- Email: [email protected]
276 OUTCOMES IN PATIENTS WITH SMALL HEPATOCELLULAR CARCINOMA AND CHRONIC HEPATITIS C INFECTION TREATED WITH RFA AND ANTIVIRAL THERAPY
POSTERS had a longer survival thereafter, adjusted for age, sex and symptoms, p = 0.029, HR 0.457 (95% CI 0.227–0.921): 326 versus 193 days. Conclusion: Patients with time to progression to AFP > 3 months achieve longer survival afterward. Further validation of this finding is needed. 275 A COMPARISON OF PRIMARY SURGICAL RESECTION TO LIVER TRANSPLANTATION (LT) AMONG TRANSPLANT-ELIGIBLE HEPATOCELLULAR CARCINOMA (HCC) PATIENTS USING AN INTENTION-TO-TREAT MODEL R.J. Wong1 , J. Wantuck2 , A. Valenzuela1 , A. Ahmed1 , C. Bonham3 , A. Gallo3 , M. Melcher3 , G. Lutchman1 , W. Concepcion3 , C. Esquivel3 , G. Garcia1 , T. Daugherty1 , M.H. Nguyen1 . 1 Division of Gastroenterology and Hepatology, 2 Department of Medicine, 3 Department of Surgery, Stanford University Medical Center, Stanford, CA, USA E-mail: [email protected] Background and Aims: The efficacy of LT in the management of HCC is limited by scarce organ availability, resulting in disease progression and mortality on transplant waitlists. Surgical resection is generally limited to treatment of small, localized tumors in patients with well-preserved hepatic function. Data comparing resection with LT among transplant-eligible patients is limited. Methods: We performed a retrospective case cohort study comparing transplant-eligible patients (by Milan criteria) who underwent resection (cases) with those listed for LT (controls) in an intention-to-treat (ITT) model over a 15-year period. Controls included two patients for every case, matched by age ± 5 years, sex, and HCC etiology (HCV vs. non-HCV). Survival was evaluated using Kaplan Meier methods, log-rank test, and multivariate cox proportional hazards models.
Results: Our study included 171 patients (57 cases and 114 controls). Compared to controls, cases had lower rates of cirrhosis (61.4% vs. 90.4%, p < 0.001), lower MELD (8.9 vs. 11.2, p < 0.001), and greater post-treatment tumor recurrence (43.9% vs. 12.9%, p < 0.001). Using ITT, no survival difference was observed between cases and controls in post-MELD exception era (5-year survival: 69.5% vs. 66.6%, p = 0.87), but a trend towards higher survival was seen in pre-MELD era (5-year survival: 69.5% vs. 46.7%, p = 0.09). When including patients receiving LT, controls had higher survival in post-MELD era (5-year survival: 100% vs. 69.5%, p = 0.04), but not in pre-MELD era (Figure). In multivariate cox proportional hazards models also inclusive of cirrhosis, race (Asian vs. non-Asian), BCLC stage (A/B vs. C/D), MELD score, and largest tumor size, treatment with surgical resection was associated with significantly higher risk of death (HR 2.89; 95% CI, 1.12–7.49) compared to those who actually underwent transplantation.
Conclusion: Using an ITT model of transplant-eligible patients, no significant difference in survival was observed between patients treated with resection and those listed for LT. However, patients who received LT had significantly better outcomes, and resection was a significant independent predictor for poorer survival. LT is superior to surgical resection in treating HCC in transplant-eligible patients if patients can successfully undergo LT. 276 OUTCOMES IN PATIENTS WITH SMALL HEPATOCELLULAR CARCINOMA AND CHRONIC HEPATITIS C INFECTION TREATED WITH RFA AND ANTIVIRAL THERAPY N. Zhang1,2 , W. Lu1,2 , S. Liang1,2 , G. Neff3 . 1 Tianjin Infectious Disease Hospital, 2 Tianjin Liver Medical Institution, Tianjin, China; 3 Tampa General Medical Group, Tampa, FL, USA E-mail: [email protected] Introduction: Hepatocellular carcinoma (HCC) is the third most common cause of death worldwide. The risk of developing HCC in patients suffering from cirrhosis is increased in the setting of chronic HCV. Objective: To determine the tumor recurrence, safety, and survival outcomes of HCC patients with chronic hepatitis C (genotype 1) infection after receiving radiofrequency ablation (RFA) and antiviral therapy using peg-alfa interferon and weight based ribavirin. Methods: Using our institution’s database, we identified all patients with chronic Hepatitis C (HCV) genotype 1 and small HCC (less than 3.0 cm) between December 2007 – December 2010. The following data was extracted; sustained virological rate (SVR), tumor necrosis rate and tumor recurrent rate, and 1-year survival rate. HCC recurrence and monitoring was done using serum a-fetoprotein (AFP) test and radiological findings. Results: During the study period, there were 75 patients (42 males, 33 females, age 43 years (32–54) with HCC (≤3 cm) and HCV (genotype 1). We divided the patients into two groups: control group (n = 33) received RFA only and treatment group (n = 42) received RFA and peg-alfa interferon with weight based ribavirin. The tumor complete necrosis rate at three months in the control group was 24.24% versus Rx group was 50% (P < 0.05). The one-year viral suppression in the control group was 30.3% versus Rx group 64.28% (P < 0.05). The HCC recurrence rate in the control group was 38.39% versus Rx group 7.1% (P < 0.05). The one-year survival rate was 30.3% in control group versus Rx group 61.9% (P < 0.05). Conclusion: The above results demonstrate potential benefits of adding antiviral therapy and suppressing HCV virus in patients with compensated cirrhosis and small HCC undergoing RFA. Further trials involving larger number of patients are needed to delineate the overall impact of HCV eradication in the patient with compensated cirrhosis and HCC. As the antiviral therapies continue to evolve future trials may offer an opportunity at viral eradication prior to LTx thus improving long term outcomes. 277 SORAFENIB ENHANCES EFFECTS OF TRANSARTERIAL CHEMOEMBOLISATION FOR HEPATOCELLULAR CARCINOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS Q. Fu, Q. Zhang, X. Bai, Q. Hu, T. Liang. Zhejiang University 2nd Affiliated Hospital, Hangzhou, China E-mail: [email protected] Objective: Combination therapy of sorafenib and transarterial chemoembolization (TACE) showed benefits for hepatocellular carcinoma (HCC). This systematic review aims for evaluation of efficacy and safety between sorafenib plus TACE and TACE alone for HCC. Methods: We systematically searched multi-databases to identify eligible studies. Studies comparing sorafenib combined with TACE and TACE alone for HCC were included.
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Results: Our study included 171 patients (57 cases and 114 controls). Compared to controls, cases had lower rates of cirrhosis (61.4% vs. 90.4%, p < 0.001), lower MELD (8.9 vs. 11.2, p < 0.001), and greater post-treatment tumor recurrence (43.9% vs. 12.9%, p < 0.001). Using ITT, no survival difference was observed between cases and controls in post-MELD exception era (5-year survival: 69.5% vs. 66.6%, p = 0.87), but a trend towards higher survival was seen in pre-MELD era (5-year survival: 69.5% vs. 46.7%, p = 0.09). When including patients receiving LT, controls had higher survival in post-MELD era (5-year survival: 100% vs. 69.5%, p = 0.04), but not in pre-MELD era (Figure). In multivariate cox proportional hazards models also inclusive of cirrhosis, race (Asian vs. non-Asian), BCLC stage (A/B vs. C/D), MELD score, and largest tumor size, treatment with surgical resection was associated with significantly higher risk of death (HR 2.89; 95% CI, 1.12–7.49) compared to those who actually underwent transplantation.
Conclusion: Using an ITT model of transplant-eligible patients, no significant difference in survival was observed between patients treated with resection and those listed for LT. However, patients who received LT had significantly better outcomes, and resection was a significant independent predictor for poorer survival. LT is superior to surgical resection in treating HCC in transplant-eligible patients if patients can successfully undergo LT. 276 OUTCOMES IN PATIENTS WITH SMALL HEPATOCELLULAR CARCINOMA AND CHRONIC HEPATITIS C INFECTION TREATED WITH RFA AND ANTIVIRAL THERAPY N. Zhang1,2 , W. Lu1,2 , S. Liang1,2 , G. Neff3 . 1 Tianjin Infectious Disease Hospital, 2 Tianjin Liver Medical Institution, Tianjin, China; 3 Tampa General Medical Group, Tampa, FL, USA E-mail: [email protected] Introduction: Hepatocellular carcinoma (HCC) is the third most common cause of death worldwide. The risk of developing HCC in patients suffering from cirrhosis is increased in the setting of chronic HCV. Objective: To determine the tumor recurrence, safety, and survival outcomes of HCC patients with chronic hepatitis C (genotype 1) infection after receiving radiofrequency ablation (RFA) and antiviral therapy using peg-alfa interferon and weight based ribavirin. Methods: Using our institution’s database, we identified all patients with chronic Hepatitis C (HCV) genotype 1 and small HCC (less than 3.0 cm) between December 2007 – December 2010. The following data was extracted; sustained virological rate (SVR), tumor necrosis rate and tumor recurrent rate, and 1-year survival rate. HCC recurrence and monitoring was done using serum a-fetoprotein (AFP) test and radiological findings. Results: During the study period, there were 75 patients (42 males, 33 females, age 43 years (32–54) with HCC (≤3 cm) and HCV (genotype 1). We divided the patients into two groups: control group (n = 33) received RFA only and treatment group (n = 42) received RFA and peg-alfa interferon with weight based ribavirin. The tumor complete necrosis rate at three months in the control group was 24.24% versus Rx group was 50% (P < 0.05). The one-year viral suppression in the control group was 30.3% versus Rx group 64.28% (P < 0.05). The HCC recurrence rate in the control group was 38.39% versus Rx group 7.1% (P < 0.05). The one-year survival rate was 30.3% in control group versus Rx group 61.9% (P < 0.05). Conclusion: The above results demonstrate potential benefits of adding antiviral therapy and suppressing HCV virus in patients with compensated cirrhosis and small HCC undergoing RFA. Further trials involving larger number of patients are needed to delineate the overall impact of HCV eradication in the patient with compensated cirrhosis and HCC. As the antiviral therapies continue to evolve future trials may offer an opportunity at viral eradication prior to LTx thus improving long term outcomes. 277 SORAFENIB ENHANCES EFFECTS OF TRANSARTERIAL CHEMOEMBOLISATION FOR HEPATOCELLULAR CARCINOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS Q. Fu, Q. Zhang, X. Bai, Q. Hu, T. Liang. Zhejiang University 2nd Affiliated Hospital, Hangzhou, China E-mail: [email protected] Objective: Combination therapy of sorafenib and transarterial chemoembolization (TACE) showed benefits for hepatocellular carcinoma (HCC). This systematic review aims for evaluation of efficacy and safety between sorafenib plus TACE and TACE alone for HCC. Methods: We systematically searched multi-databases to identify eligible studies. Studies comparing sorafenib combined with TACE and TACE alone for HCC were included.
Journal of Hepatology 2013 vol. 58 | S63–S227
S117