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The role of Spleen Stiffness measurement as predictor of HCC recurrence after curative resection in cirrhotic patients
Abstracts / Digestive and Liver Disease 49S (2017) e19–e42
being present only in F4 patients. SSM and LSM represent a useful prognostic tools in patients treated with DAA. http://dx.doi.org/10.1016/j.dld.2017.01.085 T-48 The role of Spleen Stiffness measurement as predictor of HCC recurrence after curative resection in cirrhotic patients G. Marasco 1,∗ , A. Colecchia 1 , A. Colli 2 , G. Casazza 3 , F. Ravaioli 1 , A. Cucchetti 1 , M. Cescon 1 , A.D. Pinna 1 , D. Festi 1 1 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy 2 Department of Internal Medicine, Manzoni Hospital Lecco, Lecco, Italy 3 Department of Clinical and Biochemical Sciences, University of Milan, Milano, Italy
Introduction: Hepatocellular carcinoma (HCC) is a frequent complication in patients with chronic liver diseases and one of the most common malignancies worldwide. Liver resection is the gold standard treatment option for patients with solitary tumors; however, tumor recurrence complicates 70% of cases of hepatic resection at 5 years. Recently it has been demonstrated that the degree of portal hypertension (PH) measured by HVPG is directly correlated with the risk of developing HCC. We recently documented that spleen (SSM) and liver (LSM) stiffness measurement are accurate non-invasive markers of portal hypertension in cirrhosis. Aims: The aim of our study was to identify the role of SSM and LSM as predictors of HCC recurrence after curative resection. Materials and methods/Results: 157 patients with HCC who underwent curative resection between 2008 and 2014 were prospectively enrolled to assess early (<12 months) and late (>24 months) recurrence. The results of LSM and SSM assessed with ® TE (Fibroscan , Echosens) together with clinical and histological data were collected before surgery and their association with early or late recurrence was assessed by uni and multivariate logistic regression analysis. Forty-nine (49) patients with early and 22 with late HCC recurrence were identified during follow-up period. At univariate analysis, early recurrences were associated with etiology, number of nodules, HCC diameter and grading, infiltrated resection margins and satellitosis. Multivariate analysis showed that only viral (HCV, HBV) etiology, tumor diameter and margin infiltration were independently associated with early recurrence with an area under the curve (AUC) of 0.73. At univariate analysis late recurrence was associated only with SSM (p = 0.0027) with an AUC of 0.70. Conclusions: Early HCC recurrence is associated with HCC clinical and pathological features; late recurrence was best predicted by the assessment of SSM, thus suggesting a role of portal hypertension in the development of HCC late recurrence. http://dx.doi.org/10.1016/j.dld.2017.01.086
e41
T-49 Impact of adrenal dysfunction on psoas muscle thickness assessed by computed tomography in patients with liver cirrhosis G. Privitera, L. Spadaro, D. Russo, S. Marchisello, F. Purrello Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy Background and aims: Sarcopenia and adrenal insufficiency (AI) are common features of cirrhosis and contribute to mortality. Nausea and weight loss represent common symptoms of AI and may participate to muscle waste. The aim of our study was to evaluate the role of AI on psoas muscle thickness assessed by CT in a cohort of cirrhotics. Methods: 74 cirrhotic patients were examined. Laboratory parameters of malnutrition (albumin, pre-albumin, transferrin and lymphocytes) were assessed. Axial (APMT) and Transversal psoasmuscle-thickness (TPMT) were measured on CT at the level of the umbilicus. Psoas-muscle-thickness was normalized to stature by division by height (APMT/h and TPMT/h). Adrenal function was assessed using the Standard-Dose-short-synacthen test. A peak cortisol > 18 g/dl was defined normal. Results: AI was present in 23 patients. The severity of cirrhosis graded by Child-Pugh and MELD was increased in AI compared to normal adrenal function (NAF) patients (p = 0.001). AI patients exhibited lower values of pre-albumin (6 ± 3 vs 10 ± 8; p = 0.03) and transferrin (150 ± 84 vs 220 ± 76; p = 0.003) compared to NAF subjects. A significant reduction of TPMT values was observed in female compared to male (23.5 ± 6 vs 31 ± 8; p = 0.002). Cirrhotics with AI showed increased levels of both APMT (44 ± 6 vs 20 ± 5; p = 0.02) and TPMT (32 ± 8 vs 27 ± 7; p = 0.03) compared to NAF. A significant correlation was found between TPMT/h and peak cortisol values (r = 0.38; p = 0.01). When we stratified our population using TPMT/h < 16.8 mm/h, the number of NAF patients was significantly increased compared to AI (p = 0.01). Finally, after stratifying our our population according to ascites presence, we observed a significant reduction of APMT in ascites (37 ± 5 vs 43 ± 7; p = 0.02). Conclusion: Our data suggest that adrenal dysfunction does not contribute to sarcopenia in cirrhotic patients. Cortisol is an important catabolic hormone, and its deficiency seems to play a protective role on muscle waste in cirrhotic patients. http://dx.doi.org/10.1016/j.dld.2017.01.087
being present only in F4 patients. SSM and LSM represent a useful prognostic tools in patients treated with DAA. http://dx.doi.org/10.1016/j.dld.2017.01.085 T-48 The role of Spleen Stiffness measurement as predictor of HCC recurrence after curative resection in cirrhotic patients G. Marasco 1,∗ , A. Colecchia 1 , A. Colli 2 , G. Casazza 3 , F. Ravaioli 1 , A. Cucchetti 1 , M. Cescon 1 , A.D. Pinna 1 , D. Festi 1 1 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy 2 Department of Internal Medicine, Manzoni Hospital Lecco, Lecco, Italy 3 Department of Clinical and Biochemical Sciences, University of Milan, Milano, Italy
Introduction: Hepatocellular carcinoma (HCC) is a frequent complication in patients with chronic liver diseases and one of the most common malignancies worldwide. Liver resection is the gold standard treatment option for patients with solitary tumors; however, tumor recurrence complicates 70% of cases of hepatic resection at 5 years. Recently it has been demonstrated that the degree of portal hypertension (PH) measured by HVPG is directly correlated with the risk of developing HCC. We recently documented that spleen (SSM) and liver (LSM) stiffness measurement are accurate non-invasive markers of portal hypertension in cirrhosis. Aims: The aim of our study was to identify the role of SSM and LSM as predictors of HCC recurrence after curative resection. Materials and methods/Results: 157 patients with HCC who underwent curative resection between 2008 and 2014 were prospectively enrolled to assess early (<12 months) and late (>24 months) recurrence. The results of LSM and SSM assessed with ® TE (Fibroscan , Echosens) together with clinical and histological data were collected before surgery and their association with early or late recurrence was assessed by uni and multivariate logistic regression analysis. Forty-nine (49) patients with early and 22 with late HCC recurrence were identified during follow-up period. At univariate analysis, early recurrences were associated with etiology, number of nodules, HCC diameter and grading, infiltrated resection margins and satellitosis. Multivariate analysis showed that only viral (HCV, HBV) etiology, tumor diameter and margin infiltration were independently associated with early recurrence with an area under the curve (AUC) of 0.73. At univariate analysis late recurrence was associated only with SSM (p = 0.0027) with an AUC of 0.70. Conclusions: Early HCC recurrence is associated with HCC clinical and pathological features; late recurrence was best predicted by the assessment of SSM, thus suggesting a role of portal hypertension in the development of HCC late recurrence. http://dx.doi.org/10.1016/j.dld.2017.01.086
e41
T-49 Impact of adrenal dysfunction on psoas muscle thickness assessed by computed tomography in patients with liver cirrhosis G. Privitera, L. Spadaro, D. Russo, S. Marchisello, F. Purrello Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy Background and aims: Sarcopenia and adrenal insufficiency (AI) are common features of cirrhosis and contribute to mortality. Nausea and weight loss represent common symptoms of AI and may participate to muscle waste. The aim of our study was to evaluate the role of AI on psoas muscle thickness assessed by CT in a cohort of cirrhotics. Methods: 74 cirrhotic patients were examined. Laboratory parameters of malnutrition (albumin, pre-albumin, transferrin and lymphocytes) were assessed. Axial (APMT) and Transversal psoasmuscle-thickness (TPMT) were measured on CT at the level of the umbilicus. Psoas-muscle-thickness was normalized to stature by division by height (APMT/h and TPMT/h). Adrenal function was assessed using the Standard-Dose-short-synacthen test. A peak cortisol > 18 g/dl was defined normal. Results: AI was present in 23 patients. The severity of cirrhosis graded by Child-Pugh and MELD was increased in AI compared to normal adrenal function (NAF) patients (p = 0.001). AI patients exhibited lower values of pre-albumin (6 ± 3 vs 10 ± 8; p = 0.03) and transferrin (150 ± 84 vs 220 ± 76; p = 0.003) compared to NAF subjects. A significant reduction of TPMT values was observed in female compared to male (23.5 ± 6 vs 31 ± 8; p = 0.002). Cirrhotics with AI showed increased levels of both APMT (44 ± 6 vs 20 ± 5; p = 0.02) and TPMT (32 ± 8 vs 27 ± 7; p = 0.03) compared to NAF. A significant correlation was found between TPMT/h and peak cortisol values (r = 0.38; p = 0.01). When we stratified our population using TPMT/h < 16.8 mm/h, the number of NAF patients was significantly increased compared to AI (p = 0.01). Finally, after stratifying our our population according to ascites presence, we observed a significant reduction of APMT in ascites (37 ± 5 vs 43 ± 7; p = 0.02). Conclusion: Our data suggest that adrenal dysfunction does not contribute to sarcopenia in cirrhotic patients. Cortisol is an important catabolic hormone, and its deficiency seems to play a protective role on muscle waste in cirrhotic patients. http://dx.doi.org/10.1016/j.dld.2017.01.087