studies

448A AASLD ABSTRACTS HEPATOLOGY, October, 2015
Disclosures:
Armando Carvalho - Advisory Committees or Review Panels: Gilead Sciences,
Bristol-Myers Squibb, Roche, Janssen, Bayer, AbbVie; Grant/Research Support:
Boehringer-Ingelheim, AbbVie
The following authors have nothing to disclose: Adélia Simão, Miriam Santos,
Raquel S. Silva, Pedro Correia, Lurdes Correia, Pedro Henriques Abreu, Alberto
Cardoso, José N. Costa
474
Long-term Survival Analysis of Re-resection Versus
Re-radiofrequency Ablation for Intrahepatic Recurrence
After Initial Hepatectomy or Radiofrequency Ablation
for Hepatocellular Carcinoma: A 10-year Observational
Study
Minjong Lee 1 , Sohee Oh 2 , YOUNG CHANG 1 , Joon Yeul Nam 1 ,
Young Youn Cho 1 , Jeong-Ju Yoo 1 , Yuri Cho 1 , Donghyeon Lee 1 ,
Eun Ju Cho 1 , Jeong-Hoon Lee 1 , Su Jong Yu 1 , Nam-Joon Yi 3 , Jeong
Min Lee 4 , Kwang-Woong Lee 3 , Jung-Hwan Yoon 1 , Kyung-Suk
Suh 3 , Yoon Jun Kim 1 ; 1 Department of Internal Medicine and Liver
Research Institute, Seoul National University College of Medicine,
Seoul, Korea (the Republic of); 2 Department of Biostatistics, Seoul
Metropolitan Government Seoul National University Boramae
Medical Center, Seoul, Korea (the Republic of); 3 Department of
Surgery, Seoul National University College of Medicine, Seoul,
Korea (the Republic of); 4 Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (the Republic of)
Background/Aim: Survival outcomes of resection (OP) and
radiofrequency ablation (RFA) were not significantly different
in HCC patients with the Barcelona Clinic Liver Cancer (BCLC)
stage 0/A. However, in patients with recurrent HCC, survival
rates of patients treated with re-OP have not been compared
with those with re-RFA. We aimed to compare survival of patient
treated with re-OP to those with re-RFA in patients with BCLC
0/A. Methods: This retrospective study included 225 patients
with recurred BCLC 0/A HCC in Child-Pugh class A/B. According
to initial treatment strategies, patients were divided into two
groups; 148 patients treated with RFA; 77 patients with OP.
For treating recurrent HCC, patients were also divided into two
treatments: 181 patients treated with RFA; 44 patients with OP.
Survival rates comparing each group according to treatment
strategies were analyzed after matching of propensity scores
after matching of propensity scores according to established
liver cirrhosis or HCC risk factors. Results: The median tumor
size 2.4/1.5 cm; single HCC 80.9/84.9% in patients with
initial/recurrent HCC, respectively. The 5-year overall survival
rates were 85.3%, 89.5%, 93.0%, and 95.0% in patients
treated with RFA-RFA, OP-RFA, RFA-OP, and OP-OP for initial
and recurrent HCC, respectively. Patients treated with re-OP
for initial and recurrent HCCs showed significantly lower mortality
than those with re-RFA; hazard ratio (HR)=0.143 (95%
confidence interval[CI], 0.021–0.991, P=0.04). Patients who
received resection at least for initial or recurrent HCC showed
lower mortality than those who only treated with re-RFA;
HR=0.414 (95% CI, 0.187–0.913, P=0.029). Conclusions: In
patients with initial and recurrent BCLC stage 0/A, and early
cirrhosis, who recurred HCC with BCLC stage 0/A, re-hepatectomy
improves the patient survival compared to those treated
with re-RFA treatment. Treatments including resection for initial
or recurrent HCC also improves the survival when compared
to RFA only treatment. Therefore, for selected patients, re-hepatectomy
should be considered as the first treatment option for
initial and recurrent HCC.
Disclosures:
Jeong Min Lee - Advisory Committees or Review Panels: Bayer healthcare
Kwang-Woong Lee - Grant/Research Support: ChongGeunDang, Astellas,
GreenCross
Yoon Jun Kim - Grant/Research Support: Bristol-Myers Squibb, Roche, JW Creagene,
Bukwang Pharmaceuticals, Handok Pharmaceuticals, Hanmi Pharmaceuticals,
Yuhan Pharmaceuticals; Speaking and Teaching: Bayer HealthCare
Pharmaceuticals, Gilead Science, MSD Korea, Yuhan Pharmaceuticals, Samil
Pharmaceuticals, CJ Pharmaceuticals, Bukwang Pharmaceuticals, Handok Pharmaceuticals
The following authors have nothing to disclose: Minjong Lee, Sohee Oh, YOUNG
CHANG, Joon Yeul Nam, Young Youn Cho, Jeong-Ju Yoo, Yuri Cho, Donghyeon
Lee, Eun Ju Cho, Jeong-Hoon Lee, Su Jong Yu, Nam-Joon Yi, Jung-Hwan Yoon,
Kyung-Suk Suh
475
Simple serological tests and Transient Elastography as
screening tools for clinically significant portal hypertension
in resectable hepatocellular carcinoma
Simona Bota, Florian Hucke, Mattias Mandorfer, Remy Schwarzer,
Philipp Schwabl, Thomas Reiberger, Arnulf Ferlitsch, Michael
Trauner, Wolfgang Sieghart, Markus Peck-Radosavljevic; Gastroenterology
and Hepatology, Medical University of Vienna, Vienna,
Austria
Background:Hepatocellular carcinoma (HCC) resection is recommended
by the EASL Guideline as first-line treatment option
for patients with solitary HCC and very well-preserved liver
function, defined as normal bilirubin with either hepatic venous
pressure gradient (HVPG)≤10 mmHg.However HVPG measurements
are available only in highly specialized Hepatology centers.
Aim:to assess the diagnostic value of serological scores
(initially developed for fibrosis evaluation) and transient elastrography
(TE) as screening tool for prediction of HVPG>10
mmHg in patients with potentially resectable HCC. Methods:
Our study included 46 consecutive patients with chronic liver
disease and potentially resectable (Child-Pugh A,normal bilirubin,
platelet count≥100000cells/mm 3 and no esophageal
varices) evaluated in our Hemodynamic Labor.We performed
HVPG measurements, serological tests and TE in a subgroup
of patients.Simple serological scores were calculated:Fibrosis
Index (FI),Forns score and Lok score. According to the newly
proposed TE quality criteria, ten valid measurements with a
median liver stiffness value ≥7.1kPa and IQR/median>30%
were considered poorly reliable and not included for analysis.
TE cases without 10 valid measurements were also excluded.
Results:The etiology of liver disease was : alcholic -41.3%,
viral -39.1%, others etiologies – 19.6%. The presence of
HVPG>10mmHg was diagnosed in 10/46 patients (21.7%).
Liver stiffness measurements by TE were available in 67.3%of
patients. Reliable liver stiffness measurements were obtained
in 87% of patients. Transient Elastography had a very good
performace (93.7%) to exclude the presence of CSPH, while
from the serological tests Fibrosis Index (FI) had the best performance
(NPV 84.7%)(Table) Conclusions:TE is a very good
tool to exclude the presence of HVPG>10mmHg in patients
with potentially resectable HCC.Simple serological tests were
less accurate and could correctly exclude CSPH in 80-85% of
cases, but were feasible in all patients.