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T1937 Magnitude of B-Viral HCC - Epidemics of B-Viral HCC in Single Institute Experience
AASLD Abstracts
20-mm LeVeen needle percutaneously into the liver, a 21-G PEI needle was placed near the LeVeen needle, and intratumoral pressure was monitored using an invasive blood pressure monitor. Based on the results of the basic study, RFA was performed using the multi-step method (30 W 8-step deployment). 2) PEI. 10 HCC patients with a mean tumor size of 12.7±1.7 mm were studied. Ethanol was injected based on the tumor size (5 to 10 ml for one session), and intratumoral pressure was monitored in the same way as during RFA. CT was performed postoperatively to ensure that adequate ablation was achieved. [Results] A. Basic study: The hepatic parenchymal pressures were: single-step method, 154±30.9 mmHg; multi-step method, 24.1±18.2 mmHg; and PEI, 12.0±8.5 mmHg. B. Clinical study: Intratumoral pressure was 41.3±33.7 mmHg for RFA and 10.1±1.7 mmHg for PEI. Postoperative CT showed that all HCCs were sufficiently ablated. Of note, with the multi-step RFA method, pain could be alleviated during treatment. [Conclusions] PEI was not associated with intratumoral pressure increases. With the single-step RFA method, hepatic parenchymal pressure rapidly increased just before power roll-off. Conversely, with the multi-step RFA method, increases in intrahepatic pressure were suppressed in both the basic and clinical studies. The multi-step RFA method should be used.
contact was obtained in all patients for survival and disease status. Results Eleven (73%) patients presented with hepatic metastases, while 4 developed them at median of 10 months after diagnosis. Patients underwent hepatic biopsy (2), wedge resection (8), segmentectomy (1), bisegmentectomy (2) and lobectomy (2). Resected hepatic histology included: necrosis (40%), viable tumor (27%), mature teratoma (20%) and benign histology (8%). Concomitant resection of extra-hepatic disease (14 patients, 93%) revealed necrosis (53%), mature teratoma (27%) and viable tumor (13%). There was no operative mortality. Five (33%) experienced complications, with one re-operation for diaphragmatic defect. At 8.2 years (median) from hepatic surgery, 11 patients (73%) were alive: 5 with no evidence of disease, 2 with elevated tumor marker only, and 4 with gross disease. Four patients (27%) died at 2.2 years from hepatic surgery (2 of progressive disease, 1 of gastrointestinal hemorrhage, and 1 of unknown cause). The 10-year overall survival was 65% from hepatic surgery and 61% from diagnosis. Conclusion Resection of post-chemotherapy hepatic disease is safe, even when combined with resection of extra-hepatic disease. The absence of reliable selection factors, the varied hepatic histology, and the prolonged survival achieved support a multidisciplinary approach for patients with GCT which includes surgical resection of hepatic metastases.
T1937
T1941
Magnitude of B-Viral HCC - Epidemics of B-Viral HCC in Single Institute Experience Hideo Yoshida, Eriko Goto, Takahisa Sato, Takamasa Ohki, Ryota Masuzaki, Ryosuke Tateishi, Tadashi Goto, Keisuke Hamamura, Fumihiko Kanai, Shuichiro Shiina, Haruhiko Yoshida, Masao Omata
Decreasing Platelet Counts Are Associated with the Risk of Hepatocellular Carcinoma Yoko Toda, Ryosuke Tateishi, Haruhiko Yoshida, Eriko Goto, Takahisa Sato, Takamasa Ohki, Ryota Masuzaki, Tadashi Goto, Hideo Yoshida, Fumihiko Kanai, Keisuke Hamamura, Naoya Kato, Shuichiro Shiina, Takao Kawabe, Masao Omata
AIM To investigate the epidemics of hepatocellularcarcinoma in patients with hepatitis B virus (HBV) infection followed up at single tertiary care center. METHODS Patients with HBV infection followed up for at least 1 year at our center between 1992 and 2005 were included. The development of hepatocellular carcinoma (HCC) during the following up period was observed. Cumulative incidence of HCC was calculated. RESULTS Six-thousand nine patients consulted our center between 1992 and 2005. One-thousand two-hundred ninety patients had HCC at the time of first visit. Six-hundred twenty patients visited at our center for second opinion. Four-thousand ninety-nine patients were followed up for at least one year. Among 4099 patients, 338 patients were HBV positive and hepatitis C virus (HCV) negative. Those patients were observed for median follow up of 4.3 years (range 1.0-14.3 years). Median age of the patients was 47 years old (range 14-79). Two hundred twenty-four patients were male, and 114 were female. Thirty-nine patients developed HCC during follow-up period. Cumulative rate of development of HCC among HBV infected patients (n=338) were 0.9, 5.6, 10.8, and 22.8% at 1, 3, 5, and 10 years, respectively. Patients with high serum albumin level (>4.0g/deciliter) and with high platelet count (>180,000/microliter) showed lower incidence of HCC than patients with low albumin level (4.0 vs 20.0% at 5 year, p=0.0001 by Logrank test) and low platelet count (3.2 vs 17.4% at 5 year, p<0.0001). CONCLUSION The mean incidence of HCC was 2.3% per year in HBV positive patients followed up at our tertiary care center. Serum albumin level and platelet count may have the potential for the prediction of HCC development.
Background & Aims: Low platelet counts are thought to be an indicator of advanced liver fibrosis and reported as a strong predictor of hepatocarcinogenesis in patients with chronic hepatitis C (CH-C). It is not uncommon that the platelet count of a patient with chronic hepatitis decreases substantially during observation. We investigated in this study whether the decrease in platelet count is associated with the risk of hepatocellular carcinoma (HCC) among CH-C patients. Methods: We followed 1431 CH-C patients for an average of 6.1 years and observed 340 HCC (AASLD 2006). For each case a control was selected from patients without HCC, using sex, age, platelet count and serum albumin concentration at the first visit as the matching factors, resulting in 206 matched case-control pairs. Changes in platelet count and albumin are defined as those between the first visit and HCC development in a case, and those between the same interval in the control. Using HCC development as the outcome variable, odds ratios were calculated for changes in platelet count (absolute or relative), changes in albumin concentration, and AST level by using conditional logistic regression. Results: The analysis set included 129 men and 77 women with an average age of 64.3 years. During the average interval of 3.87 years, platelet counts changed from 124.4 (x1000/µL) to 108.2 (P <.0001 by paired t-test, Figure) in the cases and from 124.4 to 126.7 (P = 0.354) in the controls. By conditional logistic regression, the decrease in platelet count was revealed to be associated with HCC with an odds ratio of 1.222 (unit 10 x1000/ µL, 95% CI: 1.004 - 1.431, P = 0.0128) when the baseline count was 120 - 160, and of 1.288 (95% CI: 1.008 - 1.527, P = 0.0035) when > 160. The changes in platelet count were not significantly associated with HCC when the baseline count was below 120. Relative changes in platelet counts led to similar results. Conclusions: Decreasing platelet counts indicate increased risk of HCC development in CH-C patients even when the baseline platelet count was high.
T1939 Prognosis Following Recurrent Therapy After Successful Initial Ablation Therapy for Patients with Unresectable Hepatocellular Carcinoma Manabu Morimoto, Kazushi Numata, Masaaki Kondou, Akihito Nozaki, Takashi Ogura, Ayumi Amano, Katsuaki Tanaka Aim: The aims of this study were to identify prognostic factors in patients who developed recurrent hepatocellular carcinoma (HCC) after initial percutaneous ablation therapy, especially, whether repeat percutaneous ablation therapy contributes to the survival of the patients. Methods: One hundred eighty-three HCC patients received initial percutaneous ablation therapy were retrospectively studied. As initial therapy, 143 patients were received percutaneous radiofrequency ablation, and 40 patients were received percutaneous ethanol injection therapy. Contrast enhanced CT examination in 6 months after the initial therapy proved 36 patients to be evaluated incomplete initial therapy. The prognostic factors and the factors for disease-free survival of 147 patients who were evaluated successful initial therapy were univariately and multivariately analyzed using clinical variables. Results: During a mean follow-up of 33 months, local and/or distant tumor recurrences developed in 77 (52 per cent) of 147 patients with successful initial therapy. Forty-six (60 per cent) of 77 patients had up to 3 recurrent HCC tumors, and received percutaneous ablation therapy as second therapy. Thirty-one (40 per cent) of 77 patients had more than three (multiple) recurrent HCC tumors, and received transcatheter arterial chemoembolization (TACE) as second therapy. Multivariate analysis revealed serum alpha fetoprotein level at HCC recurrence (≥100ng/mL vs 100ng/mL>, P=0.0005) and number of recurrent tumors (up to 3 vs more than 3, P=0.0102) to be independent prognostic factors after recurrent therapy. Diseasefree survival after initial ablation therapy was longer in patients with serum albumin level at initial therapy more than 3.5g/dL (P=0.0096) or Child-Pugh grade A (P=0.0361). Conclusion: Repeat percutaneous ablation therapy for patients with recurrent HCC (up to three tumors) had survival benefits. And good liver function at initial therapy, especially high serum albumin level, contributed to long disease-free survival.
T1942 Prospective Randomized Study Comparing Ultrasound and Tri-Phasic CT Scan for Screening for HCC Among Patients with Cirrhosis: the VA Experience Bilal Hameed, Taimur Khan, Samuel B. Ho, Bashar Aqel, Janet Durfee, Kelly M. McCarthy, Jodi Patterson INTRODUCTION: Hepatocellular carcinoma (HCC) is one of the most frequent primary malignancies of the liver responsible for death, with incidence rates of up to 3-5% in patients with cirrhosis. Early identification of hepatocellular cancer allows consideration of specific treatment options such as resection, chemoembolization, local ablative therapy and liver transplant. Screening strategies have used ultrasound (US) or computed tomography (CT), but which modality is more effective, and cost-effective remains unclear. AIM: The goal of our study was to compare the effectiveness of the two screening methods in combination with AFP testing in the United States veteran population with liver cirrhosis and determine the direct medical costs associated with each screening strategy. METHODS: The study is a prospective ongoing randomized pilot study. Inclusion criteria included, patients with Child-Pugh A liver cirrhosis, Hepatitis C and negative radiological imaging within 12 months of enrollment. Informed consent was obtained from all the patients and then randomized to either a dedicated hepatic US every 6 months or a tri-phasic CT scan annually, with AFP done at 6 month intervals in both arms. Cost analysis was done based on our VA estimates
T1940 Resection of Hepatic Metastases from Germ Cell Tumor: Is It Worth It? Y. Nancy You, Bradley C. Leibovich, Florencia G. Que Background Chemotherapy is highly effective for metastatic germ cell tumor (GCT), but some patients further benefit from surgical resection postchemotherapy. Aims/Objectives To review experience with resection of hepatic metastases from GCT. Methods Between 1975 and 2001, 15 of the 36 male patients with GCT metastatic to the liver underwent hepatic surgery. Response to pre-resection chemotherapy, pathology, short-term (30-day or in-hospital) mortality and morbidity were reviewed. Long-term follow-up to death or last
AASLD Abstracts
A-826
20-mm LeVeen needle percutaneously into the liver, a 21-G PEI needle was placed near the LeVeen needle, and intratumoral pressure was monitored using an invasive blood pressure monitor. Based on the results of the basic study, RFA was performed using the multi-step method (30 W 8-step deployment). 2) PEI. 10 HCC patients with a mean tumor size of 12.7±1.7 mm were studied. Ethanol was injected based on the tumor size (5 to 10 ml for one session), and intratumoral pressure was monitored in the same way as during RFA. CT was performed postoperatively to ensure that adequate ablation was achieved. [Results] A. Basic study: The hepatic parenchymal pressures were: single-step method, 154±30.9 mmHg; multi-step method, 24.1±18.2 mmHg; and PEI, 12.0±8.5 mmHg. B. Clinical study: Intratumoral pressure was 41.3±33.7 mmHg for RFA and 10.1±1.7 mmHg for PEI. Postoperative CT showed that all HCCs were sufficiently ablated. Of note, with the multi-step RFA method, pain could be alleviated during treatment. [Conclusions] PEI was not associated with intratumoral pressure increases. With the single-step RFA method, hepatic parenchymal pressure rapidly increased just before power roll-off. Conversely, with the multi-step RFA method, increases in intrahepatic pressure were suppressed in both the basic and clinical studies. The multi-step RFA method should be used.
contact was obtained in all patients for survival and disease status. Results Eleven (73%) patients presented with hepatic metastases, while 4 developed them at median of 10 months after diagnosis. Patients underwent hepatic biopsy (2), wedge resection (8), segmentectomy (1), bisegmentectomy (2) and lobectomy (2). Resected hepatic histology included: necrosis (40%), viable tumor (27%), mature teratoma (20%) and benign histology (8%). Concomitant resection of extra-hepatic disease (14 patients, 93%) revealed necrosis (53%), mature teratoma (27%) and viable tumor (13%). There was no operative mortality. Five (33%) experienced complications, with one re-operation for diaphragmatic defect. At 8.2 years (median) from hepatic surgery, 11 patients (73%) were alive: 5 with no evidence of disease, 2 with elevated tumor marker only, and 4 with gross disease. Four patients (27%) died at 2.2 years from hepatic surgery (2 of progressive disease, 1 of gastrointestinal hemorrhage, and 1 of unknown cause). The 10-year overall survival was 65% from hepatic surgery and 61% from diagnosis. Conclusion Resection of post-chemotherapy hepatic disease is safe, even when combined with resection of extra-hepatic disease. The absence of reliable selection factors, the varied hepatic histology, and the prolonged survival achieved support a multidisciplinary approach for patients with GCT which includes surgical resection of hepatic metastases.
T1937
T1941
Magnitude of B-Viral HCC - Epidemics of B-Viral HCC in Single Institute Experience Hideo Yoshida, Eriko Goto, Takahisa Sato, Takamasa Ohki, Ryota Masuzaki, Ryosuke Tateishi, Tadashi Goto, Keisuke Hamamura, Fumihiko Kanai, Shuichiro Shiina, Haruhiko Yoshida, Masao Omata
Decreasing Platelet Counts Are Associated with the Risk of Hepatocellular Carcinoma Yoko Toda, Ryosuke Tateishi, Haruhiko Yoshida, Eriko Goto, Takahisa Sato, Takamasa Ohki, Ryota Masuzaki, Tadashi Goto, Hideo Yoshida, Fumihiko Kanai, Keisuke Hamamura, Naoya Kato, Shuichiro Shiina, Takao Kawabe, Masao Omata
AIM To investigate the epidemics of hepatocellularcarcinoma in patients with hepatitis B virus (HBV) infection followed up at single tertiary care center. METHODS Patients with HBV infection followed up for at least 1 year at our center between 1992 and 2005 were included. The development of hepatocellular carcinoma (HCC) during the following up period was observed. Cumulative incidence of HCC was calculated. RESULTS Six-thousand nine patients consulted our center between 1992 and 2005. One-thousand two-hundred ninety patients had HCC at the time of first visit. Six-hundred twenty patients visited at our center for second opinion. Four-thousand ninety-nine patients were followed up for at least one year. Among 4099 patients, 338 patients were HBV positive and hepatitis C virus (HCV) negative. Those patients were observed for median follow up of 4.3 years (range 1.0-14.3 years). Median age of the patients was 47 years old (range 14-79). Two hundred twenty-four patients were male, and 114 were female. Thirty-nine patients developed HCC during follow-up period. Cumulative rate of development of HCC among HBV infected patients (n=338) were 0.9, 5.6, 10.8, and 22.8% at 1, 3, 5, and 10 years, respectively. Patients with high serum albumin level (>4.0g/deciliter) and with high platelet count (>180,000/microliter) showed lower incidence of HCC than patients with low albumin level (4.0 vs 20.0% at 5 year, p=0.0001 by Logrank test) and low platelet count (3.2 vs 17.4% at 5 year, p<0.0001). CONCLUSION The mean incidence of HCC was 2.3% per year in HBV positive patients followed up at our tertiary care center. Serum albumin level and platelet count may have the potential for the prediction of HCC development.
Background & Aims: Low platelet counts are thought to be an indicator of advanced liver fibrosis and reported as a strong predictor of hepatocarcinogenesis in patients with chronic hepatitis C (CH-C). It is not uncommon that the platelet count of a patient with chronic hepatitis decreases substantially during observation. We investigated in this study whether the decrease in platelet count is associated with the risk of hepatocellular carcinoma (HCC) among CH-C patients. Methods: We followed 1431 CH-C patients for an average of 6.1 years and observed 340 HCC (AASLD 2006). For each case a control was selected from patients without HCC, using sex, age, platelet count and serum albumin concentration at the first visit as the matching factors, resulting in 206 matched case-control pairs. Changes in platelet count and albumin are defined as those between the first visit and HCC development in a case, and those between the same interval in the control. Using HCC development as the outcome variable, odds ratios were calculated for changes in platelet count (absolute or relative), changes in albumin concentration, and AST level by using conditional logistic regression. Results: The analysis set included 129 men and 77 women with an average age of 64.3 years. During the average interval of 3.87 years, platelet counts changed from 124.4 (x1000/µL) to 108.2 (P <.0001 by paired t-test, Figure) in the cases and from 124.4 to 126.7 (P = 0.354) in the controls. By conditional logistic regression, the decrease in platelet count was revealed to be associated with HCC with an odds ratio of 1.222 (unit 10 x1000/ µL, 95% CI: 1.004 - 1.431, P = 0.0128) when the baseline count was 120 - 160, and of 1.288 (95% CI: 1.008 - 1.527, P = 0.0035) when > 160. The changes in platelet count were not significantly associated with HCC when the baseline count was below 120. Relative changes in platelet counts led to similar results. Conclusions: Decreasing platelet counts indicate increased risk of HCC development in CH-C patients even when the baseline platelet count was high.
T1939 Prognosis Following Recurrent Therapy After Successful Initial Ablation Therapy for Patients with Unresectable Hepatocellular Carcinoma Manabu Morimoto, Kazushi Numata, Masaaki Kondou, Akihito Nozaki, Takashi Ogura, Ayumi Amano, Katsuaki Tanaka Aim: The aims of this study were to identify prognostic factors in patients who developed recurrent hepatocellular carcinoma (HCC) after initial percutaneous ablation therapy, especially, whether repeat percutaneous ablation therapy contributes to the survival of the patients. Methods: One hundred eighty-three HCC patients received initial percutaneous ablation therapy were retrospectively studied. As initial therapy, 143 patients were received percutaneous radiofrequency ablation, and 40 patients were received percutaneous ethanol injection therapy. Contrast enhanced CT examination in 6 months after the initial therapy proved 36 patients to be evaluated incomplete initial therapy. The prognostic factors and the factors for disease-free survival of 147 patients who were evaluated successful initial therapy were univariately and multivariately analyzed using clinical variables. Results: During a mean follow-up of 33 months, local and/or distant tumor recurrences developed in 77 (52 per cent) of 147 patients with successful initial therapy. Forty-six (60 per cent) of 77 patients had up to 3 recurrent HCC tumors, and received percutaneous ablation therapy as second therapy. Thirty-one (40 per cent) of 77 patients had more than three (multiple) recurrent HCC tumors, and received transcatheter arterial chemoembolization (TACE) as second therapy. Multivariate analysis revealed serum alpha fetoprotein level at HCC recurrence (≥100ng/mL vs 100ng/mL>, P=0.0005) and number of recurrent tumors (up to 3 vs more than 3, P=0.0102) to be independent prognostic factors after recurrent therapy. Diseasefree survival after initial ablation therapy was longer in patients with serum albumin level at initial therapy more than 3.5g/dL (P=0.0096) or Child-Pugh grade A (P=0.0361). Conclusion: Repeat percutaneous ablation therapy for patients with recurrent HCC (up to three tumors) had survival benefits. And good liver function at initial therapy, especially high serum albumin level, contributed to long disease-free survival.
T1942 Prospective Randomized Study Comparing Ultrasound and Tri-Phasic CT Scan for Screening for HCC Among Patients with Cirrhosis: the VA Experience Bilal Hameed, Taimur Khan, Samuel B. Ho, Bashar Aqel, Janet Durfee, Kelly M. McCarthy, Jodi Patterson INTRODUCTION: Hepatocellular carcinoma (HCC) is one of the most frequent primary malignancies of the liver responsible for death, with incidence rates of up to 3-5% in patients with cirrhosis. Early identification of hepatocellular cancer allows consideration of specific treatment options such as resection, chemoembolization, local ablative therapy and liver transplant. Screening strategies have used ultrasound (US) or computed tomography (CT), but which modality is more effective, and cost-effective remains unclear. AIM: The goal of our study was to compare the effectiveness of the two screening methods in combination with AFP testing in the United States veteran population with liver cirrhosis and determine the direct medical costs associated with each screening strategy. METHODS: The study is a prospective ongoing randomized pilot study. Inclusion criteria included, patients with Child-Pugh A liver cirrhosis, Hepatitis C and negative radiological imaging within 12 months of enrollment. Informed consent was obtained from all the patients and then randomized to either a dedicated hepatic US every 6 months or a tri-phasic CT scan annually, with AFP done at 6 month intervals in both arms. Cost analysis was done based on our VA estimates
T1940 Resection of Hepatic Metastases from Germ Cell Tumor: Is It Worth It? Y. Nancy You, Bradley C. Leibovich, Florencia G. Que Background Chemotherapy is highly effective for metastatic germ cell tumor (GCT), but some patients further benefit from surgical resection postchemotherapy. Aims/Objectives To review experience with resection of hepatic metastases from GCT. Methods Between 1975 and 2001, 15 of the 36 male patients with GCT metastatic to the liver underwent hepatic surgery. Response to pre-resection chemotherapy, pathology, short-term (30-day or in-hospital) mortality and morbidity were reviewed. Long-term follow-up to death or last
AASLD Abstracts
A-826