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236 Genotype C hepatitis B virus infection is associated with increased risk of hepatocellular carcinoma. A prospective cohort study
Category 3: Liver Tumors (Epidemiology, Diagnosis, Management) were 34% and 19%, respectively. Five major complications and 25 minor complications were observed. In three patients portal vein thrombosis occurred after treatment. Conclusions: Survival of patients with HCC treated by RFTA is related to baseline albumin and platelet levels and to tumor size. The high rate of recurrence (both local and distant) points out the palliative role of this therapy.
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gender, HBeAg status and ALT levels did not predict HCC development. Patients infected with genotype C HBV tend to have persistently positive HBeAg or fluctuating HBeAg status and higher ALT levels during the follow-up period. Conclusion: Genotype C HBV infection is an independent risk factor for HCC development on top of liver cirrhosis.
237 RADIOFREQUENCY ABLATION VERSUS SURGICAL 235 IT IS FEASIBLE TO EXPAND THE HEAPTOCELLULAR CARCINOMA CRITERIA TO LIVER TRANSPLANTATION?
RESECTION IN THE TREATMENT OF HEPATOCELLULAR CARCINOMA; RETROSPECTIVE COMPARATIVE STUDY
E. Carrera 1 , L. Cid-Gomez 1 , M. Garcia-Gonzalez 1 , R. Barcena 1 , G. Plaza 1 , J.R. Foruny 1 , J. Nuno 2 , E. Vicente 2 , A. Garcia‘Plaza 1 . 1 Gastroenterology. Ramon Y Cajal Hospital, Madrid, v; 2 Surgery Department. Ramon Y Cajal Hospital, Madrid, Spain
C.M. Cho 1 , K.T. Kwon 1 , D.S. Lee 1 , S.W. Jeon 1 , Y.D. Lee 1 , M.K. Lee 1 , H.-E. Seo 1 , C.K. Park 1 , W.Y. Tak 1 , Y.O. Kweon 1 , S.K. Kim 1 , Y.H. Choi 1 , Y.J. Hwang 2 , Y.I.L. Kim 2 . 1 Dept of Internal Medicine, 2 Dept of Surgery, Kyungpook National Univ. Hospital, Daegu, South Korea
Liver transplantation (LT) is the optimal treatment for liver hepatocarcinoma (HCC). Unilobular node < than 5 cm or three tumors < than 3 cm were criteria more frequently used. Expanded criteria (nodule < than 6.5 cm or multiple nodules until 8 cm in all) are under evaluation. Aim: to evaluate survival in patients with liver HCC and mortality in waiting list, before an hypotetical change to expanded criteria for HCC LT. Material and Methods: Between 1994-October 2003, 453 LT was performed, 68 of them were HC. Ultrasound, dual phase helical computed tomography scan, magnetic resonance imaging with gadolinium or arteriography were obtained routinely. Waiting list mortality in our Unit and in Spain of 2002 were obtained. Results: Global HCC mortality was 36.7% (25/68, mean time observed 33.23, range 2 days to 120 months, 8 of them secondary to recurrence, 11.76%). Pathologic tumor staging of the explanted liver changed to T4 in 15 patients (22%) with a 13.3% recurrence. 2001 to 2002 mortality, time in waiting list and dropout increase from 15% to 22%, 5 to 8 month and 5 to 9% respectively, despite of liver donor increase from 972 to 1033 (9.4%). 2002 mortality and time in waiting list in Spain were 9.5% and 4 month. Conclusions: Results of recurrence made feasible to expand HCC for LT criteria, but with a negative impact in mortality, time in waiting list and probabilities of dropout.
Background/Aims: Surgical resection remains the gold standard therapy for hepatocellular carcinoma. Unfortunately, only selected patients can undergo resection because of the underlying cirrhosis or the diffuse distribution of the tumor. Also, recurrence is common in the remnant. Radiofrequency ablation (RFA) is gaining increasing attention as an alternative to standard surgical therapies. We compared the results of RFA and surgical resection in the treatment of HCC. Patients and methods: From January 2000 to December 2002, one hundred-sixty patients who underwent surgical resection or RFA at our hospital were analyzed. The patients with tumor size less than 5 cm in diameter, less than 3 tumors in number, Child Pugh class A, and no evidence of extrahepatic metastasis were enrolled. The recurrence pattern was classified into two: local recurrence and distant recurrence. Sixty-one patients were treated by surgical resection at that period and 99 patients were ablated by percutaneously. We compared the recurrence pattern and survival rates between two groups. Results: 1) The local recurrence rate is 9.8% after surgical resection and 18.2% after RFA and distant recurrence rate is 32.8% and 28.3%, respectively. 2) The 1-, 2-, and 3-year overall cumulative survival rates after RFA and surgery were 95.8, 86.8, 80.0, 98.3, 87.0, and 77.4%, respectively. 3) The incidence of complication is 6.5% after surgical resection and 5.0% after RFA, respectively. Conclusions: Radiofrequency ablation shows comparative results as to surgical resection in the treatment of HCC. However, recurrence after RFA is frequent. Therefore, alternative treatment is required instead of both therapeutic procedures.
236 GENOTYPE C HEPATITIS B VIRUS INFECTION IS ASSOCIATED WITH INCREASED RISK OF HEPATOCELLULAR CARCINOMA. A PROSPECTIVE COHORT STUDY.
H.L.Y. Chan, A.Y. Hui, M.L. Wong, A.M.L. Tse, L.C.T. Hung, V.W.S. Wong, J.J.Y. Sung. Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Background: Identification of risk factors of hepatocellular carcinoma (HCC) is important for surveillance program in chronic hepatitis B virus (HBV) infection. We aimed to study the independent risk factors and the effect of HBV genotypes for HCC development in a prospective longitudinal cohort of chronic hepatitis B patients. Patients and Methods: Chronic hepatitis B patients recruited since 1997 in hepatitis clinic were prospectively followed up for the development of HCC. HCC was diagnosed by a combination of alfa-fetoprotein, imaging and histology. Liver cirrhosis was defined as ultrasonic features of cirrhosis together with hypersplenism, ascites, varices and/or encephalopathy. Results: In total, 426 patients were followed up for 1664 person-year; median 225 (range 12 to 295) weeks. 49 (11%) patients had underlying clinical liver cirrhosis. 242 (57%) and 179 (42%) patients had genotype C and B HBV respectively. 25 patients developed HCC in a median followup 121 (range 14 to 236) weeks. The overall incidence of HCC was 1502 cases per 100,000 person-year. On multivariate analysis, clinical liver cirrhosis and genotype C HBV infection were independently associated with HCC development with adjusted relative risk of 7.61 (95% CI 3.26-17.70, p<0.001) and 2.58 (95% CI 1.02-6.50, p=0.045) respectively. Patient age,
238 RADIOFREQUENCY ABLATION VS. SURGICAL RESECTION IN THE TREATMENT OF SMALL HEPATOCELLULAR CARCINOMA - A COMPARATIVE STUDY -
M.S. Choi 1 , S.N. Hong 1 , J.H. Lee 1 , K.C. Koh 1 , S.W. Paik 1 , B.C. Yoo 1 , J.C. Rhee 1 , D. Choi 2 , H.K. Lim 2 , J.W. Joh 3 . 1 Department of Medicine, 2 Department of Radiology, 3 Department of Surgery, Sungkyunkwan University School of Medicine/Samsung Medical Center, Seoul, Korea Background/Aims: The aim of this study was to compare the therapeutic efficacy of radiofrequency ablation (RFA) and surgical resection in the treatment of small hepatocellular carcinoma (HCC). Methods: To minimize the effect of tumor burden and hepatic impairment, we selected patients with a Child–Pugh score 5 and small HCC nodules (three or less, each 3 cm or smaller). Sixty-two patients treated by RFA and 102 who underwent hepatic resection were enrolled. The median follow-up was 29 months. Results: The local recurrence rate in the RFA group was high compared with that in the surgery group (11.3% vs. 2.0%, p = 0.011). There was no significant difference in the remote recurrence rate between the groups (53.7% vs. 45.3%, p = 0.958). The one- and three-year overall survival rates in the RFA group were 100% and 73.9%, and those in the surgery group were 97.1% and 83.0%, respectively (p = 0.754). The one- and three-year
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gender, HBeAg status and ALT levels did not predict HCC development. Patients infected with genotype C HBV tend to have persistently positive HBeAg or fluctuating HBeAg status and higher ALT levels during the follow-up period. Conclusion: Genotype C HBV infection is an independent risk factor for HCC development on top of liver cirrhosis.
237 RADIOFREQUENCY ABLATION VERSUS SURGICAL 235 IT IS FEASIBLE TO EXPAND THE HEAPTOCELLULAR CARCINOMA CRITERIA TO LIVER TRANSPLANTATION?
RESECTION IN THE TREATMENT OF HEPATOCELLULAR CARCINOMA; RETROSPECTIVE COMPARATIVE STUDY
E. Carrera 1 , L. Cid-Gomez 1 , M. Garcia-Gonzalez 1 , R. Barcena 1 , G. Plaza 1 , J.R. Foruny 1 , J. Nuno 2 , E. Vicente 2 , A. Garcia‘Plaza 1 . 1 Gastroenterology. Ramon Y Cajal Hospital, Madrid, v; 2 Surgery Department. Ramon Y Cajal Hospital, Madrid, Spain
C.M. Cho 1 , K.T. Kwon 1 , D.S. Lee 1 , S.W. Jeon 1 , Y.D. Lee 1 , M.K. Lee 1 , H.-E. Seo 1 , C.K. Park 1 , W.Y. Tak 1 , Y.O. Kweon 1 , S.K. Kim 1 , Y.H. Choi 1 , Y.J. Hwang 2 , Y.I.L. Kim 2 . 1 Dept of Internal Medicine, 2 Dept of Surgery, Kyungpook National Univ. Hospital, Daegu, South Korea
Liver transplantation (LT) is the optimal treatment for liver hepatocarcinoma (HCC). Unilobular node < than 5 cm or three tumors < than 3 cm were criteria more frequently used. Expanded criteria (nodule < than 6.5 cm or multiple nodules until 8 cm in all) are under evaluation. Aim: to evaluate survival in patients with liver HCC and mortality in waiting list, before an hypotetical change to expanded criteria for HCC LT. Material and Methods: Between 1994-October 2003, 453 LT was performed, 68 of them were HC. Ultrasound, dual phase helical computed tomography scan, magnetic resonance imaging with gadolinium or arteriography were obtained routinely. Waiting list mortality in our Unit and in Spain of 2002 were obtained. Results: Global HCC mortality was 36.7% (25/68, mean time observed 33.23, range 2 days to 120 months, 8 of them secondary to recurrence, 11.76%). Pathologic tumor staging of the explanted liver changed to T4 in 15 patients (22%) with a 13.3% recurrence. 2001 to 2002 mortality, time in waiting list and dropout increase from 15% to 22%, 5 to 8 month and 5 to 9% respectively, despite of liver donor increase from 972 to 1033 (9.4%). 2002 mortality and time in waiting list in Spain were 9.5% and 4 month. Conclusions: Results of recurrence made feasible to expand HCC for LT criteria, but with a negative impact in mortality, time in waiting list and probabilities of dropout.
Background/Aims: Surgical resection remains the gold standard therapy for hepatocellular carcinoma. Unfortunately, only selected patients can undergo resection because of the underlying cirrhosis or the diffuse distribution of the tumor. Also, recurrence is common in the remnant. Radiofrequency ablation (RFA) is gaining increasing attention as an alternative to standard surgical therapies. We compared the results of RFA and surgical resection in the treatment of HCC. Patients and methods: From January 2000 to December 2002, one hundred-sixty patients who underwent surgical resection or RFA at our hospital were analyzed. The patients with tumor size less than 5 cm in diameter, less than 3 tumors in number, Child Pugh class A, and no evidence of extrahepatic metastasis were enrolled. The recurrence pattern was classified into two: local recurrence and distant recurrence. Sixty-one patients were treated by surgical resection at that period and 99 patients were ablated by percutaneously. We compared the recurrence pattern and survival rates between two groups. Results: 1) The local recurrence rate is 9.8% after surgical resection and 18.2% after RFA and distant recurrence rate is 32.8% and 28.3%, respectively. 2) The 1-, 2-, and 3-year overall cumulative survival rates after RFA and surgery were 95.8, 86.8, 80.0, 98.3, 87.0, and 77.4%, respectively. 3) The incidence of complication is 6.5% after surgical resection and 5.0% after RFA, respectively. Conclusions: Radiofrequency ablation shows comparative results as to surgical resection in the treatment of HCC. However, recurrence after RFA is frequent. Therefore, alternative treatment is required instead of both therapeutic procedures.
236 GENOTYPE C HEPATITIS B VIRUS INFECTION IS ASSOCIATED WITH INCREASED RISK OF HEPATOCELLULAR CARCINOMA. A PROSPECTIVE COHORT STUDY.
H.L.Y. Chan, A.Y. Hui, M.L. Wong, A.M.L. Tse, L.C.T. Hung, V.W.S. Wong, J.J.Y. Sung. Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Background: Identification of risk factors of hepatocellular carcinoma (HCC) is important for surveillance program in chronic hepatitis B virus (HBV) infection. We aimed to study the independent risk factors and the effect of HBV genotypes for HCC development in a prospective longitudinal cohort of chronic hepatitis B patients. Patients and Methods: Chronic hepatitis B patients recruited since 1997 in hepatitis clinic were prospectively followed up for the development of HCC. HCC was diagnosed by a combination of alfa-fetoprotein, imaging and histology. Liver cirrhosis was defined as ultrasonic features of cirrhosis together with hypersplenism, ascites, varices and/or encephalopathy. Results: In total, 426 patients were followed up for 1664 person-year; median 225 (range 12 to 295) weeks. 49 (11%) patients had underlying clinical liver cirrhosis. 242 (57%) and 179 (42%) patients had genotype C and B HBV respectively. 25 patients developed HCC in a median followup 121 (range 14 to 236) weeks. The overall incidence of HCC was 1502 cases per 100,000 person-year. On multivariate analysis, clinical liver cirrhosis and genotype C HBV infection were independently associated with HCC development with adjusted relative risk of 7.61 (95% CI 3.26-17.70, p<0.001) and 2.58 (95% CI 1.02-6.50, p=0.045) respectively. Patient age,
238 RADIOFREQUENCY ABLATION VS. SURGICAL RESECTION IN THE TREATMENT OF SMALL HEPATOCELLULAR CARCINOMA - A COMPARATIVE STUDY -
M.S. Choi 1 , S.N. Hong 1 , J.H. Lee 1 , K.C. Koh 1 , S.W. Paik 1 , B.C. Yoo 1 , J.C. Rhee 1 , D. Choi 2 , H.K. Lim 2 , J.W. Joh 3 . 1 Department of Medicine, 2 Department of Radiology, 3 Department of Surgery, Sungkyunkwan University School of Medicine/Samsung Medical Center, Seoul, Korea Background/Aims: The aim of this study was to compare the therapeutic efficacy of radiofrequency ablation (RFA) and surgical resection in the treatment of small hepatocellular carcinoma (HCC). Methods: To minimize the effect of tumor burden and hepatic impairment, we selected patients with a Child–Pugh score 5 and small HCC nodules (three or less, each 3 cm or smaller). Sixty-two patients treated by RFA and 102 who underwent hepatic resection were enrolled. The median follow-up was 29 months. Results: The local recurrence rate in the RFA group was high compared with that in the surgery group (11.3% vs. 2.0%, p = 0.011). There was no significant difference in the remote recurrence rate between the groups (53.7% vs. 45.3%, p = 0.958). The one- and three-year overall survival rates in the RFA group were 100% and 73.9%, and those in the surgery group were 97.1% and 83.0%, respectively (p = 0.754). The one- and three-year