor growth and metastases and may also be involved in the cancer neoangiogenesis. CD34 is a well known marker of both haematopoietic stem cells and endothelial precursors within the bone marrow (BM). It has been demonstrated that CD34+ BM cells can migrate from the BM into the peripheral blood and then be recruited by
POSTERS
carcinomas (10), germ cell tumors (6) and in undifferentiated childhood tumors: Wilms tumor (5), neuroblastoma (7), meduloblastoma (5), kidney rhabdoid tumor (1). Results: All the hepatoblastomas were positive for DLK. The staining was mostly focal covering 5−30% of the areas of tumors, the surrounding liver tissue remained negative. The reaction was present always in the epithelial component of the tumors but there was no preferential staining over the fetal or embryonic parts. The staining pattern was membranous and cytoplasmic. The differentiating cells of two ganglioneuroblastomas stained positively, no reaction was observed in any other tumors. Conclusions: DLK immunostaining seems to be a highly sensitive and specific marker for hepatoblastomas. If this primary observation can be confirmed DLK can be used as an immunohistochemical marker for hepatoblastomas. The biological function of DLK in hepatoblastomas requires further studies. However since DLK is a membrane receptor it can be considered a molecular target for therapeutical approaches. This study was supported by ETT 32/2006 and OTKA K67697 397 LONG-TERM RESULTS OF RADIOFREQUENCY ABLATION (RFA) IN PATIENTS WITH CIRRHOSIS AND HCC 5 CM IN DIAMETER G. Nkontchou1 , O. Seror2 , A. Mahamoudi1 , A. Mounir3 , N. Ganne Carrie1 , V. Grando Lemaire1 , E. Vicaut3 , J.C. Trinchet1 , M. Beaugrand1 . 1 Liver Unit, 2 Radiology Unit Hˆ opital Jean Verdier, Assistance PubliqueHˆopitaux de Paris, Bondy, France; 3 U, .URC Hˆopital Lariboisi`ere E-mail: [email protected] This study aims to assess the long-term prognosis of patients with cirrhosis and HCC 5cm treated by RFA. Patients and Methods: From January 2001 to June 2007, among 311 patients with cirrhosis and HCC non eligible for resection treated by RFA, we selected all naive patients with 3 or less HCC 5 cm. 235 patients (mean age 65±10 yrs; cirrhosis classed Child-Pugh A (205) or B (30) related to alcohol (89), viral C (115) or B (16), hemochromatosis (5) or others (10) with 307 HCCs (mean diameter of the large tumor: 29 mm (93 30 mm), 53 bi or trifocal forms). 76 patients were excluded due to tumour size >5 cm (48), recurrence after resection (16) or embolization (12). Efficacy of the treatment was evaluated by CT scan and serum AFP at 1 month, and every 3 months after complete ablation. In case of local recurrence or new lesions, treatment by RFA was performed when possible. Results: A complete ablation was obtained in 222 patients. Three major complications occurred: One death related to chock and renal failure 2 days after the procedure, one neoplastic seeding and one liver abscess. After a mean follow-up of 813±611 days, 82 patients died, including 61 death related to HCC progression, 29 patients were transplanted.124 patients were alive and non transplanted (103 without detectable tumour). In intention-to-treat, overall and HCC free survival rates at 3 and 5 yrs were 60% and 40% and 56% and 31% respectively. In multivariate analysis, factors associated with HCC free survival were: total bilirubin: OR 1.6 (1−2.6) p = 0.04, serum AFP: OR 1 (1−1) p < 0.0001, multifocal tumour: OR 1.8 (1.19−2.6) p = 0.004. In patients with unique HCC and bilirubin 15 Um (n = 82), survival rates at 3 and 5 years were 75% and 61% respectively. Conclusion: RFA of HCC 5cm in patients with cirrhosis non eligible for resection had a low morbidity and high survival rates particularly in patients with a unique HCC and bilirubin 15 uM
398 PREDICTIVE FACTORS OF HCC FREE SURVIVAL IN 203 PATIENTS WITH CIRRHOSIS CLASSED CHILD PUGH A AND HCC ( 5CM) TREATED BY RADIOFREQUENCY ABLATION (RFA) G. Nkontchou1 , O. Seror2 , A. Mahamoudi1 , A. Mounir3 , N. Ganne Carrie1 , V. Grando Lemaire1 , E. Vicaut3 , J.C. Trinchet1 , M. Beaugrand1 . 1 Liver Unit, 2 Radiology Unit, Hˆ opital Jean Verdier, Assistance PubliqueHˆopitaux de Paris, avenue du 14 Juillet, 93140 Bondy, France; 3 U, .URC Hˆopital Saint Louis Paris E-mail: [email protected] Long term prognosis of patients with cirrhosis Child Pugh A and small HCC ( 5cm) treated by RFA mostly depend of the occurrence of distant recurrence either intrahepatic metastasis or new lesions A better knowledge of factors associated with distant recurrence could help to improve the management of these patients This study aimed to assess factors associated with distant recurrence and survival free recurrence after RFA of HCC ( 5cm) in patients with cirrhosis Child-Pugh A. Patients and Methods: 203 naive patients non eligible for resection (mean age 66.2 years with cirrhosis related to alcohol (72), viral C (105) or B (15), hemochromatosis (5), or others (6) bearing 254 HCCs (mean diameter of 3 cm for the larger nodule (78 nodules 3 cm), 44 bifocal and 3 trifocal forms) were treated by RFA between January 2001 and Jun 2007.The efficacy of the treatment was evaluated by CT scan and serum AFP at 1 month, and every 3 months after complete ablation. In case of incomplete ablation or recurrence, treatment by RFA was performed when possible. Results: A complete ablation was obtained in 189 patients. After a mean follow-up of de 2, 4±1, 8 yrs, 65 patients died (38 related to HCC). 113 patients were alive including 96 without detectable tumor and 25 have been transplanted. Distant recurrence rate was 42% and 75% and overall survival rate 61% and 40% at 3 and 5 yrs respectively. In multivariate analysis, factors associated with distant recurrence were level of AFP OR 1 (1−1) p = 0.01 and multifocal HCC OR = 2.3 (1.4−3.6) p = 0.0003. In patients younger than 65 yrs (n = 82), HCC free survival rate at 3 and 5 yrs was 71% and 55% for patients with unifocal HCC and 50% and 20% for multifocal HCC respectively (p = 0.04) Conclusion: In patients with Child-Pugh A cirrhosis and HCC 5 cm, multifocality is an important prognostic factor of long term HCC free survival. This suggests that liver transplantation could be proposed for patients with cirrhosis Child Pugh A more than one tumor. 399 BONE MARROW STEM CELLS EXPRESSING CD34 ARE MOBILIZED IN DIFFERENT HISTOTYPES OF LIVER CANCER M. Novi1 , E. Rinninella1 , A.C. Piscaglia1 , E.C. Lauritano1 , M.A. Zocco1 , N. Saulnier1 , M.A. Puglisi1 , F. Giuliante2 , F. Barbaro1 , M.L. Serricchio1 , C. Rumi3 , G. Leone3 , G. Nuzzo2 , G. Ghirlanda1 , A. Gasbarrini1 . 1 Internal Medicine, 2 Surgical Sciences, 3 Hematology, Catholic University of Rome, Gemelli Hospital, Rome, Italy E-mail: [email protected] Background and Aim: Several studies have suggested that haemolymphopoietic and solid tumors harbour a population of cells that show typical stem cell properties, such as self-renewal and differentiation potential. These cells seem to sustain the tumor growth and metastases and may also be involved in the cancer neoangiogenesis. CD34 is a well known marker of both haematopoietic stem cells and endothelial precursors within the bone marrow (BM). It has been demonstrated that CD34+ BM cells can migrate from the BM into the peripheral blood and then be recruited by