670 SHOULD LIVER BIOPSIES BE REPORTED BY PATHOLOGISTS WITH A SUBSPECIALIST INTEREST IN HEPATOLOGY?

POSTERS 669 VALIDATION OF THE MESIAH SCORE AS PREDICTOR OF SURVIVAL IN HIV-INFECTED PATIENTS WITH HEPATOCELLULAR CARCINOMA (HCC) N. Qazi1,2 , B. M´ınguez3 , M. Ventura3 , M.B. Badshah4 , M.K. Jain5 , M. Harris6,7 , L.E. Taylor8,9 , L. Kikuchi10 , J. Marrero5 , N. Brau ¨ 4,11 , Liver 1 Cancer in HIV Study Group. Washington, DC VA Medical Center, 2 George Washington University School of Medicine, Washington, DC, USA; 3 Liver Unit, Hospital Universitario Vall d’Hebron, Barcelona, Spain; 4 JJP VA Medical Center, Bronx, NY, 5 University of Texas Southwestern Medical Center, Dallas, TX, USA; 6 St. Paul’s Hospital, 7 University of British Columbia, Vancouver, BC, Canada; 8 Miriam Hospital, 9 Brown University, Providence, RI, USA; 10 Universidade de S˜ ao Paulo, S˜ ao Paulo, Brazil; 11 Divisions of Infectious Diseases and Liver Diseases, Mount Sinai School of Medicine, New York, NY, USA E-mail: [email protected] Background: Recently, the MESIAH score (Model to Estimate Survival In Ambulatory HCC Patients) has been proposed as predictor of survival in patients with HCC. It has not been validated in HCC patients with HIV infection, which is the objective of this study. Methods: Overall, 206 HIV-infected patients with HCC were retrospectively identified from 1992–2012 in 38 centers in North and South America, Europe, and Australia. Predictability of survival using the MESIAH score was compared with 4 other published prediction models: BCLC (Barcelona-Clinic-Liver-Cancer), CLIP (Cancer-of-the-Liver-Italian-Program), JIS (Japan-IntegratedSystem) and Okuda. Univariate analysis was determined by Kaplan Meier analysis for univariate analysis of categorical variables and unadjusted Cox regression for continuous variables. Multivariate analysis was performed by Cox regression. The likelihood ratio and c-statistic determined the goodness of the fit of the Cox models. Results: Among the 206 patients, there were 124 deaths with a median survival of 10.0 months (95% confidence interval, 6.5– 13.5 months). The median MESIAH score was 3.960 (range, 2.09– 7.39, interquartile range, 3.16–4.79) with 82% of patients having a performance status (PS) of 0–1. In univariate analysis, all 5 models significantly (all p < 0.0001) predicted survival. In multi-variable stepwise Cox regression analysis using the 5 models but no other variables, only MESIAH (hazard ratio, 1.63; p < 0.0001) and BCLC (H.R., 1.35; p = 0.0001) independently predicted of survival, but not CLIP, JIS and Okuda. After controlling for age, CD4+ cell count, log HIV viral load and MELD score, both MESIAH (H.R., 1.53; p = 0.0002) and BCLC (H.R., 1.28; p-0.0003) remained independent predictors of survival. MESIAH correlated well with BCLC stages (p < 0.05 for all comparisons of MESIAH scores between stages). The strength of the predictability of MESIAH (likelihood ratio, 1071; C statistic, 0.67) was similar to that of BCLC (likelihood ratio, 1075; C statistic, 0.71). Within BCLC stage A (but not stages B-D), MESIAH further differentiated survival using the median as cut-off (median survival, 41.8 vs. 18 months, p = 0.03, log rank). Conclusion: MESIAH and BCLC complement each other in predicting survival of HCC in HIV-infected patients. In BCLC stage A, MESIAH can further differentiate survival. 670 SHOULD LIVER BIOPSIES BE REPORTED BY PATHOLOGISTS WITH A SUBSPECIALIST INTEREST IN HEPATOLOGY? B. Krishnan1,2 , M. Stares1 , H. Rajabally1 , R. D’Souza1 . 1 Gastroenterology, Chasefarm Hosptial, Enfield, 2 Gastroenterology, University College Hospital, London, UK E-mail: [email protected] Introduction: Histopathologists working in a district general hospital usually do not have a subspecialist interest in hepatology. Most district general hospitals have a gastroenterology service and local pathologists usually report liver biopsies. The Royal college of S272

Pathologist (RCP) recommend that ‘as minimal acceptable practice’ a liver biopsy report should include the clinical diagnosis, biopsy size, overall architecture, degree of fibrosis, severity in chronic liver disease (staging/grading), a definitive diagnosis or discussion of the differential diagnosis. Appropriate negative findings (e.g. lack of iron overload or alpha-1-antitrypsin globules) should be documented in the report. Aims and Methods: A single centre retrospective analysis of all the liver biopsies between January 2010 to February 2012 at two district general hospitals (Barnet and Chasefarm NHS trust) in North London was performed. Data was collected from medical records and electronic results. Our aim was to assess whether liver biopsies provided the clinician with adequate information about diagnosis. Results: 107 liver biopsies were performed during this period under ultrasound guidance by a radiologist. Mean patient age was 62 (Range 19–90). The mean number of core biopsies per patient was 1.5 (range 1–6). 10.7% (10/107) of the report did not mention a clinical diagnosis. 30% (32/107) of the biopsy report did not have a definitive or a differential diagnosis about possible etiology of underlying liver disease. However 98% (47/48) of patients with cancer had a definite or a differential diagnosis. Only 53% (9/17) patients with chronic hepatitis had severity scoring (Ishak staging/grading). Conclusion: About one third of liver biopsies did not have diagnosis or discussion about a differential diagnosis. This number goes up to 47.5% (28/59) if we exclude malignancies. The mortality associated with percutaneous liver biopsy ranges between 0.13 and 0.33%. From an audit from UK district general hospital. With the advent of fibroscan there is less need to perform liver biopsies except in diagnosing malignancies or in hepatitis of unknown/unclear etiology. We believe that non-cancer liver biopsies should be reported by pathologists with subspecialist interest in hepatology or the procedure should be performed in a tertiary hospital to give the clinician an accurate diagnosis to aid treatment. 671 CLINICAL FEATURES OF NON ALCOHOLIC STEATOHEPATITIS (NASH)-RELATED HEPATOCELLULAR CARCINOMA (HCC) IN ITALY: A MULTICENTER PROSPECTIVE SURVEY A. Rossini1 , R. Sacco2 , F. Fornari3 , I. De Sio4 , G. Spinzi5 , G. Francica6 , G. Parisi7 , A. Salmi8 , E. Dionigi9 , F. Farinati10 , M. Di Fonzo11 , M. Salvagnini12 , S. Vicari13 , M. Borzio9 . 1 Hepatology Unit-Dept. of Internal Medicine, A.O. Spedali Civili, Brescia, 2 Gastroenterology Unit, Cisanello Hospital, Pisa, 3 Gastroenterology and Hepatology Unit, G. da Saliceto Hospital, Piacenza, 4 Gastroenterology Unit, Policlinico Hospital, Napoli, 5 Gastroenterology Unit, Valduce Hospital, Como, 6 Dept. of Internal Medicine, S. Maria Piet` a Camillani Hospital, Casoria, Italy; 7 Dept. of Internal Medicine, S. Maria del Prato Hospital, Feltre, Ivory Coast, 8 Gastroenterology Unit, S. Orsola-Poliambulanza Hospital, Brescia, 9 Gastroenterology Unit, A.O. Melegnano, Melegnano, 10 Dept. of Surgical and Gastroenterological Sciences, Policlinico Hospital, Padova, 11 Gastroenterology Unit, A.O. S. Andrea, Roma, 12 Gastroenterology Unit, San Bortolo Hospital, Vicenza, 13 Gastroenterology Unit, Bentivoglio Hospital, Bologna, Italy E-mail: [email protected] Background and Aims: Many reports suggest that NASH is a risk factor for the development of cirrhosis and HCC. The aim of this study was to compare the clinical features and the therapeutic allocation of NASH-related (group A) and hepatitis virus-related (group B) HCCs. Methods: In 30 Italian hepatology units, from September 2008 to November 2011 HCC was diagnosed in 891 cirrhotic patients. Patients with both hepatitis viruses and NASH, with other etiologies or insufficient data were excluded. Of 555 patients, 56 (10.1%) were included in group A and 499 (89.9%) in group B, the latter including

Journal of Hepatology 2013 vol. 58 | S229–S407