studies

414A AASLD ABSTRACTS HEPATOLOGY, October, 2015
Cumulative overall survival rates of periostin positive and negative
gruops according to the existence of microvascular invasion.
Disclosures:
Won Young Tak - Advisory Committees or Review Panels: Gilead Korea; Grant/
Research Support: SAMIL Pharma; Speaking and Teaching: Bayer Korea
The following authors have nothing to disclose: Se Young Jang, Soo Young Park,
Young Oh Kweon, Keun Hur, Gyeonghwa Kim, Yong-Hun Choi, Jung Gil Park,
Yu Rim Lee, Sun Kyung Jang, Su Hyun Lee
404
Impact of screening on Hepatocellular Carcinoma survival
in patients with Chronic Hepatitis B - A regional
population based study
Rasham Mittal, Bechien U. Wu; Kaiser Permanente Los Angeles
Medical Center, Los Angeles, CA
Background: The impact of screening for hepatocellular carcinoma
(HCC) in patients with chronic hepatitis B (CHB) remains
controversial. Aim: To determine if screening is associated with
improved survival among CHB patients with HCC in a diverse
regional U.S.population. Methods: Retrospective cohort study
(2006-2013) from an integrated health care system in Southern
California. All CHB (age ≥18 years) patients identified
using ICD codes and confirmed by serology. HCC patients
were identified using ICD code and cross referenced through
prospective internal cancer registry. Patients were considered
to have undergone screening if they had USG, CT scan or MRI
abdomen with contrast imaging at 6-18 months prior to HCC
diagnosis. Patients were excluded if they did not have active
Kaiser Membership for at least 18 months prior to HCC diagnosis.
Survival curves estimated using Kaplan-Meyer analysis.
Cox proportional hazard regression analysis was performedt o
adjust for baseline characteristics. Results: From a total of 9811
CHB patients, we identified 185 HCC cases [median age at
HCC diagnosis 61 years, IQR 53, 68 years; 147 (79.4%)
male; 136 (73.5%) Asians; 123 (66.5%) liver cirrhosis]. Out
of 185, 110 patients had screening prior to HCC while 75 presented
with HCC without prior screening. The median observed
survival was higher in screening versus unscreened group (5.9
years versus 3.2 years; P=0.036). In regression analysis, HCC
screening (HR 0.60; 95%CI, 0.37-0.96; P=0.03) were associated
with improved survival after adjusting for baseline characteristics
such as age (HR 0.97; 95%CI, 0.95-0.99; P=0.259),
female gender (HR 0.40; 95%CI, 0.20-0.85; P=0.012) Charlson
co-morbidity score (HR 1.14; 95%CI, 1.04-1.24; P=0.003)
and liver cirrhosis (HR 1.14; 95%CI, 0.66-1.98; P=0.623).
Conclusion: HCC surveillance was associated with improved
survival in CHB patients in a large regional U.S. population.
Disclosures:
The following authors have nothing to disclose: Rasham Mittal, Bechien U. Wu
405
Influence of hepatitis B virus DNA elevation on recurrence
of hepatocellular carcinoma after surgical resection
and the preventive role of antiviral therapy
Yang J. Yoo, Ji Hoon Kim, Seong Hee Kang, Young-Sun Lee, Tae
Suk Kim, Sang Jun Suh, Young Kul Jung, Yeon Seok Seo, Hyung
Joon Yim, Jong Eun Yeon, Kwan Soo Byun; Department of Internal
Medicine, Korea University College of Medicine, Seoul, Korea (the
Republic of)
Aims Surgical resection is the treatment of choice for early
stage hepatocellular carcinoma (HCC). Previous studies
revealed that reactivation of hepatitis B virus is associated with
the recurrence of hepatitis B virus (HBV) related HCC after surgical
resection. We aimed to investigate the influence of HBV
DNA elevation on HCC recurrence and the preventive role of
antiviral therapy. Methods One hundred eleven patients who
had BCLC stage 0 or A and received surgical resection as primary
therapy were enrolled. HBV DNA elevation was defined
as reactivation (increase >1log 10
IU/ml or re-emergence of
HBV DNA) in patients without preoperative antiviral therapy or
virologic breakthrough in patients with preoperative antiviral
therapy (n=62). Results Mean age was 54.1±9.4 years and
male consisted 76.6% (n=85). All patients belonged in Child
class A. BCLC 0 consisted 29.7% (n=33) and 30.6% (n=34)
had Hepatitis B envelope antigen positivity and 42.3% (n=
47) had HBV DNA level ≥ 2000 IU/mL at the time of surgery.
Overall 1 year, 3 year, 5 year recurrence was 17.3%, 36.4%,
40%. In multivariate analysis for risk factors of recurrence,
multiple tumor, HBV DNA elevation, ALT ≥ 30 IU/L, were independently
associated with HCC recurrence. In subgroup analysis,
patients with preoperative antiviral therapy showed similar
HCC recurrence rate with patients who start antiviral therapy
after resection and significantly higher recurrence rate than
patients with no antivirals during follow up. In multivariate analysis
for risk factors of HBV DNA elevation, Age < 50 years,
no preoperative antiviral therapy, HBV DNA ≥ 2000 remained
as risk factors. To rule out the antiviral effect, we investigated
risk factors for HCC recurrence in each group with or without
preoperative antiviral therapy. In patients with preoperative
antiviral therapy, multiple tumor was the only risk factor for
HCC recurrence. In patients without preoperative antiviral therapy,
male sex and HBV DNA elevation were independent risk
factors for HCC recurrence. Risk factors for HBV DNA elevation
were further analyzed in patients without preoperative antiviral