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256 JIS scoring system combined with 3 tumor makers (modified JIS score) is an exellent prognostic staging system for hepatocellular carcinoma (HCC): Analysis of 4525 patients with HCC
80
Poster Sessions
Material and methods: 12 human HCC and 12 colon metastasis sample were examined by real-time RT-PCR for expression of claudin 1-5 and 7. Relative quantification was utilized using GAPDH as internal control. The HCC samples did not show nuclear staining for beta-catenin indicating activation of the wnt pathway. Results: Claudin 4 in HCCs was found downregulated 42 folds and 33 folds compared to normal livers and metastases, respectively. Claudin 2 showed 26 fold downregulation in comparison to normal liver, however, there was no significant expressional difference to metastases. Claudin 2 was 7 fold downregulated in HCCs compared to surrounding nontumorous liver, while non significant 9 fold downregulation was found between metastases and normal liver. Claudin 1 was upregulated 4.5 fold in HCCs compared to metastases. Claudin 7 was upregulated in HCCs and metastases 9 and 8 fold, respectively. These results however, were slightly out of significance. Conclusion: Taken together, claudin-4 expression was markedly downregulated in HCCs contrary to metastases and normal liver. On the other hand pronounced downregulation of claudin-2 was found significant between HCCs and normal liver. These findings are not associated with the activation of the wnt pathway. The project was supported by grants: Bio14/2001, NKFP-1/0023/2002, ETT- 228/201.
The median post-transplant follow-up: 33 (10-111) months. The 1 and 5 year survival: 81% and 62%. HCC recurrence was observed in 12 (11.5%) patients. The 1 and 5 year recurrence-free survival were 93% and 83%. HCC recurrence was observed in 12% of patients who fulfilled the Milan criteria and in 22% of patients who didn’t. For prediction of HCC recurrence, the Milan criteria had: sensitivity 67%, specificity 55%, PPV 90%, NPV 21%. HCC recurrence was observed in 3/3 (100%) patients with a single nodule of largest diameter >5cm, in 3/20 (15%) patients with ≤ 3 nodules with the largest diameter < 3 cm and in 0/5 (0%) patients with more than 3 nodules. Tumour differentiation, satellitosis, serum AFP predicted recurrence free survival. 95% and 92% one and 5 year recurrence-free survival were observed for the 86 patients who had (a) a single nodule up to 5 cm, (b) up to 3 nodules all < 4.5 cm, (c) more than 3 nodules < to 2.5 cm. For those not fulfilling these criteria, the 1 and 5 year recurrence-free survival were 75% and 54%. Conclusion: The Milan criteria can be extended to permit transplantation of a greater number of HCC patients. Tumour size appears more important than tumour number
256 JIS SCORING SYSTEM COMBINED WITH 3 TUMOR MAKERS 254 PERCUTANEOUS ULTRASOUND-GUIDED RADIOFREQUENCY ABLATION WITH ARTIFICIAL PLEURAL EFFUSION FOR HEPATOCELLULAR CARCINOMA LOCATED UNDER THE DIAPHRAGM
M. Koda, M. Ueki, Y. Maeda, K. Mimura, K. Okamoto, Y. Matsunaga, M. Kawakami, K. Hosho, Y. Murawaki. Second Department of Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan [Objective] Ultrasound -guided radiofrequency ablation is performed as one of the effective treatments for hepatocellular carcinoma. However, the localization of tumor is a major limiting factor in the use of the Ultrasound -guided procedure. Ultrasound examination with artificial pleural effusion improved the visualization of hepatocellular carcinoma under the diaphragm. We investigated the safety, benefits and local efficacy of radiofrequency ablation with artificial pleural effusion. [Methods] Twentyfive lesions in 23 patients were performed by radiofrequency ablation with artificial pleural effusion, which was injected 5% glucose solution into the pleural cavity. [Results] The benefits of artificial pleural effusion were as follows: making possible the visualization of a tumor that was invisible in 7 lesions, making possible the visualization of the whole tumor that was only partially visible in 15 lesions and ensuring the safety of the puncture line in 14 lesions. In 23 (92%) of 25 lesions, at least one of these benefits was obtained. Complete necrosis was obtained in 22 (88%) of 25 lesions. During a mean follow up period of 10.6 ± 6.5 months, local recurrence at the ablation site was diagnosed in one (4.5%) of 22 lesions. Mild cough in 3 patients and mild dyspnea in 2 patients were observed as adverse effects due to artificial pleural effusion, but these were temporary. The oxygen saturation of blood during artificial pleural effusion was slightly decreased. [Conclusion] Radiofrequency ablation with artificial pleural effusion is a safe and beneficial treatment option that offers excellent local control of hepatocellular carcinoma under the diaphragm.
255 PRIMARY HEPATOCELLULAR CANCER (HCC) IN THE EXPLANTED LIVER: OUTCOME OF TRANSPLANTATION AND RISK FACTORS FOR HCC RECURRENCE
L.A. Kondili, A. Lala, B. Gunson, S. Hubscher, S. Olliff, S. Bramhall, D. Mutimer. Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Birmingham, UK The clinical records of patients with HCC in the explanted liver during the past decade were examined. Clinical and histological risk factors for post-transplant HCC recurrence and survival rates were evaluated. 104 explanted livers contained HCC, 27 (26%) were not identified pre-transplant.
(MODIFIED JIS SCORE) IS AN EXELLENT PROGNOSTIC STAGING SYSTEM FOR HEPATOCELLULAR CARCINOMA (HCC): ANALYSIS OF 4525 PATIENTS WITH HCC
M. Kudo 1 , H. Chung 2 , Y. Osaki 3 , H. Oka 4 , H. Kasugai 5 , Y. Sasaki 6 , T. Seki 7 . 1 Dept. of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan; 2 Dept. of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan; 3 Dept. of Gastroenterology, Osaka Red Cross Hospital, Osaka, Japan; 4 Dept. of Gastroenterology, Osaka City General Medical Center, Osaka, Japan; 5 Dept. of Gastroenterology, Osaka Medical Center For Cancer and CVD, Osaka, Japan; 6 Dept. Surgery, Osaka Medical Center For Cancer and CVD, Osaka, Japan; 7 3rd Dept. of Medicine, Kansai Medical University, Kansai, Japan Background/Aim: Japan Integrated Staging system (JIS score) has been reported that its stratification ability in patients with hepatocellular carcinoma is much superior to that by CLIP scoring system. One of the major differences in 2 staging systems are; 1) tumor morphology, and 2) whether or not tumor markers such as alpha-fetoprotein (AFP) are included. In this multicenter study, we compared modified JIS score, which includes 3 types of tumor markers, which includes AFP, AFP-L3% fraction, and des-gamma-carboxy prothrombin (DCP) as compared with conventional JIS score and CLIP score. Patients and Methods: A total of 4,525 Japanese patients with HCCs were included into this study. JIS score was obtained by 2 variables; TNM stage by Liver Cancer Study Group of Japan and Child-Pugh score (J Gastroenterol (2003; 38:207-215). As far as tumor markers, score 0 was allocated if none of AFP, AFP-L3% fraction and DCP were positive, Score 1 was allocated when any 1 of 3 tumor markers were positive. Score 2 was allocated when any 2 of 3 markers were positive. Modified JIS score was clculated by combining JIS score and the results of tumor markers. Results: Modified JIS score showed beautiful stratification ability even better than conventional JIS score. CLIP score showed worst stratification ability among 3 staging systems. The prognosis ofthe worst prognostic subgroup (score 7) by modified JIS score was much worse than that of the worst subgroup (score 5) by JIS score. This evidence implies all 3 tumor markers’ positivity along with JIS score is a good prognostic indicator. Conclusion: Modified JIS score is the best staging system, which concerns tumor stage, liver disease stage, and tumor biology. In addition, if tumor biology marker is included into the staging system, all the 3 tumor markers should be taken into account, unlike CLIP score, which includes AFP alone.
Poster Sessions
Material and methods: 12 human HCC and 12 colon metastasis sample were examined by real-time RT-PCR for expression of claudin 1-5 and 7. Relative quantification was utilized using GAPDH as internal control. The HCC samples did not show nuclear staining for beta-catenin indicating activation of the wnt pathway. Results: Claudin 4 in HCCs was found downregulated 42 folds and 33 folds compared to normal livers and metastases, respectively. Claudin 2 showed 26 fold downregulation in comparison to normal liver, however, there was no significant expressional difference to metastases. Claudin 2 was 7 fold downregulated in HCCs compared to surrounding nontumorous liver, while non significant 9 fold downregulation was found between metastases and normal liver. Claudin 1 was upregulated 4.5 fold in HCCs compared to metastases. Claudin 7 was upregulated in HCCs and metastases 9 and 8 fold, respectively. These results however, were slightly out of significance. Conclusion: Taken together, claudin-4 expression was markedly downregulated in HCCs contrary to metastases and normal liver. On the other hand pronounced downregulation of claudin-2 was found significant between HCCs and normal liver. These findings are not associated with the activation of the wnt pathway. The project was supported by grants: Bio14/2001, NKFP-1/0023/2002, ETT- 228/201.
The median post-transplant follow-up: 33 (10-111) months. The 1 and 5 year survival: 81% and 62%. HCC recurrence was observed in 12 (11.5%) patients. The 1 and 5 year recurrence-free survival were 93% and 83%. HCC recurrence was observed in 12% of patients who fulfilled the Milan criteria and in 22% of patients who didn’t. For prediction of HCC recurrence, the Milan criteria had: sensitivity 67%, specificity 55%, PPV 90%, NPV 21%. HCC recurrence was observed in 3/3 (100%) patients with a single nodule of largest diameter >5cm, in 3/20 (15%) patients with ≤ 3 nodules with the largest diameter < 3 cm and in 0/5 (0%) patients with more than 3 nodules. Tumour differentiation, satellitosis, serum AFP predicted recurrence free survival. 95% and 92% one and 5 year recurrence-free survival were observed for the 86 patients who had (a) a single nodule up to 5 cm, (b) up to 3 nodules all < 4.5 cm, (c) more than 3 nodules < to 2.5 cm. For those not fulfilling these criteria, the 1 and 5 year recurrence-free survival were 75% and 54%. Conclusion: The Milan criteria can be extended to permit transplantation of a greater number of HCC patients. Tumour size appears more important than tumour number
256 JIS SCORING SYSTEM COMBINED WITH 3 TUMOR MAKERS 254 PERCUTANEOUS ULTRASOUND-GUIDED RADIOFREQUENCY ABLATION WITH ARTIFICIAL PLEURAL EFFUSION FOR HEPATOCELLULAR CARCINOMA LOCATED UNDER THE DIAPHRAGM
M. Koda, M. Ueki, Y. Maeda, K. Mimura, K. Okamoto, Y. Matsunaga, M. Kawakami, K. Hosho, Y. Murawaki. Second Department of Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan [Objective] Ultrasound -guided radiofrequency ablation is performed as one of the effective treatments for hepatocellular carcinoma. However, the localization of tumor is a major limiting factor in the use of the Ultrasound -guided procedure. Ultrasound examination with artificial pleural effusion improved the visualization of hepatocellular carcinoma under the diaphragm. We investigated the safety, benefits and local efficacy of radiofrequency ablation with artificial pleural effusion. [Methods] Twentyfive lesions in 23 patients were performed by radiofrequency ablation with artificial pleural effusion, which was injected 5% glucose solution into the pleural cavity. [Results] The benefits of artificial pleural effusion were as follows: making possible the visualization of a tumor that was invisible in 7 lesions, making possible the visualization of the whole tumor that was only partially visible in 15 lesions and ensuring the safety of the puncture line in 14 lesions. In 23 (92%) of 25 lesions, at least one of these benefits was obtained. Complete necrosis was obtained in 22 (88%) of 25 lesions. During a mean follow up period of 10.6 ± 6.5 months, local recurrence at the ablation site was diagnosed in one (4.5%) of 22 lesions. Mild cough in 3 patients and mild dyspnea in 2 patients were observed as adverse effects due to artificial pleural effusion, but these were temporary. The oxygen saturation of blood during artificial pleural effusion was slightly decreased. [Conclusion] Radiofrequency ablation with artificial pleural effusion is a safe and beneficial treatment option that offers excellent local control of hepatocellular carcinoma under the diaphragm.
255 PRIMARY HEPATOCELLULAR CANCER (HCC) IN THE EXPLANTED LIVER: OUTCOME OF TRANSPLANTATION AND RISK FACTORS FOR HCC RECURRENCE
L.A. Kondili, A. Lala, B. Gunson, S. Hubscher, S. Olliff, S. Bramhall, D. Mutimer. Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Birmingham, UK The clinical records of patients with HCC in the explanted liver during the past decade were examined. Clinical and histological risk factors for post-transplant HCC recurrence and survival rates were evaluated. 104 explanted livers contained HCC, 27 (26%) were not identified pre-transplant.
(MODIFIED JIS SCORE) IS AN EXELLENT PROGNOSTIC STAGING SYSTEM FOR HEPATOCELLULAR CARCINOMA (HCC): ANALYSIS OF 4525 PATIENTS WITH HCC
M. Kudo 1 , H. Chung 2 , Y. Osaki 3 , H. Oka 4 , H. Kasugai 5 , Y. Sasaki 6 , T. Seki 7 . 1 Dept. of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan; 2 Dept. of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan; 3 Dept. of Gastroenterology, Osaka Red Cross Hospital, Osaka, Japan; 4 Dept. of Gastroenterology, Osaka City General Medical Center, Osaka, Japan; 5 Dept. of Gastroenterology, Osaka Medical Center For Cancer and CVD, Osaka, Japan; 6 Dept. Surgery, Osaka Medical Center For Cancer and CVD, Osaka, Japan; 7 3rd Dept. of Medicine, Kansai Medical University, Kansai, Japan Background/Aim: Japan Integrated Staging system (JIS score) has been reported that its stratification ability in patients with hepatocellular carcinoma is much superior to that by CLIP scoring system. One of the major differences in 2 staging systems are; 1) tumor morphology, and 2) whether or not tumor markers such as alpha-fetoprotein (AFP) are included. In this multicenter study, we compared modified JIS score, which includes 3 types of tumor markers, which includes AFP, AFP-L3% fraction, and des-gamma-carboxy prothrombin (DCP) as compared with conventional JIS score and CLIP score. Patients and Methods: A total of 4,525 Japanese patients with HCCs were included into this study. JIS score was obtained by 2 variables; TNM stage by Liver Cancer Study Group of Japan and Child-Pugh score (J Gastroenterol (2003; 38:207-215). As far as tumor markers, score 0 was allocated if none of AFP, AFP-L3% fraction and DCP were positive, Score 1 was allocated when any 1 of 3 tumor markers were positive. Score 2 was allocated when any 2 of 3 markers were positive. Modified JIS score was clculated by combining JIS score and the results of tumor markers. Results: Modified JIS score showed beautiful stratification ability even better than conventional JIS score. CLIP score showed worst stratification ability among 3 staging systems. The prognosis ofthe worst prognostic subgroup (score 7) by modified JIS score was much worse than that of the worst subgroup (score 5) by JIS score. This evidence implies all 3 tumor markers’ positivity along with JIS score is a good prognostic indicator. Conclusion: Modified JIS score is the best staging system, which concerns tumor stage, liver disease stage, and tumor biology. In addition, if tumor biology marker is included into the staging system, all the 3 tumor markers should be taken into account, unlike CLIP score, which includes AFP alone.