studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 417A
410
Significant Suppression of Local Tumor Recurrence in
Treatment for Hepatocellular Carcinoma with Peritumoral
Vessels by Radiofrequency Ablation with Percutaneous
Ethanol Injection: Propensity Score Matching
Analysis
Kazuhide Takata 1 , Akira Anan 1 , Takashi Tanaka 1 , Keiji
Yokoyama 1 , Daisuke Morihara 1 , Yasuaki Takeyama 1 , Makoto
Irie 1 , Satoshi Shakado 1 , Kaoru Iwata 2 , Tetsuro Sohda 1 , Shotaro
Sakisaka 1 ; 1 Gastroenterology and Medicine, Fukuoka University
Faculty of Medicine, Fukuoka, Japan; 2 Internal medicine,
Meotoiwa Hospital, Fukuoka, Japan
Background and Aims: Radiofrequency ablation (RFA) is a
major modality for the treatment of early stage hepatocellular
carcinoma (HCC). However, serious problems of RFA remain
in local recurrence of HCC with peritumoral vessels, probably
due to heat-sink effect. Therefore, we have undergone percutaneous
ethanol injection (PEI) to the peritumoral vessels side of
the tumor to complete tumor necrosis by ethanol, with RFA. The
aim of the study was to evaluate the effect PEI combination RFA
for HCC with peritumoral vessels. Methods: From Jun 2001 to
Mar 2015, 371 patients, who diagnosed newly HCC (total
525 nodules), 3 cm or less and within 3 nodules, were treated
RFA as an initial treatment in our hospital. Among 190 nodules
with peritumoral vessels located less than 5 mm from the tumor,
patients in group of RFA monotherapy (61 nodules) or group
of PEI combination (61 nodules) were 1 : 1 matched according
to their propensity scores. Ethanol was injected inside the
tumor close to the peritumoral vessels in the combination therapy
group. Cumulative incidences of HCC local recurrence
were analyzed. Results: The overall median follow-up period
was 42 months (range, 3-134). The cumulative HCC local
recurrence rates were 7.2%, 18.7%, and 24.1% at 1, 3, 5
years, respectively, in the PEI combination group, and 15.1%,
34.9%, 46.9% in the RFA monotherapy group; showing significantly
lower recurrence rates in PEI combination group (P <
0.05). In Cox regression analysis, presence of PEI combination
was significantly associated with the risk reduction of HCC
local recurrence (hazard ratio, 0.44; 95% CI: 0.21, 0.88; P <
0.05). Conclusions: RFA combined with PEI reduced the risk of
a local recurrence rate by half, compared with RFA alone, in
early stage HCC with peritumoral vessels. Further prospective
studies based on cumulative local recurrence rate may be helpful
in improving the quality of RFA for HCC.
Disclosures:
The following authors have nothing to disclose: Kazuhide Takata, Akira Anan,
Takashi Tanaka, Keiji Yokoyama, Daisuke Morihara, Yasuaki Takeyama, Makoto
Irie, Satoshi Shakado, Kaoru Iwata, Tetsuro Sohda, Shotaro Sakisaka
411
Comparison of balloon-occluded Transarterial chemoembolization
(TACE) with conventional TACE for treatment
of hepatocellular carcinoma
Takuro Niinomi, Masatoshi Ishigami, Yoji Ishizu, Teiji Kuzuya,
Takashi Honda, Kazuhiko Hayashi, Yoshiki Hirooka, Hidemi Goto;
Gastroenterology and Hepatology, Nagoya Univercity Graduate
School of Medicine, Nagoya, Japan
AIM: Transarterial chemoembolization (TACE) has been widely
performed as a treatment for hepatocellular carcinoma (HCC)
in patients who don’t have the indication for curative treatment.
Selecting the anti-cancer agents, treatment methods and equipment
for the best therapeutic effect is becoming more important
for performing better quality of TACE. In recent years, balloon-occluded
TACE (B-TACE) by using microballoon catheters
with small diameters has been widely applied, primarily in
Japan. The purpose of this study was to compare the early
therapeutic efficacy and lipiodol deposition of B-TACE with
those of conventional TACE (C-TACE). Patients and Methods:
From April 2013 to November 2014, 200 consecutive patients
with unresectable HCC were treated with TACE at our institution.
The patients were divided into two groups based on the
usage of microballoon catheter. Treatment efficacy and lipiodol
deposition were retrospectively compared between two
groups. Of these patients, 20 patients with 51 nodules were
treated with B-TACE and 39 patients with 99 nodules were
treated with conventional TACE (C-TACE). Mean lesion density
and lipiodol emulsion concentration ratio of HCC to embolized
liver parenchyma (LECHL ratio) in Hounsfield units (HU) were
evaluated on non-enhanced CT imaging immediately after
TACE. The treatment effect of TACE was evaluated by dynamic
CT 1 to 3 months after TACE, and was evaluated based on
the Response Evaluation Criteria in Cancer Study Group of
Japan (RECICL2009). Results: The median lesion density on CT
immediately after TACE was higher in B-TACE group than in
C-TACE group (B-TACE 533 HU; range 121-1117 HU versus
C-TACE 422 HU; range 136-1322 HU, P=0.057, Mann-Whitney
U test). LECHL ratio on CT immediately after TACE was
remarkably higher in B-TACE group than in C-TACE group
(B-TACE 3.69; range 1.29-9.7 versus C-TACE 2.82; range
0.96-12.83, P=0.017, Mann-Whitney U test). The treatment
effect on the target nodule classified as TE4, TE3, TE2 and
TE1 were 68%, 16%, 16% and 0% in the B-TACE group, and
58%, 9%, 28% and 5% in the C-TACE group respectively.
Response rate (TE4+TE3) was significantly higher in B-TACE
group than in C-TACE group (84% versus 67%, P=0.0216,
Fisher’s exact test). Conclusion: Mean lesion density was higher
in B-TACE group than in C-TACE group. Notably, LECHL ratio
which imply selective deposition of lipiodol, were significantly
higher in B-TACE group than in C-TACE group. These results
suggested that compared with C-TACE, B-TACE significantly
improved lipiodol deposition on HCC nodule during TACE
procedure, and could obtain better treatment efficacy.
Disclosures:
Hidemi Goto - Grant/Research Support: MSD, Roche, Bayer, Bristol-Myers, Eisai,
Ajinomoto, Otsuka, Astra, Tanabe, Takeda
The following authors have nothing to disclose: Takuro Niinomi, Masatoshi
Ishigami, Yoji Ishizu, Teiji Kuzuya, Takashi Honda, Kazuhiko Hayashi, Yoshiki
Hirooka
412
Hepatic Decompensation After Transarterial Chemoembolization
For Hepatocellular Carcinoma
Dempsey Hughes, Fredric D. Gordon, Keith E. Stuart, FW Nugent,
Sebastian Flake, Mary Ann Simpson, Amir A. Qamar; Transplantation,
Lahey Hospital and Medical Center, Burlington, MA
Background:Hepatic decompensation(HD)is a concern in
patients with cirrhosis who undergo transarterial chemoembolization(TACE)for
hepatocellular carcinoma.Identifying predictors
associated with treatment-related HD would allow better
risk assessment risk associated with TACE.The aim of this study
is to assess HD after TACE and to identify any pre-treatment
factors related to HD. Methods:A retrospective cohort study
of 184 patients with cirrhosis and HCC who underwent TACE
at our institution from 2009-14 was analyzed.TACE-related
HD was defined as:1)new onset variceal hemorrhage(VH),
ascites or hepatic encephalopathy(HE), 2)treatment change
for known history of VH,ascites (increased diuretic or paracentesis
requirement), HE(increase or addition of lactulose or
rifaximin), or spontaneous bacterial peritonitis within 90 days
of first TACE.TACE was performed using standard protocol.