Page 295 - ebook HCC

PROGRAMME
GENEV
EASL HCC SUMMITHCC SUMMIT
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292 PROGRAMME AND ABSTRACTSAND ABSTRACTS GENEVA, SWITZERLANDA, SWITZERLAND EASL 293
292
FEBRUARY 13 - 16, 2014Y 13 - 16, 2014
FEBRUAR
Poster Board Number C61 Poster Board Number C62
ASSESSMENT OF PIVKA II AS A MARKER IN LOCOREGIONAL TREATMENTS FOR
RECURRENT HEPATOCELLULAR CARCINOMA HEPATOCELLULAR CARCINOMA IN CIRRHOTIC
AFTER RADIOFREQUENCY ABLATION THERAPY PATIENTS: ASSESSMENT OF LIVER FUNCTION
BY 13C-AMINOPYRINE BREATH TEST
Mohsen M. Maher , Wesam A. Ibrahim , Osama M. Hetta , Ahmed M. El-Ghandour
1
2
1
1 Internal Medicine Department, Radiology Department, Marco Guarracino, Pietro Coccoli, Marco Sanduzzi Zamparelli, Costantino Sgamato,
2
Ain Shams University, Cairo, Egypt Maria Grazia Iannuzzi, Gerardo Nardone
Corresponding author’s e-mail: wesamahmed74@yahoo.com
Corresponding author’s e-mail: marco.guarracinomd@gmail.com
Introduction: Hepatocellular carcinoma is the most frequent primary hepatic malignancy.
Radiofrequency ablation therapy (RFA) is one of the most recent curative treatment of Introduction: Hepatocellular carcinoma (HCC) is the sixth common cancer in the world
and the third cause of death for cancer. Orthotopic liver transplantation is the choice
early diagnosed hepatocellular carcinoma. Recurrence rate is high following treatment. treatment but it is hampered by organ availability. An alternative treatment according to
So tumor marker protein induced by vitamin K absence (PIVKA II) level can be used as a Barcellona criteria are the mini invasive percutaneous locoregional treatments, including
predictor of prognosis of patients following RFA therapy and to diagnose recurrence more percutaneous ethanol injection (PEI) and radiofrequency termoablation (RFA).
earlier for better outcome.
Aims: While the efficacy of locoregional treatments is well-known, its impact on liver
Aims: To detect the importance of PIVKA II as a tumor marker in patients with recurrent function remains unclear. This is a critical issue since, HCC develops in more than 90%
HCC after curative radiofrequency ablation therapy. of cases in cirrhotic patients. Aim of this study was to evaluate in patients with HCC the
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effects of locoregional treatments (PEI and RFA) on liver function by -C Aminopyrine
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Methodology: This study was done on 40 patients with hepatocellular carcinoma which is breath test ( -C ABT).
diagnosed by abdominal ultrasonography, triphasic CT and alphafetoprotein and treated
by radiofrequency ablation therapy 2 years ago before the study, all patients from Internal Methodology: We prospectively included 20 consecutive patients (M/F: 11/9, mean age
Medicine Department and Radiology Department in Ain Shams University hospitals. The 68) with HCC candidate to loco-regional therapy (PEI or RFA). The effectiveness of the
therapy was evaluated by contrast-enhanced ultrasound (CEUS) after procedures, US
patients divided into 2 groups according to recurrence then PIVKA II serum level measured (the following day and at 90th day) and TC (after 30 days). Liver function was evaluated
by enzyme immunoassay method and the statistics were done using chi square test, by -C ABT laboratory parameters (Albumin, Protrombin time, AST, ALT, Bilirubin, GGT,
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independent sample t test, Mann-whitney test and spearmann’s correlation coefficient. ALP, LDH, AFP). -C ABT was performed by administering -C Aminopyrine 2mg/kg of
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body weight, dissolved in 200ml of water; then breath samples were collected baseline and
CLINICAL POSTER ABSTRACTS carcinoma who developed recurrence after curative radiofrequency ablation therapy, all h, 7, 30 and 90 days after the procedure. CLINICAL POSTER ABSTRACTS
Results: The patients divided into 2 groups: Group I: 20 patients with hepatocellular
each 30 minutes for 2 h. All these tests were performed before treatment, and repeated 24
patients in group I are males with mean age (54.45 ± 7.7), 16 patients were diabetics,
Results: Ten patients underwent PEI and 10 RFA. No significant differences were found
and all of them were HCV+ve and HBV-ve. Group II: 20 patients who did not develop
in terms of demographic carachteristics, etiology and Child-Pugh score between the
recurrence after curative radiofrequency ablation therapy, all patients in group II are males
groups. Both PEI and RFA were effective in 100% of the cases. After a transient increase
with mean age (55.9 ± 6.63), 8 patient were diabetics, 18 patients from them were HCV+ve
of AST (p<0,001), ALT (p<0,001) and Bilirubin (p<0,01) for both procedures, all these
and 2 patients were HCV –ve and all of them were HBV-ve. Comparison between group
I and group II as regard PIVKA II level showing highly statistically significant relationship
did not change during the 90 days. Six out of 20 patients showed an elevated value of
between PIVKA II level and the recurrence of HCC after RFA therapy as P = 0.000. values returned to baseline levels at the end of follow up, while GGT, ALP and LDH values
AFP at baseline that declined up to normal during the follow-up. Finally, liver function,
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as explored by C-ABT, after an initial reduction in the first days treatment, showed a
Conclusion: There were high PIVKAII level in patients with recurrent HCC after curative complete recovery, up to reach value higher than baseline (baseline mean value: %dose/h
RFA therapy. So PIVKAII (DCP) can be used to predict poor prognosis after RFA therapy 3,17 - cum/dose 4,5; 90 day mean value: %dose/h 3,81 - cum/dose 5,31)
th
of HCC. So patients who have high PIVKAII before treatment of HCC should be carefully
followed, because of high incidence of HCC recurrence after curative RFA therapy. Conclusion: RFA and PEI do not affect liver function in cirrhotic patients as detected by
13CABT in the short and long period