Risk of hepatocellular carcinoma recurrence in hepatitis C cirrhotic patients treated with direct acting antivirals

POSTER PRESENTATIONS (commonly attributed to non-alcoholic steatohepatitis (NASH)) HCC becomes increasingly important. We also compared other clinical features and survival outcomes between ELD and non-ELD patients. Methods: The study cohort comprised 1430 patients seen in the Department of Gastroenterology and Hepatology, Singapore General Hospital, prospectively enrolled in a HCC database since 1988. The ELD group consisted of patients with HCC diagnosed at age 70 years or more. Demography, clinical characteristics and mortality data were compared between ELD and non-ELD groups. Survival census was performed with the National Registry of Deaths on 31 October 2015. Statistical and survival analyses were performed using SPSS. Study was approved by IRB. Results: There were 378 (26.4%) and 1052 (73.6%) patients in ELD and non-ELD groups respectively. Median age was 75 and 59 years respectively ( p < 0.001). There were significantly more female patients in ELD group (30.4% vs. 13.8%, p < 0.01). Hepatitis B was significantly less prevalent in ELD group (35.9% vs. 68.5%, p < 0.0001). Conversely, cryptogenic ( presumably NASH) HCC was significantly more prevalent in ELD group (27.3% vs. 11%, p < 0.0001). There were significantly less Child Pugh A (CP-A) patients in ELD group (CP-A/B/C in ELD vs. non-ELD: 42%/44.3%/13.7% vs. 53.6%/32.6%/13.8%, p < 0.001). Single lesion HCC at presentation was more common in ELD group (55.8% vs. 49.0%, p < 0.05). There was no significant difference in BCLC staging between ELD and non-ELD. Portal vein invasion was less common in ELD group (25.4% vs. 35.6%, p < 0.001). Mean ± SEM survival of ELD was significantly lower than non-ELD (23.8 ± 2.67 vs. 53.7 ± 4.45 months, p < 0.01). Conclusions: There were more female elderly patients with HCC compared with non-elderly patients. Cryptogenic ( presumably NASH) HCC becomes more important in elderly patients. Elderly patients tended to have less aggressive disease with less multifocal disease and less portal vein invasion but still had poorer survival. Thus, the outcome of HCC is poorer and risk indicators associated with HCC in the elderly differ from our younger patients. This has implications in the surveillance for HCC in the elderly. THU-096 Risk of hepatocellular carcinoma recurrence in hepatitis C cirrhotic patients treated with direct acting antivirals G. Cabibbo1, I. Cacciola2, M.R. Cannavò3, S. Madonia4, V. Calvaruso5, S. Petta1, M. Di Stefano6, L. Larocca7, T. Prestileo8, F. Tinè9, A. Digiacomo10, G. Bertino11, L. Giannitrapani12, F. Benanti13, A. Davì14, R. Volpes15, L. Guarneri16, A. Averna17, I. Scalisi18, C. Iacobello19, G. Mazzola20, F. Cartabellotta21, V. Portelli22, M. Russello23, G. Scifo24, G. Squadrito25, G. Raimondo25, A. Craxì1, V. Di Marco1, C. Cammà1 and on behalf of RESIST-HCV (Rete Sicilia Selezione Terapia – HCV). 1 Gastroenterologia ed Epatologia, DIBIMIS, Università di Palermo, Palermo; 2Epatologia Clinica e Molecolare, AOUP “G. Di Martino”, Messina; 3UOD di Epatologia, ARNAS “Garibaldi-Nesima”, Catania; 4 Medicina Interna, AO Cervello Villa Sofia; 5Gastroenterologia ed Epatologia, Università di Palermo, Palermo; 6Malattie Infettive, UmbertoI, Siracusa; 7Malattie INfettive, AOUP Vittorio Emanuele, Catania; 8Malattie Infettive, ARNAS Civico “Di Cristina-Benefratelli”; 9 Gastroenterologia, AO Cervello-Villa Sofia, Palermo; 10Medicina Interna, Presidio Ospedaliero, Comiso; 11Medicina Interna e Urgenza, “Vittorio Emanuele”, Catania; 12Medicina Interna, Università di Palermo, Palermo; 13Malattie Infettive, “Garibaldi-Nesima”, Catania; 14Malattie Infettive, Presidio Ospedaliero Modica, Modica; 15ISMETT, ISMETT, Palermo; 16Malattie Infettive, Umberto I, Enna; 17Malattie Infettive, S. Elia, Caltanissetta; 18Medicina Interna, Presidio Ospedaliero di Castelvetrano, Trapani; 19Malattie Infettive, Cannizzaro, Catania; 20 Malattie Infettive, Università di Palermo, Palermo, Italy; 21Medicina Interna, Buccheri La Ferla, Palermo, Israel; 22Malattie Infettive, P.O., Trapani; 23Gastroenterologia, Garibaldi, Catania; 24Malattie Infettive, Umberto I, Siracusa; 25Epatologia Clinica e Molecolare, Università di Messina, Messina, Italy E-mail: [email protected]

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Background and Aims: Use of direct acting antivirals (DAA) is a revolution for the treatment of patients with chronic hepatitis C. However, conflicting data exists regarding the impact of DAA treatments on the rate of tumor recurrence after curative treatment of hepatocellular carcinoma (HCC) in HCV-related cirrhotic patients. To evaluate the risk of HCC early recurrence in successfully treated HCV-related HCC after DAA therapy, we analysed the on-going dataset from RESIST-HCV, which includes all HCV patients evaluated in 22 Centres of Sicily. Methods: Between March 2015 and October 2016, 185 patients with HCV-related compensated cirrhosis and an HCC who achieved complete radiological response after curative treatment underwent anti-HCV treatment with DAAs. DAA regimens and use of Ribavirin were established by each physician. The baseline characteristics and radiologic tumor response were registered in all patients before starting antiviral therapy and during the follow-up according to the clinical practice policy. The primary endpoint of the analysis was the time to HCC recurrence, defined as the initiation of DAA to the documentation of HCC recurrence. Results: Median follow-up was 9.9 months (mo.). One hundred fifty six patients was in Child-Pugh A, while 29 was in Child-Pugh B. Seventy nine patients had a 12 –mo. therapy regimen while 106 had a 24 mo. therapy regimen. One hundred seven patients completed therapy during follow-up and 78 were still on treatment. The crude rate of HCC recurrence was 13% (24/185). Pattern of recurrence was nodular in 83% patients (20/24) and infiltrative in 17% (4/24). The actuarial probability by Kaplan-Meier method of developing HCC recurrence during follow-up is shown in Figure 1. The 6 and 12 mo. HCC recurrence rates were 7.9% and 16.3%, respectively. One patient died during follow-up.

Conclusions: In patients with HCV-related successfully treated HCC DAAs does not increase the risk of HCC recurrence. Moreover, potential benefit of DAA on preservation of liver function, resulting in a lower cirrhosis-related mortality and a greater change of receiving curative treatments, should improve survival of patients with HCV-related HCC who achieved complete radiological response after curative treatment. THU-097 Hepatocellular carcinoma and rheumatoid arthritis: a 10-year population-based propensity-score matched cohort study in Taiwan C.-S. Hsu1, H.-C. Lang2, K.-Y. Huang3, C.-L. Chen4. 1Liver Diseases Research Center, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei; 2Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei; 3Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi; 4Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan E-mail: [email protected]

Journal of Hepatology 2017 vol. 66 | S95–S332