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Mo2026 Epidemiology and Clinical Outcomes of Asians With Hepatocellular Carcinoma (HCC) Compared to Non-Asian Patients
is difficult. On the other hand, contrast-enhanced ultrasonography with Sonazoid® (CEUS) also can detect small HCC especially with its vascularity. Thus, in this study, we examined whether CE-US can detect the vascularity of the liver nodules which were not detected at arterial phase in Gd-EOB MRI. Materials and Method: 24 nodules revealed by Gd-EOB MRI were analyzed. We analyzed nodules that meet the three conditions: (1) Nodules showing hypointensity at HB phase, but not showing hypereintensity at arterial phase in Gd-EOB MRI; (2) Nodules examined with CE-US within one month after the GdEOB MRI; (3) Nodules treatment has not been taken between (1) and (2). Results: All 24nodules were observed in cirrhotic livers of 20 males and 4 females. Mean age of the cases was 69.5 years (47-82 years). The mean diameter of the nodules was 12.5 mm (6-33 mm). Sixteen nodules (66.7 %) were detected with the B-mode US. Hypervascularity of 6 nodules (25 %) was observed at arterial phase of CE-US. Further, of these 6 nodules, 5 were also detected as contrast-defect nodules at kupffer phase. Univariate analysis revealed that the diameter of the nodules is the only factor related to the detection rate of the tumor hypervascularity with CE-US (P,0.001). The mean diameter of the nodules detected as hypervascular was 21 mm (13-33 mm), while that of the undetectable nodules was 11 mm (6-19 mm). Alpha-fetoprotein, protein induced by vitamin K absence or antagonist-II, or diffusion weighted MRI were not related to the detection rate. Conclusion: CE-US is useful for the detection of vascularity of nodules detected only at HB phase but not at arterial phase of Gd-EOB MRI. These data indicate that the combination of CE-US nad Gd-EOB MRI can improve the differential diagnosis of liver tumors and enhance the detection rate of small HCC.
Diagnostic Accuracy of Multidetector Computed Tomography (MDCT) Combined With High Resolution Ultrasonography (Hrus) for Small Gallbladder Polyps : Compared With Endoscopic Ultrasonography (EUS) Dong Uk Kim, Gwang Ha Kim, Geun Am Song Background : Endoscopic ultrasonography (EUS) is considered to be the best modality to predict the neoplastic polyps of the gallbladder. However, EUS has several limitations following as 1) the considerable experience of investigators, 2) presence of the interobserver variations and 3) unavailability of EUS in some centers. Multidetector computed tomography (MDCT) provides fine section image of gallbladder and allows to reduce the interobserver variations. We evaluated the accuracy of MDCT combined with high resolution ultrasonography (HRUS) for gallbladder polyps smaller than 2cm compared with EUS. Methods : From Dec 2005 to June 2010, 109 patients who underwent cholecystectomy due to gallbladder polyps were enrolled. Subjects were divided in two groups (reference group : 63 patients who were performed MDCT and HRUS vs. validation group : 46 patients who underwent MDCT, HRUS, and EUS). New scoring system was developed from reference group, and applied to validation group, while previously reported EUS scoring system was applied to the same validation group. Results : In reference group, size (p ,0.001), number (p=0.015), shape (p=0.001), and CT/US size ratio of polyps (p=0.008) were significant variables in univariate analysis. Area under the ROC curve draw by new scoring system was 0.859 and cut-off value was set to 3. In validation group, new scoring system showed comparable accuracy (65.2%) with previously reported EUS scoring system(73.9%, p=0.434). Conclusion : MDCT combined with HRUS provide comparatively high accuracy in small gallbladder polyps in distinguishing between neoplastic and non-neoplastic polyps as preoperative diagnostic modality.
Mo2026 Epidemiology and Clinical Outcomes of Asians With Hepatocellular Carcinoma (HCC) Compared to Non-Asian Patients James M. Wantuck, Robert J. Wong, Nghiem B. Ha, Benjamin Yip, Aijaz Ahmed, Mindie H. Nguyen
Mo2024
Purpose: In the U.S, the Asian population has a disproportionately high HCC disease burden. Since many Asian Amercians are foreign-born and can be affected by diseases endemic in their countries of origin, the etiologies of underlying liver disease as well as other disease outcomes of Asian HCC patients are likely to differ from those of the general U.S. population. Asian Americans are also relatively understudied, and our goal is to elucidate potential differences that may exist in disease presentation and long-term survival between Asians and non-Asians with HCC. Methods: We conducted a retrospective cohort study of patients who presented with HCC at a U.S. university hospital between 01/1991 and 10/2011. Via computer query using ICD 9 diagnosis codes, a total of 1412 consecutive patients with HCC were identified. Of these, 635 (45%) were Asian and 777 (55%) were non-Asian. Data from individual chart review and National Death Index were obtained. Results: As seen in the Table, Asian HCC patients were significantly older, much less likely to have cirrhosis; and among those with cirrhosis, Asian patients had lower mean CPT score. The vast majority of non-Asian HCC cases were associated with hepatitis C virus (HCV) infection with the remaining due to non-viral causes. Among Asians, HBV infection is the most common underlying disease followed by HCV infection. Compared to non-Asians, Asian patients presented with more advanced HCC with less patients meeting the Milan criteria (37% vs. 46% p,0.01) and less patients with Barcelona Liver Clinic Cancer (BLCL) stage A (41% vs. 47%, p,0.001). There were significant differences in the types of treatment received by Asians compared to non-Asians (p ,0.001), with Asian patients more likely to receive supportive care only (25% vs. 20%) and more likely to undergo partial hepatectomy (13% vs. 5%) but less likely to be listed for liver transplantation (18% vs. 36%) or to undergo liver-directed palliative therapy (30% vs. 37%). Nevertheless, overall 5-year survival was significantly higher in Asian HCC patients (43% [95% CI= 39-47%]) compared to nonAsians (31% [95% CI= 28-35%]) (Figure). Following adjustments for age, sex, cirrhosis, treatment (vs. no treatment), AFP.500, BCLC staging, and Milan criteria with a multivariate Cox proportional hazards model, Asian ethnicity and HBV (vs. HCV) liver disease were independent predictors of higher survival (HR=0.71 95% CI=0.59-0.96 and HR=0.66 95% CI=0.52-0.82, respectively). Conclusions: HCV infection was the underlying disease in 80% of non-Asian HCC patients, while both HBV and HCV were common and involved over 90% of Asian HCC cases. Despite having more advanced HCC at presentation and lower rates of liver transplantation or palliative therapy, Asian ethnicity was an independent predictor for higher overall survival compared to non-Asian. Table 1
Treatment of Single- Nodule Hepatocellular Carcinoma: Comparison Between Surgical Resection and Transcatheter Arterial Chemioembolization Combined With Percutaneous Radiofrequency (TACE-RFA) Valentina Cesario, Federico Barbaro, Mariachiara Campanale, Michele La Torre, Alessandra Guerra, Teresa Antonella Di Rienzo, Silvia Pecere, Francesca Romana Ponziani, Emanuele Rinninella, Giovanni Gigante, Massimo Siciliano, Brigida E. Annicchiarico, Maria Assunta Zocco, Laura Riccardi, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Grieco, Gennaro Nuzzo, Felice Giuliante, Salvatore Agnes, Anna Maria De Gaetano, Giovanni B. Gasbarrini, Roberto Iezzi, Lorenzo Bonomo, Antonio Gasbarrini Background and aims: Currently surgical resection is the standard treatment option in patients with single nodule HCC.Recent evidence suggest that the combination of radiofrequency and transarterial chemoembolization may have a higher rate of complete response in the treatment of single HCC,even greater than 3 cm. The aim of this study was to compare the survival rate and the time to progression of disease in patients with single-nodule Hepatocellular carcinoma . 3 cm who underwent surgical resection(SR) or single step balloon-occluded RFA followed by TACE(TACE-RFA). We also evaluated the difference in post-procedural deterioration of liver function between the two treatments. Methods:Medical records of 37 HCC patients selected by the archive of the Multidisciplinary Group for the Treatment of Hepatocellular Carcinoma of our Centre (HEPATOCATT) with single nodule (maximum diameter . 3cm and Child-Pugh class A-B) treated with surgical resection (n=18) or RFA combined to TACE (n=19) since January 2010 to March 2012, were retrospectively reviewed. The patients survival outcomes were compared. Survival and Time To Progression (TTP) curves were obtained with the Kaplan-Meier method and compared by using the logrank test. Changes in liver laboratory tests after the procedures were considered to attest deterioration of liver function. Results: Patients of the two study groups were similar in epidemiological features,liver disease stage and lesion characteristics. Tumor size was comparable in both group (mean tumor size: SR 5.67 ± 3.82 cm; TACE-RFA group 4.65 ± 2.12 ; P = 0,3187). During follow-up (mean,15 months; range, 1-26 months), local tumor progression was observed in 11/19 (57.9%) patients of treated lesions in the combined treatment group and in 13/18 (72.2%) in SR group; P=0.57. There were not statistically significant differences in TTP rates among the two groups (median TTP SR: 278 ± 167.18 days; in TACE-RFA : 226±196.54 days; P =0.777). The 1-year local tumor progression rates evaluated by Kaplan Meier analysis, were comparable in the TACE + RFA group and in the surgical group (P =0.777). Interestingly the recurrence was always multinodular in SR group. The 1-year overall survival rate was 70% with combined treatment and 88% with SR (P = 0.09). Changes in Child-Pugh score one month after treatment were statistically significant only in surgical group (SR from 5.22 ±0.44 to 6.38 ±0.9 p ,0.0001; TACE-RFA group from 6.20 ± 1.75 to 6.64 ± 2.06 p=0.551) Conclusions: In our retrospective analysis we observed that in patients with single nodule HCC . 3 cm, survival rate and local tumor progression rate after treatment with single step balloon-occluded RFA followed by TACE (TACERFA) or surgical resection are similar. However our data showed that surgery can lead to deterioration of liver function more frequently than loco-regional treatment Mo2025 Usefulness of CE-US for Evaluating Vascularity of the Nodules Detected Only At Hepatobiliary Phase but Not At Arterial Phase in Gd-Eob MRI Shinichiro Minami, Takashi Goto, Kouichi Miura, Shigetoshi Ohshima, Tomomi Shibuya, Wataru Sato, Takahiro Dohmen, Kentaro Kamada, Mitsuru Chiba, Ryo Kanata, Toshitaka Sakai, Yuko Sugimoto, Hirohide Ohnishi Background and aims: The gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging (Gd-EOB MRI) is a powerful tool to detect small hepatocellular carcinoma (HCC). In Gd-EOB MRI, typical HCC is observed as a nodule with high-intensity at arterial phase and that with low-intensity at hepatobiliary (HB) phase. However, we often notice liver nodules detected at HB phase but not at arterial phase in Gd-EOB MRI. The differential diagnosis of these nodules between HCCs and benign tumors
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in GROUP B. ALT also increased from 45.3±44.9 IU/L to 154.3±107.2 IU/L (P ,0.003) in GROUP A, from 55.6±41.23 IU/L to 88.5 ±68.3 IU/L(P=0.122) in GROUP B.These parameters returned to normal range within 3-4 weeks. No pts developed major complications in our study.Changes in Child-Pugh score 1 month after treatment were not statistically significant in both groups (GROUP A p=0.183; GROUP B p=0.282). Hospitalization time was 8.2±3.3 days in GROUP A and 9.6±5.6 in GROUP B(p= 0,4395). Technical success was achieved in 85% of pts in GROUP A(12/14; 6CR, 6PR) and 80% in GROUP B (12/15; 5 CR,7PR) on 1-month follow up CT (p=0.89).At 6 months local recurrence developed in 5/14 pts of GROUP A and 5/15 in GROUP B (p=0.78). On1 year follow up we observed that pts in GROUP B underwent a greater number of total following treatments (4 in GROUP A and 13 in GROUP B).Kaplan-Meier analysis didn't demonstrate statistically significant differences in OS among the two groups (p= 0.822). CONCLUSION: Liver function parameters and clinical features were not significantly deteriorated after both procedures;only ALT showed a greater transient increase after TACE-RFA than TACE. Although these therapeutic strategies didn't show a statistically significant difference in OS and efficacy, pts that underwent TACE needed greater number of following treatments.Therefore TACE-RFA could be more favorable than TACE alone in terms of cost-effectiveness in pts with multinodular unresecable HCC. Mo2029 Resection for Neuroendocrine Liver Metastases Give Excellent Long Term Survival but Very High Recurrence Rate. Analysis on 115 Liver Resections in a Tertiary Centre Safi Dokmak, Fadhel Samir Ftériche, Béatrice Aussilhou, Alain Sauvanet, Olivia HenticDhomé, Magaly Zappa, Pascal Hammel, Philippe Levy, Philippe B. Ruszniewski, Jacques Belghiti
Mo2027 Hepatolithiasis Should Be Followed-up Carefully to Detect Cholangiocarcinoma Even After Completeness of Stone Removal Regardless of Treatment Modality Sang Jun Suh, Jae Seon Kim, Sun Young Kim, Jong Jin Hyun, Beom Jae Lee, Jong-Jae Park, Hong Sik Lee, Chang Duck Kim, Young-Tae Bak
But: Evaluate the results of liver resection for neuro-endocrine liver metastases (NELM) in a tertiary centre. Patients and methods: Between January 2000 and December 2009, 70 patients underwent 115 liver resections for NELM. There were 36 women (52%) with a mean age of 54 years (17-76). The primary tumour was of pancreatic origin in 37 (53%), small bowel in 25 (36%), indeterminate in 7 (10%) and lung in 1 (1%). NELM were bilobar and metachronous in 46 (65%) and 17 (24%) of cases, respectively. Combined primary tumour and liver resection were necessary in 34 patients (48%) with 28 (40%) according to two step liver resection. Repeated hepatectomy was needed in 17 patients (15%). Major hepatectomy was done in 52 patients (45%) and an hypertrophy procedure of the remnant liver was necessary in 34 patients (48%) by portal vein ligation (n=26) or embolization (n= 8). The postoperative mortality was observed in one patient (0.9%) with an overall and major morbidity rate in 53% and 22%, respectively. Results: The mean NELM number and size were of 8.4 (1-31) and 3.5 cm (0.3-21), respectively. NELM were well differentiated in 58 patients (83%) with a MIB (Ki67) ≥ 5% in 26 patients (37%) and 36 patients had vascular emboli. Resection was R0 in 31 patients (44%). After a mean follow up period of 33 months (2-149), 39 patients (56%) presented recurrence and 3 died, one postoperatively and 2 diseases related. The mean overall and disease free survival were of 55 months (0149) and 33 months (0-149), respectively. The 5 and 10 year global and disease free survival were of 93%, 87%, 52% and 17%, respectively. In multivariate analysis, the major prognostic factors for recurrence or global survival were a MIB (Ki67) .5% or positive lymph node of the primary. Conclusion : Resection of NELM give an excellent long term survival but the recurrence rate still very high justifying in some subgroup of patients at higher risk of recurrence, other therapeutic alternative including liver transplantation.
Background/Aims: Hepatolithiasis is a well known risk factor of cholangiocarcinoma. Despite advances in diagnostic modalities, diagnosing cholangiocarcinoma in patients with hepatolithiasis still challenging and there are not enough reports on the incidence of cholangiocarcinoma in patient with hepatolithiasis after treatment. We aimed to evaluate the incidence and clinical characteristics of cholangiocarcinoma in patients with hepatolithiasis who underwent liver resection or non-resection. Methods: Among a total of 257 patients who received treatment for hepatolithiasis from 2002 to 2011 at Korea University Anam and Guro Hospital, 236 patients were eligible for analysis; 92 patients underwent liver resection (resection group) and 144 patients did not (non-resection group). The data were retrospectively collected and analyzed. Results: The incidence of cholangiocarcinoma was 6.8% (16/236) during follow-up period (mean 41±41 months). The median tumor occurrence time was 28 (13-111) months. Cholangiocarcinoma occurred 6.5% (6/92) and 6.9% (10/144) in resection and non-resection group respectively (P=0.425). In resection group, cholangiocarcinoma occurred in 3.6% (2/56) of patients with complete stone removal, and in 13.3% (4/ 30) of patients with incomplete stone removal (p=0.591). In non-resection group, cholangiocarcinoma occurred in 5.7% (3/53) of patients with complete stone removal, and in 8.9% (7/79) of patient with incomplete stone removal (p=0.738). When analyzed according to completeness of stone removal regardless of treatment modality, cholangiocarcinoma occurred in 4.6% (5/109) of patients with complete stone removal, and in 10.1% (11/109) of patients with incomplete stone removal (p=0.429). Although the site of stone and tumor occurrence concurred in 10/16 patients (3/6 patients in the resection group, 7/10 patient in the non-resection group), it did not match in 6 patients. On univariate analysis, none of the factors (age, gender, abdominal pain, bile duct stenosis, bile duct dilatation, liver atrophy, residual stone, stone recurrence and liver resection) showed relationship with the incidence of cholangiocarcinoma. Conclusion: There was no difference in the incidence of cholangiocarcinoma according to the treatment modality or completeness of stone removal. Therefore, patients with hepatolithiasis should carefully be followed-up to detect cholangiocarcinoma even after treatment.
Mo2030 Treatment of Portal Vein Tumor Thrombosis (PVTT) Can Impact Survival of Patients With Advanced HCC? Valentina Cesario, Emanuele Rinninella, Francesca Romana Ponziani, Matteo Garcovich, Davide Roccarina, Mariachiara Campanale, Teresa Antonella Di Rienzo, Federico Barbaro, Massimo Siciliano, Brigida E. Annicchiarico, Maurizio Pompili, Gian Ludovico Rapaccini, Laura Riccardi, Antonio Grieco, Luca Miele, Roberto Iezzi, Anna Maria De Gaetano, Enrico Di Stasio, Giovanni B. Gasbarrini, Lorenzo Bonomo, Maria Assunta Zocco, Antonio Gasbarrini
Mo2028
INTRODUCTION: HCC with PVTT is often associated with poor prognosis. Many efforts have been made to improve prognosis in this setting, but nowadays there is not a treatment of choice for HCC related PVTT. AIMS&METHODS: We retrospectively assessed epidemiologic data, tumor and underlying liver disease features, overall survival and treatment-related survival of 60 patients affected by advanced HCC complicated by PVTT. Moreover we evaluated variables associated to PVTT development and severity, and the impact of tumor thrombosis treatment on survival of patients with advanced HCC. We included both main portal vein and segmentary branches thrombosis. Diagnosis was made according to typical dynamic contrast pattern on radiological main techniques. We calculated overall survival by the time of both PVTT diagnosis and tumor onset. In addition we evaluated a possible role of performed treatment on conditioning prognosis. A Kaplan-Meier analysis was performed. RESULTS: From May 2008 to April 2012 60 patients (51 male, 9 female; mean age 66±5.6) were recruited for retrospective evaluation. 33/60 (55%) patients underwent systemic antiangiogenetic therapy; 6/60 (10%) were referred to external beam radiation therapy on thrombus; 21/60 (35%) not receive any active therapy. All patients received the best treatment on HCC concomitant nodules. A multivariate analysis showed that time between the onset of thrombosis and the diagnosis of HCC is significantly correlated to viral aetiology and BCLC stage at the diagnosis of HCC, while thrombosis extension is significantly correlated to the presence of portal hypertension. At the end of observation (47 months), survival for each group was 18%, 50% and 23%, respectively. The overall survival from the diagnosis of HCC was 753±88 days and it is significantly correlated to younger age at diagnosis, BCLC A and treatment performed on HCC nodule, but not according to PVTT treatment. The overall survival from the diagnosis of PVTT was 397±77 days. According to each group, mean survival was 408±86 days for the first group (antiangiogenetic therapy), 855±273 days for the second group (radiation therapy), 140±29 days for patients who had not received any therapy (p,0.001), regardless of age or severity of underlying liver disease. CONCLUSION: PVTT treatment seems to improve survival of patients with advanced HCC,
Comparison Between Transcatheter Arterial Chemoembolization (TACE) and Transcatheter Arterial Chemoembolization Combined With Percutaneous Radiofrequency Ablation (TACE-RFA) for Treatment of Intermediate Hepatocellular Carcinoma Mariachiara Campanale, Federico Barbaro, Valentina Cesario, Michele La Torre, Alessandra Guerra, Teresa Antonella Di Rienzo, Silvia Pecere, Giovanni Gigante, Francesca D'Aversa, Francesca Romana Ponziani, Emanuele Rinninella, Massimo Siciliano, Brigida E. Annicchiarico, Maria Assunta Zocco, Laura Riccardi, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Grieco, Gennaro Nuzzo, Felice Giuliante, Salvatore Agnes, Anna Maria De Gaetano, Giovanni B. Gasbarrini, Roberto Iezzi, Lorenzo Bonomo, Antonio Gasbarrini BACKGROUND:patients with multinodular HCC at BCLC-B stage are suitable only to palliative treatments such as TACE.Recent studies evaluated the application in this subgroup of balloon-occluded RFA combined with TACE to increase the local response and the survival rate.AIM: to compare safety tolerability and influence on liver function of TACE and single step balloon-occluded RFA followed by TACE(TACE-RFA) in pts affected by unresectable multinodular hepatocellular carcinoma.Our second purpose was to evaluate the efficacy and Overall Survival(OS) in patients treated with these two strategies.METHODS: Since January 2010 to March 2012 a group of 14 pts with multinodular unilobar unresectable HCC were submitted to TACE+RFA(GROUP A: 14 pts). These pts were individually matched with 15 pts treated only with TACE (GROUP B:15 pts) selected by the archive of our Centre (HEPATOCATT).We monitored changes in liver laboratory tests, major complications after procedures and time of hospitalization.Early local efficacy was evaluated on CT performed at 1-month and 6-months of follow-up.We also analyzed number of treatments performed during the year following the procedure.Kaplan-Meier analysis were performed to evaluate OS. RESULTS: Plasma total bilirubin increased from 1.0±0.56 mg/dL to 1.4±0.5 mg/dL on post-procedural(P =0.038) in GROUP A and from 1.5±1 mgl/dL to 2.1±1.6 mg/dL (P=0.277)
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Diagnostic Accuracy of Multidetector Computed Tomography (MDCT) Combined With High Resolution Ultrasonography (Hrus) for Small Gallbladder Polyps : Compared With Endoscopic Ultrasonography (EUS) Dong Uk Kim, Gwang Ha Kim, Geun Am Song Background : Endoscopic ultrasonography (EUS) is considered to be the best modality to predict the neoplastic polyps of the gallbladder. However, EUS has several limitations following as 1) the considerable experience of investigators, 2) presence of the interobserver variations and 3) unavailability of EUS in some centers. Multidetector computed tomography (MDCT) provides fine section image of gallbladder and allows to reduce the interobserver variations. We evaluated the accuracy of MDCT combined with high resolution ultrasonography (HRUS) for gallbladder polyps smaller than 2cm compared with EUS. Methods : From Dec 2005 to June 2010, 109 patients who underwent cholecystectomy due to gallbladder polyps were enrolled. Subjects were divided in two groups (reference group : 63 patients who were performed MDCT and HRUS vs. validation group : 46 patients who underwent MDCT, HRUS, and EUS). New scoring system was developed from reference group, and applied to validation group, while previously reported EUS scoring system was applied to the same validation group. Results : In reference group, size (p ,0.001), number (p=0.015), shape (p=0.001), and CT/US size ratio of polyps (p=0.008) were significant variables in univariate analysis. Area under the ROC curve draw by new scoring system was 0.859 and cut-off value was set to 3. In validation group, new scoring system showed comparable accuracy (65.2%) with previously reported EUS scoring system(73.9%, p=0.434). Conclusion : MDCT combined with HRUS provide comparatively high accuracy in small gallbladder polyps in distinguishing between neoplastic and non-neoplastic polyps as preoperative diagnostic modality.
Mo2026 Epidemiology and Clinical Outcomes of Asians With Hepatocellular Carcinoma (HCC) Compared to Non-Asian Patients James M. Wantuck, Robert J. Wong, Nghiem B. Ha, Benjamin Yip, Aijaz Ahmed, Mindie H. Nguyen
Mo2024
Purpose: In the U.S, the Asian population has a disproportionately high HCC disease burden. Since many Asian Amercians are foreign-born and can be affected by diseases endemic in their countries of origin, the etiologies of underlying liver disease as well as other disease outcomes of Asian HCC patients are likely to differ from those of the general U.S. population. Asian Americans are also relatively understudied, and our goal is to elucidate potential differences that may exist in disease presentation and long-term survival between Asians and non-Asians with HCC. Methods: We conducted a retrospective cohort study of patients who presented with HCC at a U.S. university hospital between 01/1991 and 10/2011. Via computer query using ICD 9 diagnosis codes, a total of 1412 consecutive patients with HCC were identified. Of these, 635 (45%) were Asian and 777 (55%) were non-Asian. Data from individual chart review and National Death Index were obtained. Results: As seen in the Table, Asian HCC patients were significantly older, much less likely to have cirrhosis; and among those with cirrhosis, Asian patients had lower mean CPT score. The vast majority of non-Asian HCC cases were associated with hepatitis C virus (HCV) infection with the remaining due to non-viral causes. Among Asians, HBV infection is the most common underlying disease followed by HCV infection. Compared to non-Asians, Asian patients presented with more advanced HCC with less patients meeting the Milan criteria (37% vs. 46% p,0.01) and less patients with Barcelona Liver Clinic Cancer (BLCL) stage A (41% vs. 47%, p,0.001). There were significant differences in the types of treatment received by Asians compared to non-Asians (p ,0.001), with Asian patients more likely to receive supportive care only (25% vs. 20%) and more likely to undergo partial hepatectomy (13% vs. 5%) but less likely to be listed for liver transplantation (18% vs. 36%) or to undergo liver-directed palliative therapy (30% vs. 37%). Nevertheless, overall 5-year survival was significantly higher in Asian HCC patients (43% [95% CI= 39-47%]) compared to nonAsians (31% [95% CI= 28-35%]) (Figure). Following adjustments for age, sex, cirrhosis, treatment (vs. no treatment), AFP.500, BCLC staging, and Milan criteria with a multivariate Cox proportional hazards model, Asian ethnicity and HBV (vs. HCV) liver disease were independent predictors of higher survival (HR=0.71 95% CI=0.59-0.96 and HR=0.66 95% CI=0.52-0.82, respectively). Conclusions: HCV infection was the underlying disease in 80% of non-Asian HCC patients, while both HBV and HCV were common and involved over 90% of Asian HCC cases. Despite having more advanced HCC at presentation and lower rates of liver transplantation or palliative therapy, Asian ethnicity was an independent predictor for higher overall survival compared to non-Asian. Table 1
Treatment of Single- Nodule Hepatocellular Carcinoma: Comparison Between Surgical Resection and Transcatheter Arterial Chemioembolization Combined With Percutaneous Radiofrequency (TACE-RFA) Valentina Cesario, Federico Barbaro, Mariachiara Campanale, Michele La Torre, Alessandra Guerra, Teresa Antonella Di Rienzo, Silvia Pecere, Francesca Romana Ponziani, Emanuele Rinninella, Giovanni Gigante, Massimo Siciliano, Brigida E. Annicchiarico, Maria Assunta Zocco, Laura Riccardi, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Grieco, Gennaro Nuzzo, Felice Giuliante, Salvatore Agnes, Anna Maria De Gaetano, Giovanni B. Gasbarrini, Roberto Iezzi, Lorenzo Bonomo, Antonio Gasbarrini Background and aims: Currently surgical resection is the standard treatment option in patients with single nodule HCC.Recent evidence suggest that the combination of radiofrequency and transarterial chemoembolization may have a higher rate of complete response in the treatment of single HCC,even greater than 3 cm. The aim of this study was to compare the survival rate and the time to progression of disease in patients with single-nodule Hepatocellular carcinoma . 3 cm who underwent surgical resection(SR) or single step balloon-occluded RFA followed by TACE(TACE-RFA). We also evaluated the difference in post-procedural deterioration of liver function between the two treatments. Methods:Medical records of 37 HCC patients selected by the archive of the Multidisciplinary Group for the Treatment of Hepatocellular Carcinoma of our Centre (HEPATOCATT) with single nodule (maximum diameter . 3cm and Child-Pugh class A-B) treated with surgical resection (n=18) or RFA combined to TACE (n=19) since January 2010 to March 2012, were retrospectively reviewed. The patients survival outcomes were compared. Survival and Time To Progression (TTP) curves were obtained with the Kaplan-Meier method and compared by using the logrank test. Changes in liver laboratory tests after the procedures were considered to attest deterioration of liver function. Results: Patients of the two study groups were similar in epidemiological features,liver disease stage and lesion characteristics. Tumor size was comparable in both group (mean tumor size: SR 5.67 ± 3.82 cm; TACE-RFA group 4.65 ± 2.12 ; P = 0,3187). During follow-up (mean,15 months; range, 1-26 months), local tumor progression was observed in 11/19 (57.9%) patients of treated lesions in the combined treatment group and in 13/18 (72.2%) in SR group; P=0.57. There were not statistically significant differences in TTP rates among the two groups (median TTP SR: 278 ± 167.18 days; in TACE-RFA : 226±196.54 days; P =0.777). The 1-year local tumor progression rates evaluated by Kaplan Meier analysis, were comparable in the TACE + RFA group and in the surgical group (P =0.777). Interestingly the recurrence was always multinodular in SR group. The 1-year overall survival rate was 70% with combined treatment and 88% with SR (P = 0.09). Changes in Child-Pugh score one month after treatment were statistically significant only in surgical group (SR from 5.22 ±0.44 to 6.38 ±0.9 p ,0.0001; TACE-RFA group from 6.20 ± 1.75 to 6.64 ± 2.06 p=0.551) Conclusions: In our retrospective analysis we observed that in patients with single nodule HCC . 3 cm, survival rate and local tumor progression rate after treatment with single step balloon-occluded RFA followed by TACE (TACERFA) or surgical resection are similar. However our data showed that surgery can lead to deterioration of liver function more frequently than loco-regional treatment Mo2025 Usefulness of CE-US for Evaluating Vascularity of the Nodules Detected Only At Hepatobiliary Phase but Not At Arterial Phase in Gd-Eob MRI Shinichiro Minami, Takashi Goto, Kouichi Miura, Shigetoshi Ohshima, Tomomi Shibuya, Wataru Sato, Takahiro Dohmen, Kentaro Kamada, Mitsuru Chiba, Ryo Kanata, Toshitaka Sakai, Yuko Sugimoto, Hirohide Ohnishi Background and aims: The gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging (Gd-EOB MRI) is a powerful tool to detect small hepatocellular carcinoma (HCC). In Gd-EOB MRI, typical HCC is observed as a nodule with high-intensity at arterial phase and that with low-intensity at hepatobiliary (HB) phase. However, we often notice liver nodules detected at HB phase but not at arterial phase in Gd-EOB MRI. The differential diagnosis of these nodules between HCCs and benign tumors
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Mo2023
AGA Abstracts
in GROUP B. ALT also increased from 45.3±44.9 IU/L to 154.3±107.2 IU/L (P ,0.003) in GROUP A, from 55.6±41.23 IU/L to 88.5 ±68.3 IU/L(P=0.122) in GROUP B.These parameters returned to normal range within 3-4 weeks. No pts developed major complications in our study.Changes in Child-Pugh score 1 month after treatment were not statistically significant in both groups (GROUP A p=0.183; GROUP B p=0.282). Hospitalization time was 8.2±3.3 days in GROUP A and 9.6±5.6 in GROUP B(p= 0,4395). Technical success was achieved in 85% of pts in GROUP A(12/14; 6CR, 6PR) and 80% in GROUP B (12/15; 5 CR,7PR) on 1-month follow up CT (p=0.89).At 6 months local recurrence developed in 5/14 pts of GROUP A and 5/15 in GROUP B (p=0.78). On1 year follow up we observed that pts in GROUP B underwent a greater number of total following treatments (4 in GROUP A and 13 in GROUP B).Kaplan-Meier analysis didn't demonstrate statistically significant differences in OS among the two groups (p= 0.822). CONCLUSION: Liver function parameters and clinical features were not significantly deteriorated after both procedures;only ALT showed a greater transient increase after TACE-RFA than TACE. Although these therapeutic strategies didn't show a statistically significant difference in OS and efficacy, pts that underwent TACE needed greater number of following treatments.Therefore TACE-RFA could be more favorable than TACE alone in terms of cost-effectiveness in pts with multinodular unresecable HCC. Mo2029 Resection for Neuroendocrine Liver Metastases Give Excellent Long Term Survival but Very High Recurrence Rate. Analysis on 115 Liver Resections in a Tertiary Centre Safi Dokmak, Fadhel Samir Ftériche, Béatrice Aussilhou, Alain Sauvanet, Olivia HenticDhomé, Magaly Zappa, Pascal Hammel, Philippe Levy, Philippe B. Ruszniewski, Jacques Belghiti
Mo2027 Hepatolithiasis Should Be Followed-up Carefully to Detect Cholangiocarcinoma Even After Completeness of Stone Removal Regardless of Treatment Modality Sang Jun Suh, Jae Seon Kim, Sun Young Kim, Jong Jin Hyun, Beom Jae Lee, Jong-Jae Park, Hong Sik Lee, Chang Duck Kim, Young-Tae Bak
But: Evaluate the results of liver resection for neuro-endocrine liver metastases (NELM) in a tertiary centre. Patients and methods: Between January 2000 and December 2009, 70 patients underwent 115 liver resections for NELM. There were 36 women (52%) with a mean age of 54 years (17-76). The primary tumour was of pancreatic origin in 37 (53%), small bowel in 25 (36%), indeterminate in 7 (10%) and lung in 1 (1%). NELM were bilobar and metachronous in 46 (65%) and 17 (24%) of cases, respectively. Combined primary tumour and liver resection were necessary in 34 patients (48%) with 28 (40%) according to two step liver resection. Repeated hepatectomy was needed in 17 patients (15%). Major hepatectomy was done in 52 patients (45%) and an hypertrophy procedure of the remnant liver was necessary in 34 patients (48%) by portal vein ligation (n=26) or embolization (n= 8). The postoperative mortality was observed in one patient (0.9%) with an overall and major morbidity rate in 53% and 22%, respectively. Results: The mean NELM number and size were of 8.4 (1-31) and 3.5 cm (0.3-21), respectively. NELM were well differentiated in 58 patients (83%) with a MIB (Ki67) ≥ 5% in 26 patients (37%) and 36 patients had vascular emboli. Resection was R0 in 31 patients (44%). After a mean follow up period of 33 months (2-149), 39 patients (56%) presented recurrence and 3 died, one postoperatively and 2 diseases related. The mean overall and disease free survival were of 55 months (0149) and 33 months (0-149), respectively. The 5 and 10 year global and disease free survival were of 93%, 87%, 52% and 17%, respectively. In multivariate analysis, the major prognostic factors for recurrence or global survival were a MIB (Ki67) .5% or positive lymph node of the primary. Conclusion : Resection of NELM give an excellent long term survival but the recurrence rate still very high justifying in some subgroup of patients at higher risk of recurrence, other therapeutic alternative including liver transplantation.
Background/Aims: Hepatolithiasis is a well known risk factor of cholangiocarcinoma. Despite advances in diagnostic modalities, diagnosing cholangiocarcinoma in patients with hepatolithiasis still challenging and there are not enough reports on the incidence of cholangiocarcinoma in patient with hepatolithiasis after treatment. We aimed to evaluate the incidence and clinical characteristics of cholangiocarcinoma in patients with hepatolithiasis who underwent liver resection or non-resection. Methods: Among a total of 257 patients who received treatment for hepatolithiasis from 2002 to 2011 at Korea University Anam and Guro Hospital, 236 patients were eligible for analysis; 92 patients underwent liver resection (resection group) and 144 patients did not (non-resection group). The data were retrospectively collected and analyzed. Results: The incidence of cholangiocarcinoma was 6.8% (16/236) during follow-up period (mean 41±41 months). The median tumor occurrence time was 28 (13-111) months. Cholangiocarcinoma occurred 6.5% (6/92) and 6.9% (10/144) in resection and non-resection group respectively (P=0.425). In resection group, cholangiocarcinoma occurred in 3.6% (2/56) of patients with complete stone removal, and in 13.3% (4/ 30) of patients with incomplete stone removal (p=0.591). In non-resection group, cholangiocarcinoma occurred in 5.7% (3/53) of patients with complete stone removal, and in 8.9% (7/79) of patient with incomplete stone removal (p=0.738). When analyzed according to completeness of stone removal regardless of treatment modality, cholangiocarcinoma occurred in 4.6% (5/109) of patients with complete stone removal, and in 10.1% (11/109) of patients with incomplete stone removal (p=0.429). Although the site of stone and tumor occurrence concurred in 10/16 patients (3/6 patients in the resection group, 7/10 patient in the non-resection group), it did not match in 6 patients. On univariate analysis, none of the factors (age, gender, abdominal pain, bile duct stenosis, bile duct dilatation, liver atrophy, residual stone, stone recurrence and liver resection) showed relationship with the incidence of cholangiocarcinoma. Conclusion: There was no difference in the incidence of cholangiocarcinoma according to the treatment modality or completeness of stone removal. Therefore, patients with hepatolithiasis should carefully be followed-up to detect cholangiocarcinoma even after treatment.
Mo2030 Treatment of Portal Vein Tumor Thrombosis (PVTT) Can Impact Survival of Patients With Advanced HCC? Valentina Cesario, Emanuele Rinninella, Francesca Romana Ponziani, Matteo Garcovich, Davide Roccarina, Mariachiara Campanale, Teresa Antonella Di Rienzo, Federico Barbaro, Massimo Siciliano, Brigida E. Annicchiarico, Maurizio Pompili, Gian Ludovico Rapaccini, Laura Riccardi, Antonio Grieco, Luca Miele, Roberto Iezzi, Anna Maria De Gaetano, Enrico Di Stasio, Giovanni B. Gasbarrini, Lorenzo Bonomo, Maria Assunta Zocco, Antonio Gasbarrini
Mo2028
INTRODUCTION: HCC with PVTT is often associated with poor prognosis. Many efforts have been made to improve prognosis in this setting, but nowadays there is not a treatment of choice for HCC related PVTT. AIMS&METHODS: We retrospectively assessed epidemiologic data, tumor and underlying liver disease features, overall survival and treatment-related survival of 60 patients affected by advanced HCC complicated by PVTT. Moreover we evaluated variables associated to PVTT development and severity, and the impact of tumor thrombosis treatment on survival of patients with advanced HCC. We included both main portal vein and segmentary branches thrombosis. Diagnosis was made according to typical dynamic contrast pattern on radiological main techniques. We calculated overall survival by the time of both PVTT diagnosis and tumor onset. In addition we evaluated a possible role of performed treatment on conditioning prognosis. A Kaplan-Meier analysis was performed. RESULTS: From May 2008 to April 2012 60 patients (51 male, 9 female; mean age 66±5.6) were recruited for retrospective evaluation. 33/60 (55%) patients underwent systemic antiangiogenetic therapy; 6/60 (10%) were referred to external beam radiation therapy on thrombus; 21/60 (35%) not receive any active therapy. All patients received the best treatment on HCC concomitant nodules. A multivariate analysis showed that time between the onset of thrombosis and the diagnosis of HCC is significantly correlated to viral aetiology and BCLC stage at the diagnosis of HCC, while thrombosis extension is significantly correlated to the presence of portal hypertension. At the end of observation (47 months), survival for each group was 18%, 50% and 23%, respectively. The overall survival from the diagnosis of HCC was 753±88 days and it is significantly correlated to younger age at diagnosis, BCLC A and treatment performed on HCC nodule, but not according to PVTT treatment. The overall survival from the diagnosis of PVTT was 397±77 days. According to each group, mean survival was 408±86 days for the first group (antiangiogenetic therapy), 855±273 days for the second group (radiation therapy), 140±29 days for patients who had not received any therapy (p,0.001), regardless of age or severity of underlying liver disease. CONCLUSION: PVTT treatment seems to improve survival of patients with advanced HCC,
Comparison Between Transcatheter Arterial Chemoembolization (TACE) and Transcatheter Arterial Chemoembolization Combined With Percutaneous Radiofrequency Ablation (TACE-RFA) for Treatment of Intermediate Hepatocellular Carcinoma Mariachiara Campanale, Federico Barbaro, Valentina Cesario, Michele La Torre, Alessandra Guerra, Teresa Antonella Di Rienzo, Silvia Pecere, Giovanni Gigante, Francesca D'Aversa, Francesca Romana Ponziani, Emanuele Rinninella, Massimo Siciliano, Brigida E. Annicchiarico, Maria Assunta Zocco, Laura Riccardi, Maurizio Pompili, Gian Ludovico Rapaccini, Antonio Grieco, Gennaro Nuzzo, Felice Giuliante, Salvatore Agnes, Anna Maria De Gaetano, Giovanni B. Gasbarrini, Roberto Iezzi, Lorenzo Bonomo, Antonio Gasbarrini BACKGROUND:patients with multinodular HCC at BCLC-B stage are suitable only to palliative treatments such as TACE.Recent studies evaluated the application in this subgroup of balloon-occluded RFA combined with TACE to increase the local response and the survival rate.AIM: to compare safety tolerability and influence on liver function of TACE and single step balloon-occluded RFA followed by TACE(TACE-RFA) in pts affected by unresectable multinodular hepatocellular carcinoma.Our second purpose was to evaluate the efficacy and Overall Survival(OS) in patients treated with these two strategies.METHODS: Since January 2010 to March 2012 a group of 14 pts with multinodular unilobar unresectable HCC were submitted to TACE+RFA(GROUP A: 14 pts). These pts were individually matched with 15 pts treated only with TACE (GROUP B:15 pts) selected by the archive of our Centre (HEPATOCATT).We monitored changes in liver laboratory tests, major complications after procedures and time of hospitalization.Early local efficacy was evaluated on CT performed at 1-month and 6-months of follow-up.We also analyzed number of treatments performed during the year following the procedure.Kaplan-Meier analysis were performed to evaluate OS. RESULTS: Plasma total bilirubin increased from 1.0±0.56 mg/dL to 1.4±0.5 mg/dL on post-procedural(P =0.038) in GROUP A and from 1.5±1 mgl/dL to 2.1±1.6 mg/dL (P=0.277)
AGA Abstracts
S-722