Page 278 - ebook HCC

PROGRAMME AND ABSTRACTSAND ABSTRACTS
GENEV
EASL
276
277
276 PROGRAMME GENEVA, SWITZERLANDA, SWITZERLAND EASL HCC SUMMITHCC SUMMIT 277
FEBRUARY 13 - 16, 2014Y 13 - 16, 2014
FEBRUAR
Poster Board Number C52 Poster Board Number C53
TREATMENT OF HEPATOCELLULAR PREDICTORS OF HCC RECURRENCE
CARCINOMA: A MONOCENTRIC TUNISIAN FOLLOWING LIVER TRANSPLANTATION: THE
STUDY SIGNIFICANCE OF ALPHA-FETOPROTEIN

Hayfa Romdhane, Rania Hefaiedh, Nour Elleuch, Rym Ennaifer, Evangelia Fatourou , James Maggs , John O’Grady , Michael Heneghan ,
1
1
1
1
Houda Ben Nejma, Najet Bel Hadj Brik Alberto Quaglia , Varuna Aluvihare , Kosh Agarwal , Nigel Heaton , Abid Suddle 1
1
1
1
1
1 Institute of Liver Studies, King’s College Hospital, London, United Kingdom
Corresponding author’s e-mail: hayfabenromdhane@yahoo.fr
Corresponding author’s e-mail: v_fatourou@hotmail.com
Introduction: Hepatocellular carcinoma (HCC) is a real public health problem because of
its frequency and severity. It develops in more than 90% of cases in a cirrhotic liver, which
determines the choice of therapy. Introduction: Liver transplantation (LT) is a curative option for a subset of patients with
hepatocellular carcinoma (HCC). High pre-LT alpha-fetoprotein (AFP) and transplantation
Aims: The purpose of this study was to describe, on a Tunisian serie, the epidemiology of beyond Milan criteria have been associated with HCC recurrence.
HCC in cirrhosis and to analyze the different treatments used and their results.
Aims: To determine predictors of recurrence following LT in patients meeting radiological
Methodology: We conducted a retrospective study including all patients hospitalized Milan criteria (1997-2010) or United Kingdom Transplant (UKT) criteria (2010-2011) in a
between 2009 and 2012 in the Mongi Slim University Hospital for HCC on liver cirrhosis.
Data were collected from the medical records of gastroenterology, surgery and radiology single liver transplant centre.
department.
Methodology: We analysed a prospectively collected database of 382 consecutive
Results: Sixty eight patients were included in the study (42 men and 26 women). The patients transplanted for HCC from 1997-2011. Explanted livers were evaluated for
average age was 62 years . HCC was considered “small” in 28 cases (41.2%). Surgical the number and diameter of lesions, histological differentiation and microvascular or
resection was indicated in 20.6% of patients (n=14), percutaneous destruction (with macrovascular invasion. Based on the above, we identified a subset of patients who were
alcohol or radiofrequency) in 20.6 % patients (n=14), intrahepatic chemoembolization in beyond Milan criteria histologically. Various epidemiological and laboratory characteristics
35.3% of patients (n=24) and the association of several radiological techniques in 5.9% of were examined.
patients (n=4). Surgical treatment consisted in tumorectomy in 5 cases, segmentectomy in
7 cases and a right or left hepatectomy in 2 cases. The post-operative course was mostly
simple: one patient developped a liver abcess and one had a decompensated cirrhosis. Results: Of 382 patients that received liver transplantation, 303 (79.3%) were male, mean
age 55.6±9.6 years and mean follow up 59.5±45.3 months. The most common underlying
CLINICAL POSTER ABSTRACTS was performed in 1 to 4 sessions. No complications were observed after the procedure. and hepatitis B (n=64, 16.8%). Based on liver explant findings, 92/382 (24.3%) patients CLINICAL POSTER ABSTRACTS
Three patients among those who underwent surgery had a reccurence of HCC treated by
aetiology of liver disease was hepatitis C (n=140, 37%), followed by alcohol (n=82, 21.5%)
radiofrequency in 1 case and by chemoembolization in 2 cases. Percutaneous treatment
Treatment outcomes were total tumor necrosis in 66.6% of cases, partial necrosis in
were outside Milan criteria at the time of LT. Fourty-six patients (12.0%) had evidence
16.7% and tumor progression in A6.7% of cases. The most frequent complications were
of HCC recurrence following LT. In univariate analysis, post-transplant recurrence was
decompensation of cirrhosis (16.6%), followed by splenic infraction (4.1%). The results
significantly associated with poor histological differentiation (p=0.04), AFP>100 ng/ml
of chemoembolization were a total tumor necrosis in 20.9% of cases, partial necrosis or
(p<0.0001), microvascular invasion (p=0.004) and transplantation beyond histological
stable tumor in 50% and tumor progression in 29.1% of cases. Treatment with Sorafenib
was indicated in 4 cases with a median survival of 3 months. Finally, symptomatic treatment
11.741; P=0.002) and transplantation beyond histological Milan criteria (OR 2.843, 95%CI
was decided in 12 patients because of tumor extension or advance cirrhosis. Milan criteria. Multivariate analysis showed that AFP>100 ng/ml (OR 4.470, 95%CI 1.702-
1.077-7.504; P=0.035) were independent predictors of tumour recurrence following LT.
Conclusion: Our study illustrates the high incidence of HCC in our center. A curative
treatment has been proposed in only 41.2% of patients. This underlines that patients are Conclusion: As LT beyond the histological Milan criteria was associated with significantly
usually referred to us at a palliative stage, because of delay in diagnosis. Much remains to increased HCC recurrence, expansion of current radiological criteria is not warranted. Pre-
be done in the field of early detection. LT AFP levels are a valuable marker of tumour recurrence and should be further explored
as part of current listing criteria.