- Email: [email protected]
997 RETROSPECTIVE ANALYSIS OF 191 PATIENTS WITH ADVANCED HEPATOCELLULAR CARCINOMA TREATED WITH TRANSARTERIAL CHEMOEMBOLISATION (TACE): VALIDATION OF THE ESTABLISHED AND CONSTRUCTION OF AN IMPROVED HCC-STAGING-SYSTEM
POSTERS of DOB peak. We suggest the cut off value of DOB peak at 20. This method is non-invasive, non-toxic, direct method to assess liver function with high predictive and dynamic range in regard to residual liver function. The sensitivity of the methacetin test to predict post-operative complications were 83%, and the specificity stands at 85% with PPV (Positive Predictive Value)=83%, and NPV (Negative Predictive Value)=85% respectively. The most common post-operative complications we encountered were ascitis and wound infections. 997 RETROSPECTIVE ANALYSIS OF 191 PATIENTS WITH ADVANCED HEPATOCELLULAR CARCINOMA TREATED WITH TRANSARTERIAL CHEMOEMBOLISATION (TACE): VALIDATION OF THE ESTABLISHED AND CONSTRUCTION OF AN IMPROVED HCC-STAGING-SYSTEM M. op den Winkel1 , D. Nagel2 , P. op den Winkel1 , J. Sappl1 , G. Straub1 , R. Lamerz1 , C. Zech3 , P. Stieber2 , F.T. Kolligs1 . 1 Medical Department 2, LMU Munich, Campus Grosshadern, 2 Department of Clinical Chemistry, LMU-Munich, Campus Grosshadern, 3 Department of Radiology, LMU Munich, Campus Grosshadern, Munich, Germany E-mail: [email protected] Background and Aims: The major fraction of HCC-patients is amenable for palliative treatment options only, e.g. TACE. Several prognostic models, developed in sometimes inhomogeneous patient-populations, exist for HCC. By applying the established staging systems, we analyzed survival rates of patients treated with TACE in order to determine which of the staging systems is most suitable for predicting survival in this well-defined HCC-patient population. Furthermore we aimed at developing a new, superior score. Methods: HCC-Patients treated at Munich’s University hospital from 2000 to 2009 were identified from an electronic medical record database. The following seven staging systems were ranked according to their ability to predict survival by using the Akaike Information Criterion (AIC) in Cox regression analysis: BCLC, CLIP, GETCH, JIS, Okuda, TNM sixth edition and Child– Pugh. Furthermore, every single variable of the staging systems and additional laboratory parameters were tested in uni- and multivariate analysis. Results: 405 patients with HCC were identified. 215 received TACE as the primary mode of therapy with 191 patients showing sufficient data to be included in the final evaluation. Overall median survival was 20 months (95% CI 16–26 months, range 1– 108 months). Kaplan–Meier analysis showed significantly different strata within all of the staging systems. Tumor extension, number of tumor nodes, ascites, AFP, GOT, LDH and CRP were negative prognostic indicators. In Cox regression analysis all of the scores remained significant with CLIP, GETCH and JIS showing the best AICvalues (1112, 1116 and 1120 respectively). AFP and CRP remained statistically significant in multivariate analysis, whereas this was not the case for any of the clinical or tumor-characteristics. The best prognostic model could be achieved by combining the JISscore with CRP and AFP (AIC 1079) or by construction of a new score with albumin, bilirubin, TNM and again CRP and AFP (AIC 1077). Conclusions: Analysis of HCC-patients treated with TACE showed clear difference in survival among the different prognostic strata of the tested staging systems. CLIP, GETCH and JIS were the three top-ranked prognostic scores. Especially the JIS-score could be further optimized by adding CRP and AFP. Prospective and external evaluation of this new score is currently underway.
998 PATHOLOGICAL CLASSIFICATION OF PRIMARY MALIGNANT LIVER TUMORS BY MALDI IMAGING S. Ben-Harzallah1 , S. Laouirem1 , N. Guedj1,2 , J. Lefaouder1 , J. Belghiti3 , P. Bedossa1,2 , V. Paradis1,2 . 1 Inserm U773 CRB3 Beaujon, 2 Pathology Dpt, 3 Liver Surgery, Beaujon Hospital, Clichy, France E-mail: [email protected] Introduction: MALDI imaging mass spectrometry is a new promising tool of in situ proteomics providing the spatial resolution of extensive protein profiles of whole tissue sections. The aim of the study was to evaluate performance of MALDI imaging in the diagnosis of primary malignant tumors of the liver. Patients and Methods: Tissue specimens were obtained from primary malignant tumors of the liver including: 12 hepatocellular carcinomas (HCC) developed on cirrhosis and 17 cholangiocarcinomas (CC). Among them, 12 CC were peripheral (6 associated with cirrhsosis and 6 occuring on normal liver), 4 were hilar and 1 case was diagnosed as hepatocholangiocarcinoma. Tissue MALDI imaging was obtained from representative cryosection of tumor samples. The in situ proteome expression was analyzed by MALDI imaging in combination with hierarchical clustering. MALDI measurement and image analysis was carried out using the flexImaging 2.1 and ClinProTools 2.2 software. Statistical analyses were carried out using ClinProTools 2.2 software. Following the MALDI imaging experiment, the same sections were stained with H&E and scanned. Results: Comparison of protein profiles obtained from HCC and peripheral CC identified a set of 13 proteins differentially expressed (p < 0.003), all them overexpressed in HCC. A set of 18 differential protein peaks (p < 0.0004) were found between HCC and hilar CC. Spectra of the 3 tumor groups (HCC, peripheral and hilar CC) were further clustered by similarity in a hierarchical dendrogram. This dendrogram displayed 2 main branches, one corresponding to hilar CC and 1 grouping all intraparenchymal carcinomas. This latter group was then subdivided into 2 classes (HCC and peripheral CC whatever the aspect of non tumoral liver). Interestingly the hepatocholangiocarcinoma clustered within the group of HCC and only one tumor was misclassified. Conclusion: This study demonstrates the interesting input of MALDI imaging in the pathological diagnosis by identifying new potential tumor specific biomarkers and accurately classifying primary malignant tumors of the liver. Our results also confirm the phenotypical difference between hilar and peripheral CC and suggest that peripheral CC are homogeneous whatever the aspect of non tumoral liver. 999 THE PROGNOSTIC ROLES OF PREOPERATIVE AFP AND PIVKA-II IN PATIENTS WITH HEPATOCELLULAR CARCINOMA UNDERGOING HEPATECTOMY (CURATIVE RESECTION) J.Y. Park, M.H. Lee, G.H. Choi, D.Y. Kim, S.H. Ahn, K.S. Kim, J.S. Choi, K.-H. Han, C.Y. Chon. Yonsei University College of Medicine, Seoul, Republic of Korea E-mail: [email protected] Background: The clinical role of a-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) as predictors of treatment outcomes in patients with hepatocellular carcinoma (HCC) undergoing hepatectomy are unclear. This study investigated whether preoperative AFP and PIVKA-II can predict treatment outcomes. Methods: We evaluated 630 patients with HCC who underwent hepatectomy between January 2001 and December 2007. From these, we excluded 282 patients for exclusion criteria. Finally, 348 patients were enrolled into current study. The patients received dynamic computed tomography or magnetic resonance imaging every 3 months for at least the first 5 years after hepatectomy.
Journal of Hepatology 2011 vol. 54 | S363–S534
S397
998 PATHOLOGICAL CLASSIFICATION OF PRIMARY MALIGNANT LIVER TUMORS BY MALDI IMAGING S. Ben-Harzallah1 , S. Laouirem1 , N. Guedj1,2 , J. Lefaouder1 , J. Belghiti3 , P. Bedossa1,2 , V. Paradis1,2 . 1 Inserm U773 CRB3 Beaujon, 2 Pathology Dpt, 3 Liver Surgery, Beaujon Hospital, Clichy, France E-mail: [email protected] Introduction: MALDI imaging mass spectrometry is a new promising tool of in situ proteomics providing the spatial resolution of extensive protein profiles of whole tissue sections. The aim of the study was to evaluate performance of MALDI imaging in the diagnosis of primary malignant tumors of the liver. Patients and Methods: Tissue specimens were obtained from primary malignant tumors of the liver including: 12 hepatocellular carcinomas (HCC) developed on cirrhosis and 17 cholangiocarcinomas (CC). Among them, 12 CC were peripheral (6 associated with cirrhsosis and 6 occuring on normal liver), 4 were hilar and 1 case was diagnosed as hepatocholangiocarcinoma. Tissue MALDI imaging was obtained from representative cryosection of tumor samples. The in situ proteome expression was analyzed by MALDI imaging in combination with hierarchical clustering. MALDI measurement and image analysis was carried out using the flexImaging 2.1 and ClinProTools 2.2 software. Statistical analyses were carried out using ClinProTools 2.2 software. Following the MALDI imaging experiment, the same sections were stained with H&E and scanned. Results: Comparison of protein profiles obtained from HCC and peripheral CC identified a set of 13 proteins differentially expressed (p < 0.003), all them overexpressed in HCC. A set of 18 differential protein peaks (p < 0.0004) were found between HCC and hilar CC. Spectra of the 3 tumor groups (HCC, peripheral and hilar CC) were further clustered by similarity in a hierarchical dendrogram. This dendrogram displayed 2 main branches, one corresponding to hilar CC and 1 grouping all intraparenchymal carcinomas. This latter group was then subdivided into 2 classes (HCC and peripheral CC whatever the aspect of non tumoral liver). Interestingly the hepatocholangiocarcinoma clustered within the group of HCC and only one tumor was misclassified. Conclusion: This study demonstrates the interesting input of MALDI imaging in the pathological diagnosis by identifying new potential tumor specific biomarkers and accurately classifying primary malignant tumors of the liver. Our results also confirm the phenotypical difference between hilar and peripheral CC and suggest that peripheral CC are homogeneous whatever the aspect of non tumoral liver. 999 THE PROGNOSTIC ROLES OF PREOPERATIVE AFP AND PIVKA-II IN PATIENTS WITH HEPATOCELLULAR CARCINOMA UNDERGOING HEPATECTOMY (CURATIVE RESECTION) J.Y. Park, M.H. Lee, G.H. Choi, D.Y. Kim, S.H. Ahn, K.S. Kim, J.S. Choi, K.-H. Han, C.Y. Chon. Yonsei University College of Medicine, Seoul, Republic of Korea E-mail: [email protected] Background: The clinical role of a-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) as predictors of treatment outcomes in patients with hepatocellular carcinoma (HCC) undergoing hepatectomy are unclear. This study investigated whether preoperative AFP and PIVKA-II can predict treatment outcomes. Methods: We evaluated 630 patients with HCC who underwent hepatectomy between January 2001 and December 2007. From these, we excluded 282 patients for exclusion criteria. Finally, 348 patients were enrolled into current study. The patients received dynamic computed tomography or magnetic resonance imaging every 3 months for at least the first 5 years after hepatectomy.
Journal of Hepatology 2011 vol. 54 | S363–S534
S397