H. Perrier

Prognosis of advanced hepatocellular carcinoma: a new stratification of Barcelona Clinic Liver Cancer stage C: results from a French multicenter study.

Background Advanced hepatocellular carcinoma (HCC) includes a wide spectrum of tumors and patients’ prognosis after treatment is highly variable. Moreover, therapeutic options based on the Barcelona Clinic Liver Cancer (BCLC) staging system algorithm are restricted to one systemic therapy. Aim of the study To refine the stratification among BCLC C HCC patients by establishing a new simple prognostic score. Patients and methods A regression model based on a BCLC stage C population and validated with an external cohort of BCLC C HCC patients defined the score. It was therefore validated among three external cohorts of BCLC C HCC patients treated with sorafenib. Results Five variables had independent prognostic values: the number of nodules, the infiltrating nature of the HCC, &agr;-fetoprotein serum level, Child–Pugh score, and Eastern Cooperative Oncology Group Performance Status grade. They were integrated into a new score named NIACE ranging from 0 to 7, well correlated with survival. With the use of one threshold value, this score enables defining of two populations with different survivals among BCLC C patients and specifically among those treated with sorafenib. Conclusion The NIACE score defines different prognostic subgroups after palliative treatment of HCC. It could be an additional tool for BCLC C HCC before inclusion in clinical trials or for the management of patients. These results must be validated in a prospective study.

NIACE score for hepatocellular carcinoma patients treated by surgery or transarterial chemoembolization

Background and aims Hepatocellular carcinoma (HCC) prognostic scores could be useful in addition to the Barcelona Clinic Liver Cancer (BCLC) system to clarify patient prognosis and guide treatment decision. The NIACE (tumor Nodularity, Infiltrative nature of the tumor, serum Alpha-fetoprotein level, Child–Pugh stage, ECOG performance status) score distinguishes different prognosis groups among BCLC A, B, and C HCC patients. Our aims are to evaluate the NIACE score and its additive value in two HCC cohorts treated either by surgery or by chemoembolization, and then according to the BCLC recommendations. Patients and methods This was a retrospective multicenter study with two BCLC A, B, and C HCC cohorts treated either by surgery (n=207) or by chemoembolization (n=168) carried out between 2008 and 2013. We studied survival time according to the baseline NIACE score and compared it with the Cancer of the Liver Italian Program score and the BCLC system. Results The NIACE score differentiates between subgroups of patients with different prognosis within each BCLC class. Among BCLC A patients treated by surgery and BCLC B patients treated by chemoembolization, the NIACE score differentiates between two subgroups with a significant difference in survival time: 68 (55–81) months versus 35 (21–56) months (P=0.0004) and 20 (17–24) months versus 13 (7–17) months (P=0.0008), respectively. Among those subgroups, the NIACE score has a significantly better prognostic value than the BCLC system or the Cancer of the Liver Italian Program score. Conclusion In this study, among HCC patients treated according to the BCLC recommendations, the NIACE score predicts more accurately than any other system the survival time.

Recommendations for the use of chemoembolization in patients with hepatocellular carcinoma: Usefulness of scoring system?

Several hepatocellular carcinoma (HCC) staging systems have been established, and a variety of country-specific treatment strategies are also proposed. The barcelona - clinic liver cancer (BCLC) system is the most widely used in Europe. The Hong Kong liver Cancer is a new prognostic staging system; it might become the reference system in Asia. Transarterial chemoembolization (TACE) is the most widely used treatment for HCC worldwide; but it showed a benefit only for intermediate stage HCC (BCLC B), and there is still no consensus concerning treatment methods and treatment strategies. In view of the highly diverse nature of HCC and practices, a scoring system designed to assist with decision making before the first TACE is performed or prior to repeating the procedure would be highly useful.

Barcelona clinic liver cancer nomogram and others staging/scoring systems in a French hepatocellular carcinoma cohort

AIM To compare the performances of the Barcelona clinic liver cancer (BCLC) nomogram and others systems (BCLC, HKLC, CLIP, NIACE) for survival prediction in a large hepatocellular carcinoma (HCC) French cohort. METHODS Data were collected retrospectively from 01/2007 to 12/2013 in five French centers. Newly diagnosed HCC patients were analyzed. The discriminatory ability, homogeneity ability, prognostic stratification ability Akaike information criterion (AIC) and C-index were compared among scoring systems. RESULTS The cohort included 1102 patients, mostly men, median age 68 [60-74] years with cirrhosis (81%), child-Pugh A (73%), alcohol-related (41%), HCV-related (27%). HCC were multinodular (59%) and vascular invasion was present in 41% of cases. At time of HCC diagnosis BCLC stages were A (17%), B (16%), C (60%) and D (7%). First line HCC treatment was curative in 23.5%, palliative in 59.5%, BSC in 17% of our population. Median OS was 10.8 mo [4.9-28.0]. Each system distinguished different survival prognosis groups (P < 0.0001). The nomogram had the highest discriminatory ability, the highest C-index value. NIACE score had the lowest AIC value. The nomogram distinguished sixteen different prognosis groups. By classifying unifocal large HCC into tumor burden 1, the nomogram was less powerful. CONCLUSION In this French cohort, the BCLC nomogram and the NIACE score provided the best prognostic information, but the NIACE could even help treatment strategies.

P976 RETREATMENT WITH TRANSARTERIAL CHEMOEMBOLIZATION (TACE): THE ABCR SCORE, AN AID TO THE DECISION-MAKING PROCESS

P975 DYNAMIC CHANGES OF THE INFLAMMATION BASED INDEX (IBI) AS A PREDICTOR OF MORTALITY FOLLOWING TRANS-ARTERIAL CHEMOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA D.J. Pinato, G. Karamanakos, A. Goyal, D. Adjogatse, A.B. Siegel, J.L. Weintraub, J. Stebbing, J.W. Jang, R. Sharma. Division of Experimental Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom; Hepatobiliary Oncology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, United States; Department of Oncology, Imperial College London, Hammersmith Hospital, London, United Kingdom; Internal Medicine, Catholic University of Korea Incheon St. Mary’s Hospital, Seoul, Korea, Republic of E-mail: david.pinato09@imperial.ac.uk Background and Aims: Transarterial chemoembolization (TACE) is a standard treatment for unresectable, intermediate stage

Ponction de la surrénale droite sous échoendoscopie : mythe ou réalité ?

RésuméIntroductionSi la ponction-aspiration sous échoendoscopie de la surrénale gauche est une méthode sûre et rentable, seulement deux études ont été publiées sur la faisabilité de la ponction-aspiration sous échoendoscopie de la surrénale droite.ObservationUn patient de 45 ans a subi une ponction- aspiration sous contrôle échoendoscopique, par voie transduodénale, d’une volumineuse lésion de la surrénale droite. Il présentait un cancer endocrine peu différencié du poumon; lors de la surveillance, le TDM a trouvé une lésion de 40 mm de la surrénale droite. La ponction sous échoendoscopie a montré qu’il s’agissait d’une métastase de son cancer pulmonaire, ce diagnostic a été confirmé par une résection chirurgicale.ConclusionLa ponction-aspiration sous échoendoscopie par voie transduodénale de la surrénale droite semble possible et sûre.AbstractIntroductionAlthough transgastric endoscopic ultrasound (EUS) guided biopsy is a safe and accurate method for sampling of the left adrenal gland, only two reports describing EUS-guided fine-needle aspiration (FNA) of the right adrenal gland have been published to date.ObservationA 45-year-old patient with a large right adrenal mass underwent transduodenal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). He had a history of metastatic lung endocrine carcinoma (low differentiated) and was found to have a 40-mm right adrenal mass during follow-up computed tomography. Endoscopic ultrasound-guided FNA showed a metastatic lung endocrine carcinoma, which was confirmed by surgical histopathologic examination. No complications were encountered during the procedure.ConlusionTransduodenal EUS-guided FNA of the right adrenal gland is feasible and safe.

Comment conduire des actes de recherche clinique en milieu libéral: de nombreuses difficultés?

ConclusionLa recherche clinique en milieu libéral est possible mais requiert une disponibilité, une implication, une ténacité de tous les instants. Elle nécessite la constitution d’une équipe associant au départ, des praticiens libéraux et ensuite, du personnel dédié à la recherche clinique où chacun des intervenants doit être animé de la même détermination et du même engagement. C’est cet esprit d’équipe qui nous a permis d’obtenir la reconnaissance des promoteurs et la pérennisation de la structure malgré les difficultés rencontrées.