Hepatocellular Carcinoma Response to Local Regional Therapy; Correlations between Pre-Liver Transplants Imaging and Explant Pathology

Hepatocellular Carcinoma Response to Local Regional Therapy; Correlations between Pre-Liver Transplants Imaging and Explant Pathology

POSTER PRESENTATIONS CI, 1.1–8.3; p = 0.037), and the >40 kPa group had a HR of 4.8 (95% CI, 1.7–13.4; p = 0.003). Differences between the 20–25 kPa g...

83KB Sizes 0 Downloads 38 Views

POSTER PRESENTATIONS CI, 1.1–8.3; p = 0.037), and the >40 kPa group had a HR of 4.8 (95% CI, 1.7–13.4; p = 0.003). Differences between the 20–25 kPa group and 25–30 kPa group were not significant.

Conclusions: This multicentre retrospective observational study shows an association between LSM at the upper extreme and HCC risk. LSM by FibroScan™ allows simple, non-invasive stratification of HCC risk in cirrhotic patients. Physicians may find this beneficial as a dynamic approach to monitor HCC risk. THU-076 HEPATOCELLULAR CARCINOMA RESPONSE TO LOCAL REGIONAL THERAPY; CORRELATIONS BETWEEN PRE-LIVER TRANSPLANTS IMAGING AND EXPLANT PATHOLOGY M. Alghanem1, K. Qumosani1, P. Marotta1, D. Driman2, B. Aljudaibi1, N. Kakani3. 1Hepatology; 2Pathology; 3Radiology, University of Western Ontario, London, Canada E-mail: [email protected] Background and Aims: HCC therapy includes Local regional Therapy (LRT) such as Radiofrequency Ablation (RFA) and Trans-Arterial Chemoembolization (TACE). Modified Response Evaluation Criteria in Solid Tumors (mRECIST) were developed to assess the response to treatment in patients with HCC, based on measurements of viable tumor using dynamic imaging (CT/MRI). Aim: To compare the estimate of viable HCC after LRT by CT imaging and before liver transplant, to the histopathological assessment of viable HCC in the hepatic explant. Methods: We prospectively evaluated fourty one patients with HCC who undwerent both LRT and liver transplantation at london health science center. Using mRECIST criteria, the response to LRT was assessed by two blinded radiologists and the percentage of necrosis was reported separately for the reference CT(rCT) completed done after the last LRT and prior to liver transplantation. The results from the radiologists were compared to the findings of an expert pathologist reporting on viable tumour present and tumour necrosis in the hepatic explants. Both parties were blinded so prevent bias in the results. Results: A total of forty one transplant recipients fulfilled the inclusion criteria for the study. At time of listing 100% were within total volume criteria, 86% within UCSF, and 68% within Milan. The average time frame from the last reference CT scan to liver transplant was 57.7 days; the average time from last LRT to reference CT was 72.5 days. Thirty four recipients (83%) had accurate assessment for necrosis (mRECIST) within 20% comparing rCT to explant (i.e. concordant). ninteen (46%) of the 41 predicted 100% concordance.

Only 7/41 (17%) had a poor concordance (>50%) between histology and reference CT images. positive correlation was detected with the correlation coefficient is calculated as 0.5723. Our study demonstarted CT-pathologic correlation in predicting number and size of tumors with Correlation coefficient 0.64 and 0.31,respectively. However, there was poor correlation in predicting total volume with correlation coefficient is calculated as 0.014. Conclusions: Dynamic CT is an accurate tool to evaluate the tumour response prior to liver transplantation and the likelihood of underestimating the tumour burden is low. With expert radiologists and pathologists, the correlation is acceptable and supports the ongoing use of frequent dynamic imaging to evaluate responses to LRT and determining transplant eligibility. THU-077 PROGNOSTIC VALIDATION OF PROPOSED BCLC-B SUBSTAGING SYSTEM IN HEPATOCELLULAR CARCINOMA PATIENTS TREATED BY TRANSARTERIAL CHEMOEMBOLIZATION M. Biolato1, G. Gallusi2, M. Iavarone3, G. Cabibbo4, S. Racco1, A.D. Santis2, C. Della Corte3, M. Maida4, A.F. Attili2, A. Sangiovanni3, C. Cammà4, G. La Torre5, A. Gasbarrini1, A. Grieco1. 1Department of Internal Medicine, Fondazione Policlinico Gemelli and Catholic University of the Sacred Heart; 2Division of Gastroenterology, Department of Clinical Medicine, La Sapienza University, Rome; 3UO Gastroenterologia ed Epatologia, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan; 4Section of Gastroenterology, DIBIMIS, University of Palermo, Palermo; 5Department of Public Health and Infectious Diseases, La Sapienza University, Rome, Italy E-mail: [email protected] Background and Aims: A subclassification system for intermediate hepatocellular carcinoma (HCC) was proposed to optimize treatment allocation. The aim of this study is to validate prognostic capacity of sub-staging proposal. Methods: Patients with intermediate HCC treated with TACE in four Italian tertiary centres were retrospectively reviewed. Predictors of survival were identified using the Cox proportional regression model. Results: 289 Barcelona Clinic Liver Cancer (BCLC) B patients were included. Median age was 68 years, 78% were male, 54% were HCVpositive, 72% had a Child A status, 61% patients were beyond Up-to-7 criterion. Median overall survival (OS) of the whole cohort was 23 months (C.I. 95% 20.2–25.8). Child A status (H.R. 1.35, C.I. 95% 1.02– 1.78) and tumor burden beyond Up-to-7 criterion (H.R. 1.39, C.I. 95% 1.07–1.80) were independent prognostic factors for overall survival on multivariate analysis. Median survival was 33.0 months for B1 stage (n = 81), 20.8 months for B2 stage (n = 106), 16.1 months for B3 stage (n = 24), 22.2 months for B4 stage (n = 42) and 15.0 months for Quasi-C stage (n = 36). Regarding discriminatory ability of sub-staging proposal, log rank test showed significant survival difference for B1 vs B4 ( p = 0.003) and B1 vs Quasi-C ( p = 0.039) and a trend for B1 vs B2 ( p = 0.05) and B1 vs B3 ( p = 0.05). Conclusions: Substage B1 correctly identified intermediate HCC patients who have the best prognosis and are the best candidates for TACE. Further studies are needed to demonstrate the real prognostic gradient and the benefit of different therapeutic allocation by TACE for patients in other intermediate HCC sub-stages. THU-078 METABOLIC DISORDERS ACROSS HEPATOCELLULAR CARCINOMA IN ITALY F. Morisco1, M. Guarino1, R. Valvano2, N. Caporaso1, F. Farinati3, E.G. Giannini4, F. Ciccarese5, F. Piscaglia6, G.L. Rapaccini7, M. Di Marco8, E. Caturelli9, M. Zoli6, F. Borzio10, R. Sacco11, C. Cammà12, M. Felder13, A. Gasbarrini7, G.S. Barone14, F.G. Foschi15, G. Missale16, A. Masotto17, R. Virdone18, F. Trevisani19 and for the Italian Liver Cancer (ITA.LI.CA) group. 1Dipartimento di Medicina Clinica e Chirugia, Università di Napoli “Federico II”, Napoli; 2Divisione di

Journal of Hepatology 2016 vol. 64 | S213–S424