D Jencks

Women with inflammatory bowel disease do not receive adequate cervical cancer screening or pregnancy counseling.

ammatory bowel disease. Clin Dermatol. 2010;26: 265–273. 3. Bernstein CN, Blanchard JF, Rawsthorne P, et al. The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol. 2001;96:1116–1122. 4. Yüksel I, Başar O, Ataseven H, et al. Mucocutaneous manifestations in inflammatory bowel disease. Inflamm Bowel Dis. 2009;15:546–550. 5. Farmer RG, Easley KA, Rankin GB. Clinical patterns, natural history, and progression of ulcerative colitis. Dig Dis Sci. 1993;38:1137–1146. 6. Basler RS. Ulcerative colitis and the skin. Med Clin North Am. 1980;64:941–954. 7. White JW. Erythema nodosum. Dermatol Clin. 1985; 3:119–127. 8. Hyrich KL, Lunt M, Watson KD, et al. British Society for Rheumatology Biologics Register. Outcomes after switching from one anti-tumor necrosis factor a agent to a second anti-tumor necrosis factor a agent in patients with rheumatoid arthritis: results from a large UK national cohort study. Arthritis Rheum. 2007;56:13–20.

Mo1045 Compared to HCC Patients With Chronic Viral Hepatitis (Viral HCC), Hcc Patients With Nonviral Etiologies (Nonviral HCC) Were Less Likely to Undergo HCC Screening, Presented With More Advanced Tumors, and Had Poorer Overall Survival

Purpose: HCC rarely occurs in patients without chronic liver disease, and the clinical outcomes of HCC patients may differ by etiologies of underlying liver disease. Routine HCC screening/surveillance is recommended for those with chronic hepatitis B and cirrhosis of all etiologies, but it is unclear if there are differences in adherence in different populations. Our goal was to compare screening adherence and clinical outcomes of viral vs. nonviral HCC patients. Methods: This is a retrospective cohort study of 200 consecutive nonviral HCC patients (67 with alcoholic liver disease [ALD], 73 with cryptogenic/nonalcoholic fatty liver disease [NAFLD] and 52 with others) and 396 patients with viral HCC (268 with chronic hepatitis C, 119 with chronic hepatitis B and 9 with both) randomly selected from a total cohort of 1,214 patients with viral HCC who presented at a U.S. medical center in 1991-2011. HCC patients were identified via ICD-9 electronic query with data collected in all cases by individual chart review and National Death Index search. HCC screening adherence was optimal if US or CT/MRI were done every 6-12 months. Results: Compared to viral HCC patients, those with nonviral HCC were older (65±13 vs. 57±11, p<0.0001) and more likely to be non-Asian (74% vs. 51%, p<0.001), but had similar CPT scores (6.6 ±1.7 vs. 6.9±1.8, p=0.13). While the majority of viral HCC patients had a history of optimal HCC screening (69%), almost none of the nonviral HCC patients did (1%). Compared to viral HCC patients, nonviral HCC patients were much more likely to present withBLCL Stage C/D (42% vs. 19%), p<0.001) and beyond the Milan criteria for liver transplantation (75% vs. 54%, p<0.001). Nonviral HCC patients had significantly lower 5-year survival compared to their viral HCC counterparts: 48% vs 57% (p=0.036) (Figure). Similarly, patients who received optimal screening had significantly higher 5-year overall survival compared to those with suboptimal or no screening (62% vs. 47%, p=0.012). Onmultivariate analysis also inclusive of age, sex and ethnicity, independent predictors for lower mortality were HCC screening (OR=0.50, p=0.015), in addition to viral liver disease etiology (OR= 0.39, p=0.002). Conclusions: Nonviral HCC patients were much less likely to have a history of HCC screening, presented with higher tumor stages, and had poorer survival. The lack of HCC screening in nonviral HCC patients may be due to poor adherence and access to care as may be seen in those with ALD or underdiagnosis of chronic liver disease/cirrhosis as may be seen in those with cryptogenic or NAFLD. Further studies and efforts should be focused on early diagnosis of underlying liver disease, cirrhosis, and improvingHCC screening compliance in at-risk patients; which is especially important with the rising obesity epidemic and projected increase of HCC incidence due to NAFLD.