Page 333 - ebook HCC

GENEVA, SWITZERLANDA, SWITZERLAND
PROGRAMME
EASL HCC SUMMITHCC SUMMIT
331
330
330 PROGRAMME AND ABSTRACTSAND ABSTRACTS GENEV EASL 331
FEBRUAR
FEBRUARY 13 - 16, 2014Y 13 - 16, 2014
Poster Board Number C89 Poster Board Number C90
STRATEGY TREATMENT OF SURGICAL NAFLD-ASSOCIATED HEPATOCELLULAR
RESECTION INCREASES THE SURVIVAL RATE CARCINOMA IN CIRRHOTIC AND NON-
OF SELECTED HEPATOCELLULAR CARCINOMA CIRRHOTIC PATIENTS IN BRAZIL
PATIENTS IN BARCELONA CLINIC LIVER
Luciana Kikuchi , Claudia P. Oliveira , Claudia M. Tani ,
1
1
1
CANCER STAGE C Mario R. Alvares-Da-Silva , Jose Tadeu Stefano , Gabriela Belitzki ,
1
2
2
Marcio Augusto Diniz , Aline L. Chagas , Regiane S. D. S. M. Alencar ,
1
1
1
Denise C. P. Vezozzo , Gilmar R. Santos , Venancio A. F. Alves , Flair J. Carrilho 1
1
1
1
Chih-Wen Lin 1 São Paulo Clínicas Liver Cancer Group, Hospital das Clínicas, Instituto do Câncer do
2
Estado de São Paulo, University of São Paulo School of Medicine, Gastroenterology,
School of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clinicas de
Corresponding author’s e-mail: lincw66@gmail.com Porto Alegre, São Paulo, Brazil
Corresponding author’s e-mail: cpm@usp.br
Introduction: Sorafenib is the only approved agent recommended by the American
Association Study of Liver Disease guidelines for hepatocellular carcinoma (HCC) patients
in Barcelona Clinic Liver Cancer (BCLC) stage C. Aims: This study was designed to assess the clinocopathological features and the survival
of non-alcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC)
in a Brazilian population.
Aims: This study aims to evaluate and compare overall survival in HCC patients in BCLC
stage C treated with different therapies or supportive care alone. Methodology: From January 2010, 44 patients with HCC related to NAFLD from the FLIP
consortium were retrieved retrospectively from 2 centres in Brazil. Unless features of the
Methodology: We retrospectively reviewed the medical records of 358 newly diagnosed metabolic syndrome were present, or NAFLD was evident from histology or ultrasound,
hepatocellular carcinoma patients between 2005 and 2012 in BCLC stage C and Child- cases were regarded as cryptogenic. Diagnosis of HCC was confirmed by histology in 19
Pugh class A were analyzed and compared at E-DA hospital, Taiwan. patients and 25 patients presented typical imaging patterns according to AASLD/EASL
guidelines. BCLC guideline was followed to conduct HCC therapy. Overall survival rate
was calculated from the date of HCC diagnosis to date of death.
Results: Six-six patients were treated with supportive care alone and 292 were treated
with surgical resection (52/292, 17.9%), local ablation treatment (5/292, 1.8%), transarterial Results: Thirty-two (73%) NAFLD-related cases and 12 (27%) cryptogenic cases were
embolization (137/292, 46.9%), systemic chemotherapy or radiotherapy (86/292, collected over 24 months. Population consisted of 17 women and 27 men with a mean age
CLINICAL POSTER ABSTRACTS group (hazard ratio, 0.52; 95% confidence interval, 0.36-0.62; p<0.001). Patients who surveillance in 56%. In 19 patients whose HCC diagnosis was made by histology, most CLINICAL POSTER ABSTRACTS
of 65 years. Most (81%) patients had been diagnosed with obesity, diabetes, hypertension,
29.5%), and sorafenib (12/292, 4.1%). Median survival was 12 months (95% confidence
or dyslipidemia. Five patients (11%) had a non-cirrhotic liver. HCC was detected by
interval, 8.6-14.3) in treated patients compared with 4.2 months in the supportive care
were classified as well-deferentiated HCC. Most patients (70%) had a single nodule with
underwent surgical resection had the better survival rate compared to patients undergoing
a median size of 50 mm. At diagnosis, most patients were classified as BCLC A (43%).
other treatments (39.6 months versus 7.9 months, p<0.0001). The 5-year survival rate
Regarding HCC therapy, TACE was employed as initial therapy in 11 patients, resection
and percutaneous ethanol injection in 4 patients (each), and radiofrequency ablation in
after surgical resection was 37.4%. Furthermore, a combination of aggressive surgical
1. Seven patients were submitted to orthotopic liver transplant and four patients received
treatment and effective preoperative transarterial embolization treatment in HCC patients
sorafenib. Among non-cirrhotic patients, tumor size varied from 15 to 109 mm, but all were
in BCLC stage C and Child-Pugh class A.
eligible for curative therapy (4 resection and 1 percutaneous ethanol injection). The 1 and
2-year overall survival rates 81 and 66%, respectively.
Conclusion: Strategy treatment of surgical resection causes excellent results in HCC
patients in BCLC stage C and Child-Pugh class A. Although sorafenib is currently Conclusion: NAFLD is an important predisposing condition for HCC in the absence
recommended, oncologists and hepatologists should select optimal candidates for surgical of other liver diseases. NAFLD-associated HCC occurs frequently with cirrhosis in our
resection to get better survival. cohort. In this setting, most HCC cases were detected in a regular screening program
and had early tumor. In non-cirrhotic NAFLD patients, treatment schedule can be more
aggressive as liver function is not deteriorated.