The Risk Factors of Developing Hepatocellular Carcinoma in Patients with Chronic Hepatitis B Treated with Oral Antiviral Therapy and Inactive Stage Disease

POSTER PRESENTATIONS surveillance had significantly higher cumulative survival from diagnosis (hazard ratio 0.4480, 95% CI 0.3021 to 0.6640, p = 0.0002). Taking upper and lower 95% CI of mean TVDT values from nine studies of primary untreated HCC, the false-negative rate of USS in the presence of lesions >1cm is between 56–79% (Figure 1). Conclusions: Ultrasound surveillance for HCC increases the chance of curative treatment and survival, although the benefit is modest and prolonged survival may be in part attributable to lead-time bias. Despite surveillance intervals close to the recommended target of 6 months in our cohort, we have identified very high rates of falsenegative US which delay diagnosis substantially. This finding is at odds with published estimates of US sensitivity for HCC detection (60% in a recent meta-analysis) but akin to estimates when explant histology is the reference standard (34% versus 70% for MRI). MRI surveillance may improve rates of HCC detection at a curable stage and therefore long-term survival. THU-094 EFFICACY AND SAFETY OF PERCUTANEOUS LASER ABLATION THERAPY FOR TREATMENT OF LARGE HEPATOCELLULAR CARCINOMA S. Camera1, G.G. Di Costanzo2, R. Tortora2, L. Addario2, F. Lampasi2, Maria T. Tartaglione2, V. Cossiga1, L. Donnarumma1, N. Caporaso1, F. Morisco1. 1Clinical Medicine and Surgery, Aou Federico II; 2Liver Unit, Cardarelli, Naples, Italy E-mail: [email protected] Background and Aims: Percutaneous laser thermal ablation (LA) represents one of currently available loco-ablative techniques for the treatment of hepatocellular carcinoma (HCC). It is a hyperthermiabased ablative technique, consisting in the thermal tissue destruction by conversion of absorbed light into heat. In an RCT we have demonstrated that LA is not inferior to RFA for treatment of small HCC. Conversely, its efficacy and safety in large HCC (>4 cm) is not well established. This study aimed to analyze the efficacy and safety of LA in patient with large HCC. Methods: Between January 2009 and December 2012, 53 cirrhotic patients (40/13 Male/Female; mean age 70, range 51–84 yrs; ChildPugh A/B: 48/5) with at least one nodule of HCC ≥ 40 mm treated with LA were enrolled at the Liver Unit of the “Cardarelli” Hospital of Naples. The diagnosis of HCC was done according to the international guidelines and patients were staged according to BCLC Staging System (BCLC stage A/B: 29/24). Forty-one patients (77%) had a single nodule HCC, while 12 patients (23%) had a multinodular HCC. The median size of the main HCC nodule was 50 mm (range 40–75 mm). Response to therapy was evaluated with imaging techniques according to the mRECIST criteria. Survival was calculated from the time of cancer diagnosis to death with values censored at the date of the last follow-up. Results: Thirty-five patients (66%) showed a complete response to LA, while only eighteen patients (34%) showed a partial response; none showed stable or progressive disease after treatment. The therapeutic efficacy was similar in nodules sized 40–50 mm in comparison to those larger than 50 mm. The cumulative survival rates were 85.8% and 56.6% at 12 and 36 months, respectively. The disease recurrence was observed in 13 patients (24%) after a median time of 16 months (range 5–40). The recurrence was not related to the size of main HCC nodule. According to safety analysis, only 3 patients (<5%) showed postablation complications: fever and mild abdominal pain for a period of at least 10 days. In one patient the fever was associated with ascites and pleural effusion, both successfully treated with diuretic therapy. Conclusions: LA could be considered an efficacious and safe therapeutic option in patients with difficult to treat large HCC.

THU-095 THE RISK FACTORS OF DEVELOPING HEPATOCELLULAR CARCINOMA IN PATIENTS WITH CHRONIC HEPATITIS B TREATED WITH ORAL ANTIVIRAL THERAPY AND INACTIVE STAGE DISEASE Y.K. Cho1, G.M. Jung 1, S.H. Yun1. 1Internal Medicine, Hepatology Department, Presbyterian Medical Center, Jeonju, South Korea E-mail: [email protected] Background and Aims: It is generally stated that oral antiviral therapy in patients with chronic hepatitis B (CHB) decreased the risk of developing hepatocellular carcinoma (HCC) as maintaining low level of HBV DNA. Although, oral nucleos(t)ide analogues (NUCs) may induced a state similar to inactive stage CHB, the difference of incidence of HCC in patients treated with NUCs compared with inactive CHB and the risk factors of developing HCC in two groups of well-controlled HBV DNA level are unclear. Methods: A total of 62 patients who were treatment naïve and started NUC therapy and 10 patients with inactive stage CHB who were HBeAg-negative and continuously had HBV DNA <2000 IU/mL were enrolled retrospectively. The NUC group was divided into two groups by continuous viral suppression: NUC complete responder (CR) and NUC incomplete responder (IR). Cumulative HCC incidence rates were compared among the groups and the risk factors of developing HCC were investigated. Results: The cumulative HCC incidence rates during 10-years followup periods were not significantly different between the NUC group and inactive stage CHB (63.9% vs 16.7%, p = 0.539), also between NUC CR and IR (32.2% vs 10%, p = 0.413). The risk factor of developing HCC in all groups was HBeAg-negative state in multivariable logistic regression ( p = 0.016, OR 7.63), and the period of NUC therapy was significant risk factor associated with the development of HCC in NUC group ( p = 0.032, OR 0.918). Conclusions: The use of potent oral antiviral therapy can suppress HBV replication in patients with CHB. However, we should be concerned about HBeAg state in groups of well-controlled HBV DNA level, and should not hesitate to start NUC therapy on appropriate time in patients belonging to criteria of NUC therapy. THU-096 GADOXETIC ACID DISODIUM-ENHANCED MRI COMBINED SURVEILLANCE IMPROVES CLINICAL OUTCOME BY SENSITIVE DETECTION OF EARLY STAGE HEPATOCELLULAR CARCINOMA, COMPARED WITH ULTRASONOGRAPHY BASED SURVEILLANCE, IN PATIENTS WITH CIRRHOSIS S.J. Yu1, J.-J. Yoo1, Y.Y. Cho1, W.-M. Choi1, M. Lee1, D.H. Lee1, Y. Cho1, E.-J. Cho1, J.-H. Lee1, Y.J. Kim1, J.M. Lee2, C.Y. Kim1, J.-H. Yoon1. 1Internal Medicine; 2Radiology, Seoul National University Hospital, Seoul, South Korea E-mail: [email protected] Background and Aims: In patients with cirrhosis, hepatocellular carcinoma (HCC) is detected by ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI). Among them, ultrasonography is only recommended for surveillance. However, prognostic role of gadoxetic acid disodium (Gd-EOBDTPA)-enhanced MRI for HCC surveillance in patients with cirrhosis has not been fully determined. Methods: From January 2008 to August 2013, 406 HCC patients who were newly diagnosed during surveillance at a tertiary care institution were consecutively enrolled. Early stage (stage 0 or A) HCC was defined by the Barcelona Clinic Liver Cancer staging system (BCLC) and the detection sensitivity of patients with early stage HCC was evaluated. Overall survival (OS) was measured from date of enrollment until death from any cause. Radiologic progression was evaluated using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) by independent radiologic assessment. Results: Among 406 patients, surveillance was performed based on ultrasonography (ultrasonography group) in 282 (69.5%) patients and Gd-EOB-DTPA-enhanced MRI combined to ultrasonography based

Journal of Hepatology 2016 vol. 64 | S213–S424

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