- Email: [email protected]
The systemic inflammatory response is a prognostic marker in human immunodeficiency virus-infected patients with hepatocellular carcinoma
POSTER PRESENTATIONS Background and Aims: In the phase 3 RESORCE trial, regorafenib (REG) improved overall survival (OS) vs placebo in patients with hepatocellular carcinoma (HCC) who progressed on sorafenib (HR 0.63; 95% CI 0.50, 0.79; P < 0.001). This exploratory analysis evaluated the relationship between efficacy and safety outcomes and REG and free aggregate exposure in RESORCE. Methods: Average REG exposure estimates were derived from population pharmacokinetic analyses for Cycle 1 and Cycles 1 plus 2. Patients were assigned to 3 exposure groups by quartile: low (1st quartile), medium (2nd + 3rd quartiles), high (4th quartile). Average exposure parameters were calculated for REG ( parent compound only) and free aggregate (sum of REG and its metabolites, M-2 and M5, corrected for molecular weight and unbound fraction). The relationship between exposure and OS or selected safety parameters was analyzed by descriptive statistics. Results: Demographics and baseline characteristics were similar across the 3 exposure groups. Geometric mean exposures in Cycle 1 and Cycles 1 plus 2 for REG were 1867 and 1496 ng/mL, respectively (geometric CVs 43.8% and 45.1%) and for free aggregate were 24.6 and 19.6 nmol/L (geometric CVs 48.1% and 50.6%). There was a trend for a difference in OS between the exposure groups, with the lowest median OS in the low exposure groups (REG [95% CI]: 260 days [194, 331]). OS was 374 days (272, 451) for the medium REG and 472 days (341, 655) for the high REG group. However, the median OS in all REG and all free aggregate exposure groups was prolonged in comparison to placebo in RESORCE (237 days [192, 269]). No obvious correlation between selected treatment-emergent adverse events (TEAEs; all grade and grade ≥3) and exposure to REG and free aggregate was observed. Low exposure groups experienced more TEAEs during the first cycle which resulted in dose modifications (low exposure group 36.1% vs 20.9% and 14.5% in medium and high exposure groups, respectively). A similar trend was observed for dose modifications during the whole treatment period. Conclusions: A trend for shorter median OS in the low REG exposure group was observed but there was no difference for the medium/high exposure groups. No consistent, relevant relationship between exposure to REG and relevant safety variables explored in this analysis was observed. More frequent dose modifications were associated with lower exposure. The analyses support the use of the approved dose of REG 160 mg QD in early treatment cycles in HCC. THU-068 Trunk and branch drivers in hepatocellular carcinoma: impact of molecular heterogeneity A. Moeini1,2, D. Sia1, A.N. Harrington1,3, S. Torrecilla1,2, Z. Zhang4, G. Camprecios1, S. Toffanin1, M.I. Fiel1, K. Hao4, M. Higuera1, L. Cabellos2, H. Cornella2, M. Mahajan1, Y. Hoshida1, A. Villanueva1, S. Florman1, M.E. Schwartz1, J.M. Llovet1,2,5. 1Mount Sinai Liver Cancer Program (Divisions of Liver Diseases, Department of Medicine, Department of Pathology, Recanati Miller Transplantation Institute), Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, United States; 2Liver Cancer Translational Research ̀ iques Laboratory, BCLC Group, Liver Unit, Institut d’Investigacions Biomed August Pi i Sunyer (IDIBAPS), Hospital Clínic, CIBERehd, Universitat de Barcelona, Barcelona, Spain; 3Department of Surgery, Residency Program, Mount Sinai St Lukes/Roosevelt Hospital; 4Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, United States; 5Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain E-mail: [email protected] Background and Aims: Molecular heterogeneity occurs in Hepatocellular carcinoma (HCC), but its implications in clinical decision-making are unknown. Trunk alterations arise at early stages and are shared by all malignant cells while branch mutations occur in subclonal cells. We characterized genomic heterogeneity by
defining trunk and branch driver alterations at early stages and defining intra- and inter-tumor diversity. Methods: A total of 153 samples representing the multiple step HCC process were analyzed by deep targeted-sequencing, transcriptome and SNP arrays. Genes mutated in early lesions [39 dysplastic nodules and 54 early HCCs (eHCC), defined as <2 cm, without satellites or vascular invasion] were defined as trunk genes. Candidate trunk genes were further explored in two additional cohorts: (a) intratumor heterogeneity cohort: 42 tumor regions of 21 tumors >4 cm (2 regions/tumor); and (2) inter-tumor heterogeneity cohort: 39 tumors from 17 patients with multinodular lesions (2–3 nodules/patient). In the inter-tumor heterogeneity cohort, the similarity of the CNVprofile was used to classify them as clonal (intra-hepatic metastasis) or non-clonal (synchronic tumors). Results: A total of 46 mutations were identified in the cohort of early lesions. eHCCs compared with dysplastic nodules, presented a higher number of mutations (1.1 vs 0.5 mutations/patient, p = 0.03) and CNV aberrations (8% vs 0.6% of aberrant chromosomal arms, p < 0.0003). Overall, 72% (23/32) eHCCs presented at least 1 trunk mutation, being TERT, TP53 and CTNNB1 the most frequent (21/23, 91%). In the intratumor heterogeneity cohort, 81% (17/21) tumors shared at least 1 mutation between different tumor regions (trunk drivers), such as TERT, TP53 and/or CTNNB1. Regarding inter-tumor heterogeneity, 6/17 (35%) of patients harbored clonal tumors according to their CNV profiles. Clonality classification was further confirmed by gene expression-based hierarchical clustering. 82% (9/11) of the sequenced clonal tumors shared TERT, TP53 and/or CTNNB1 as trunk alterations. In contrast, no trunk mutations were shared across non-clonal tumors. Conclusions: Trunk drivers mutated in early HCC tumors (TERT, TP53 and CTNNB1) remained as trunk aberrations across different regions of the same tumor and between primary and metastatic nodules in >80% of cases. These early mutations can be captured with single biopsies and could represent ideal therapeutic targets in the future. THU-069 The systemic inflammatory response is a prognostic marker in human immunodeficiency virus-infected patients with hepatocellular carcinoma D.J. Pinato1, M. Merli2, A.D. Pria3, S. Jamshaid1, K. Parker3, N. Pagani3, H. Hasson2, C. Uberti-Foppa2, E. Messina2, R. Sharma1, M. Nelson4, M. Bower3 and Imperial College Liver Cancer Study Group. 1Surgery and Cancer, Imperial College London, London, United Kingdom; 2 Infectious Diseases, IRCCS Ospedale San Raffaele, Milano, Italy; 3 National Centre for HIV Malignancy, Chelsea and Westminster NHS Trust, London, United Kingdom; 4National Centre for HIV Malignancy, Chelsea and Westminster NHS Trust, London, Italy E-mail: [email protected] Background and Aims: Hepatocellular carcinoma (HCC) is increasingly prevalent in people living with human immunodeficiency virus (HIV), especially in the context of concurrent hepatitis. Systemic inflammation is a prognostic factor independent of Barcelona Clinic Liver Cancer (BCLC) stage and Child-Pugh (CP) class in HCC. However there is no documented role of its clinical value in cases associated with HIV infection. Methods: From a large, prospectively maintained database of 602 non-AIDS defining cancer (NADCs) treated at the National Centre for HIV Oncology (London, UK), we selected all patients with HCC, diagnosed between 2001 and 2014 (n = 21) and combined them with an independent dataset from San Raffaele Hospital, Milan, Italy (n = 38). We investigated the prognostic role of a panel of inflammatory markers including neutrophil-lymphocyte (NLR) and plateletlymphocyte ratio (PLR), Inflammation-based Index (IBI) and Systemic Immune Inflammation (SII) score using uni- and multivariable overall survival (OS) analyses. Results: 59 consecutive cases were included (92% men, median age 52, range 36–71), CP A 69%, early/intermediate BCLC stage 66%. Most
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POSTER PRESENTATIONS prevalent aetiologies were HCV (69%) and HBV (32%). At HCC diagnosis median latency from HIV diagnosis was 22 years, with median CD4 count of 390 (range 56–1166) and undetectable HIV RNA in 75%. Median OS was 22 months. On univariate analysis NLR ( p < 0.001), PLR ( p = 0.03) but not SII nor IBI emerged as predictors of OS together with BCLC stage, CP ( p < 0.001), and alfafetoprotein >400 ng/ml ( p = 0.002). Patients with NLR > 5 (n = 6, 10%) had a median OS of 1 month compared to 15 of the NLR <5 group (n = 51, 90%, HR 7.3, 95% CI 2.8–19). The independent prognostic power of the NLR ( p = 0.002) was confirmed in a multivariate Cox regression model adjusted for BCLC, CP and AFP > 400. High NLR values were associated with advanced BCLC stage ( p = 0.003), poorer performance status ( p < 0.001) and higher proportion of portal vein thrombosis ( p < 0.001) but not with HIV RNA or CD4 counts.
Conclusions: Systemic activation of a pro-inflammatory response as measured by the NLR is an independent prognostic domain for survival of HIV patients with HCC. An elevated NLR is associated with adverse pathological features of malignancy but not of the co-existing HIV infection suggesting a tumour-promoting role of the innate immune response that warrants further evaluation in mechanistic studies. THU-070 Rising incidence of hepatocellular carcinoma in a Spanish health area between 2008 and 2016 A. Lue1,2, S. Lorente2, E. Martinez2, J. Nerin2, E. Solanas1,3, T. Serrano2. 1 Aragon Health Research Institute (IIS Aragon); 2Gastroenterology and Liver Unit, Hospital Clinico Universitario Lozano Blesa; 3University of Zaragoza, Zaragoza, Spain E-mail: [email protected] Background and Aims: Hepatocellular carcinoma (HCC) is the first leading cause of death in cirrhotic patients and the third cause of cancer-related deaths worldwide. In our Health Area epidemiological data are derived exclusively from mortality registry and its trend in time is unknown. Our aim is to evaluate the incidence rate of HCC in our Health Area and its trend over time. Methods: 202 consecutive new cases of HCC from the population of the Zaragoza III Health Area, Spain, were included in a well maintained registry from January of 2008 to Octuber of 2016. Age standardized incidence rate (ASIR) ( per 100.000 persons/year) were calculated using the direct method with 18 groups of 5-years age groups (0–4, 5–9,…, over 85 years) for the whole population and for each sex separately. Data for each age group were obtained from database of Biostatistics Service of the Government of Aragon. Incidence rate were standardized to the European standard population. Clinical, analytical and tumoral features were measured. To S206
evaluate trend over time patient were divided in two groups depending on they have been diagnosed before or after January 1, 2012. Results: HCC were diagnosed more frequently in men (80.2%) at a median age of 63 (55–72) years. Cirrhosis was diagnosed in 92.6% of patients. Chronic HCV infection (45.5%), alcohol (40.1%) and chronic HBV infection (12.4%) were the commonest etiologies. One hundred twenty three (60.9%) patients were diagnosed after January 1, 2012. Considering the whole cohort, HCC ASIR has significantly increased ( p < 0.0001) in the time period 2012–2016 (6.95; 95%CI: 6.44–7.49) compared to the period 2008–2011 (5.35; 95%CI: 4.91–5.82). In males, HCC ASIR was significantly higher ( p < 0.0001) in the 2012– 2016 group (12.01; 95%CI: 11.34–12.7) compared to the 2008–2011 group (8.38; IC 95%: 7.82–8.97). In females no differences were observed ( p = 0.059) in HCC ASIR in the period 2012–2016 (1.95; 95% CI: 1.68–2.24) compared to the period 2008–2011 (2.34; 95%CI: 2.05– 2.66). Between 2012 and 2016 the percentage of patients with alcohol related cirrhosis (48.8% vs 26.6%; p = 0.002) and patient who met Milan Criteria at diagnosis (52.1% vs 30.8%; p = 0.003) have significantly increased compared to 2008–2011. Conclusions: In the last years HCC incidence has increased significantly in the Zaragoza III Health Area, Spain. HCC incidence has grown specially in males and in alcohol related cirrhosis. In addition an increased rate of patients diagnosed at earlier stages has been observed. THU-071 Laparoscopic ablation for hepatocellular carcinoma: proposal of a 6-months mortality score for patient selection based on more than 1000 procedures A. Bertacco1, A. Marchini1, A. Vitale1, F. D’Amico1, E. Gringeri1, D. Neri1, D. Bassi1, G. Zanus1, C. Aliberti2, U. Cillo1. 1Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation; 2Oncology Radiodiagnostics, Oncology Institute of Veneto, Institute for the Research and Treatment of Cancer (IRCCS), Padova University, Padova, Italy E-mail: [email protected] Background and Aims: Trans-arterial-chemoembolization is the only therapeutic option for patients unsuitable for liver resection or percutaneous ablation according to international guidelines. The aim of our study was to evaluate safety and efficacy of video-laparoscopic (VLS) ablation as a therapeutic option for these HCC patients and to define an early mortality predictor score to help clinicians in patient selection. Methods: We collected patients with HCC who were unsuitable for liver resection and/or percutaneous ablation and who underwent VLS ablation (microwave, or radiofrequency) in the period 2004–2015. Early mortality (6-months) was the primary endpoint; perioperative morbidity and long term survival were secondary endpoints. Results: 1091 procedures in 903 patients (median age, 64 years) were performed following a liberal selection policy (child B-C 35%; BCLC BC-D 38%). We had not perioperative mortality but 6-months mortality was 10.5%. The overall morbidity was 33.6% with a median length of hospital stay of 2 days. Independent predictors of 6-months mortality resulted both variables related to liver function (Child Pugh, Portal Hypertension, ascites, sodium, performance status) and to tumor aggressiveness (Milan criteria, alpha-fetoprotein). A simple userfriendly score based on these 7 variables (score from 0 to 7) performed as an accurate predictor of 6-months mortality (area under ROC curve = 0.78). A cut-off of 4 proved to be a good tool for patient selection (6 months mortality <10%) and for identifying patients with optimal long-term survival (median survival 53 vs. 14 months, p < 0.0001). Conclusions: VLS ablation seems to be a safe and effective treatment in patients who are ineligible for liver resection and/or percutaneous ablation. We proposed a simple score to help clinicians in selecting patients for this procedure to obtain a curative long term survival profile.
Journal of Hepatology 2017 vol. 66 | S95–S332
defining trunk and branch driver alterations at early stages and defining intra- and inter-tumor diversity. Methods: A total of 153 samples representing the multiple step HCC process were analyzed by deep targeted-sequencing, transcriptome and SNP arrays. Genes mutated in early lesions [39 dysplastic nodules and 54 early HCCs (eHCC), defined as <2 cm, without satellites or vascular invasion] were defined as trunk genes. Candidate trunk genes were further explored in two additional cohorts: (a) intratumor heterogeneity cohort: 42 tumor regions of 21 tumors >4 cm (2 regions/tumor); and (2) inter-tumor heterogeneity cohort: 39 tumors from 17 patients with multinodular lesions (2–3 nodules/patient). In the inter-tumor heterogeneity cohort, the similarity of the CNVprofile was used to classify them as clonal (intra-hepatic metastasis) or non-clonal (synchronic tumors). Results: A total of 46 mutations were identified in the cohort of early lesions. eHCCs compared with dysplastic nodules, presented a higher number of mutations (1.1 vs 0.5 mutations/patient, p = 0.03) and CNV aberrations (8% vs 0.6% of aberrant chromosomal arms, p < 0.0003). Overall, 72% (23/32) eHCCs presented at least 1 trunk mutation, being TERT, TP53 and CTNNB1 the most frequent (21/23, 91%). In the intratumor heterogeneity cohort, 81% (17/21) tumors shared at least 1 mutation between different tumor regions (trunk drivers), such as TERT, TP53 and/or CTNNB1. Regarding inter-tumor heterogeneity, 6/17 (35%) of patients harbored clonal tumors according to their CNV profiles. Clonality classification was further confirmed by gene expression-based hierarchical clustering. 82% (9/11) of the sequenced clonal tumors shared TERT, TP53 and/or CTNNB1 as trunk alterations. In contrast, no trunk mutations were shared across non-clonal tumors. Conclusions: Trunk drivers mutated in early HCC tumors (TERT, TP53 and CTNNB1) remained as trunk aberrations across different regions of the same tumor and between primary and metastatic nodules in >80% of cases. These early mutations can be captured with single biopsies and could represent ideal therapeutic targets in the future. THU-069 The systemic inflammatory response is a prognostic marker in human immunodeficiency virus-infected patients with hepatocellular carcinoma D.J. Pinato1, M. Merli2, A.D. Pria3, S. Jamshaid1, K. Parker3, N. Pagani3, H. Hasson2, C. Uberti-Foppa2, E. Messina2, R. Sharma1, M. Nelson4, M. Bower3 and Imperial College Liver Cancer Study Group. 1Surgery and Cancer, Imperial College London, London, United Kingdom; 2 Infectious Diseases, IRCCS Ospedale San Raffaele, Milano, Italy; 3 National Centre for HIV Malignancy, Chelsea and Westminster NHS Trust, London, United Kingdom; 4National Centre for HIV Malignancy, Chelsea and Westminster NHS Trust, London, Italy E-mail: [email protected] Background and Aims: Hepatocellular carcinoma (HCC) is increasingly prevalent in people living with human immunodeficiency virus (HIV), especially in the context of concurrent hepatitis. Systemic inflammation is a prognostic factor independent of Barcelona Clinic Liver Cancer (BCLC) stage and Child-Pugh (CP) class in HCC. However there is no documented role of its clinical value in cases associated with HIV infection. Methods: From a large, prospectively maintained database of 602 non-AIDS defining cancer (NADCs) treated at the National Centre for HIV Oncology (London, UK), we selected all patients with HCC, diagnosed between 2001 and 2014 (n = 21) and combined them with an independent dataset from San Raffaele Hospital, Milan, Italy (n = 38). We investigated the prognostic role of a panel of inflammatory markers including neutrophil-lymphocyte (NLR) and plateletlymphocyte ratio (PLR), Inflammation-based Index (IBI) and Systemic Immune Inflammation (SII) score using uni- and multivariable overall survival (OS) analyses. Results: 59 consecutive cases were included (92% men, median age 52, range 36–71), CP A 69%, early/intermediate BCLC stage 66%. Most
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POSTER PRESENTATIONS prevalent aetiologies were HCV (69%) and HBV (32%). At HCC diagnosis median latency from HIV diagnosis was 22 years, with median CD4 count of 390 (range 56–1166) and undetectable HIV RNA in 75%. Median OS was 22 months. On univariate analysis NLR ( p < 0.001), PLR ( p = 0.03) but not SII nor IBI emerged as predictors of OS together with BCLC stage, CP ( p < 0.001), and alfafetoprotein >400 ng/ml ( p = 0.002). Patients with NLR > 5 (n = 6, 10%) had a median OS of 1 month compared to 15 of the NLR <5 group (n = 51, 90%, HR 7.3, 95% CI 2.8–19). The independent prognostic power of the NLR ( p = 0.002) was confirmed in a multivariate Cox regression model adjusted for BCLC, CP and AFP > 400. High NLR values were associated with advanced BCLC stage ( p = 0.003), poorer performance status ( p < 0.001) and higher proportion of portal vein thrombosis ( p < 0.001) but not with HIV RNA or CD4 counts.
Conclusions: Systemic activation of a pro-inflammatory response as measured by the NLR is an independent prognostic domain for survival of HIV patients with HCC. An elevated NLR is associated with adverse pathological features of malignancy but not of the co-existing HIV infection suggesting a tumour-promoting role of the innate immune response that warrants further evaluation in mechanistic studies. THU-070 Rising incidence of hepatocellular carcinoma in a Spanish health area between 2008 and 2016 A. Lue1,2, S. Lorente2, E. Martinez2, J. Nerin2, E. Solanas1,3, T. Serrano2. 1 Aragon Health Research Institute (IIS Aragon); 2Gastroenterology and Liver Unit, Hospital Clinico Universitario Lozano Blesa; 3University of Zaragoza, Zaragoza, Spain E-mail: [email protected] Background and Aims: Hepatocellular carcinoma (HCC) is the first leading cause of death in cirrhotic patients and the third cause of cancer-related deaths worldwide. In our Health Area epidemiological data are derived exclusively from mortality registry and its trend in time is unknown. Our aim is to evaluate the incidence rate of HCC in our Health Area and its trend over time. Methods: 202 consecutive new cases of HCC from the population of the Zaragoza III Health Area, Spain, were included in a well maintained registry from January of 2008 to Octuber of 2016. Age standardized incidence rate (ASIR) ( per 100.000 persons/year) were calculated using the direct method with 18 groups of 5-years age groups (0–4, 5–9,…, over 85 years) for the whole population and for each sex separately. Data for each age group were obtained from database of Biostatistics Service of the Government of Aragon. Incidence rate were standardized to the European standard population. Clinical, analytical and tumoral features were measured. To S206
evaluate trend over time patient were divided in two groups depending on they have been diagnosed before or after January 1, 2012. Results: HCC were diagnosed more frequently in men (80.2%) at a median age of 63 (55–72) years. Cirrhosis was diagnosed in 92.6% of patients. Chronic HCV infection (45.5%), alcohol (40.1%) and chronic HBV infection (12.4%) were the commonest etiologies. One hundred twenty three (60.9%) patients were diagnosed after January 1, 2012. Considering the whole cohort, HCC ASIR has significantly increased ( p < 0.0001) in the time period 2012–2016 (6.95; 95%CI: 6.44–7.49) compared to the period 2008–2011 (5.35; 95%CI: 4.91–5.82). In males, HCC ASIR was significantly higher ( p < 0.0001) in the 2012– 2016 group (12.01; 95%CI: 11.34–12.7) compared to the 2008–2011 group (8.38; IC 95%: 7.82–8.97). In females no differences were observed ( p = 0.059) in HCC ASIR in the period 2012–2016 (1.95; 95% CI: 1.68–2.24) compared to the period 2008–2011 (2.34; 95%CI: 2.05– 2.66). Between 2012 and 2016 the percentage of patients with alcohol related cirrhosis (48.8% vs 26.6%; p = 0.002) and patient who met Milan Criteria at diagnosis (52.1% vs 30.8%; p = 0.003) have significantly increased compared to 2008–2011. Conclusions: In the last years HCC incidence has increased significantly in the Zaragoza III Health Area, Spain. HCC incidence has grown specially in males and in alcohol related cirrhosis. In addition an increased rate of patients diagnosed at earlier stages has been observed. THU-071 Laparoscopic ablation for hepatocellular carcinoma: proposal of a 6-months mortality score for patient selection based on more than 1000 procedures A. Bertacco1, A. Marchini1, A. Vitale1, F. D’Amico1, E. Gringeri1, D. Neri1, D. Bassi1, G. Zanus1, C. Aliberti2, U. Cillo1. 1Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation; 2Oncology Radiodiagnostics, Oncology Institute of Veneto, Institute for the Research and Treatment of Cancer (IRCCS), Padova University, Padova, Italy E-mail: [email protected] Background and Aims: Trans-arterial-chemoembolization is the only therapeutic option for patients unsuitable for liver resection or percutaneous ablation according to international guidelines. The aim of our study was to evaluate safety and efficacy of video-laparoscopic (VLS) ablation as a therapeutic option for these HCC patients and to define an early mortality predictor score to help clinicians in patient selection. Methods: We collected patients with HCC who were unsuitable for liver resection and/or percutaneous ablation and who underwent VLS ablation (microwave, or radiofrequency) in the period 2004–2015. Early mortality (6-months) was the primary endpoint; perioperative morbidity and long term survival were secondary endpoints. Results: 1091 procedures in 903 patients (median age, 64 years) were performed following a liberal selection policy (child B-C 35%; BCLC BC-D 38%). We had not perioperative mortality but 6-months mortality was 10.5%. The overall morbidity was 33.6% with a median length of hospital stay of 2 days. Independent predictors of 6-months mortality resulted both variables related to liver function (Child Pugh, Portal Hypertension, ascites, sodium, performance status) and to tumor aggressiveness (Milan criteria, alpha-fetoprotein). A simple userfriendly score based on these 7 variables (score from 0 to 7) performed as an accurate predictor of 6-months mortality (area under ROC curve = 0.78). A cut-off of 4 proved to be a good tool for patient selection (6 months mortality <10%) and for identifying patients with optimal long-term survival (median survival 53 vs. 14 months, p < 0.0001). Conclusions: VLS ablation seems to be a safe and effective treatment in patients who are ineligible for liver resection and/or percutaneous ablation. We proposed a simple score to help clinicians in selecting patients for this procedure to obtain a curative long term survival profile.
Journal of Hepatology 2017 vol. 66 | S95–S332