240 Des-gamma-carboxy prothrombin-IgM immune complex as novel biomarker for hepatocellular carcinoma

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~THE EFFECT OF HEPATIC ARTERIAL BLOOD FLOW CHANGES ON PORTAL AND HEPATIC V E N O U S WEDGED P R E S S U R E IN THE ISOLATED PERFUSED CCI4-CIRRHOTIC LIVER

03. Liver tumors (epidemiology, diagnosis, m a n a g e m e n t )

A. Zipprichl'2~ M.R. Loureiro-Silva1'2, I. D'Silva2, R.J. Groszmannt2.

1Digestive Disease Section, Yale University School of Medicine, New Haven, CT, USA," 2Hepatic Hemodynamic Laboratory, Veterans Affairs Medicial Cente~ WestHaven, CT, USA Background and Aims: Portal venous pressure (PVP) has been defined as the interaction between portal venous flow and the resistance the liver is offering to this flow. This concept assumes no significant contribution from the hepatic arterial flow (HAF) to portal pressure. However, most pharmacological therapies used to reduce portal pressure are based on the reduction of portal flow. The wedged hepatic venous pressure (WHVP), a surrogate of portal pressure, is used to monitor drug efficacy. It becomes important to know the effect of changes in HAF on PVP and WHVR Therefore, the aim of this study was to investigate the influence of the HAF changes on PVP and WHVE Methods: Cirrhosis was induced by CC14 administration (/>14 weeks; male SD-rats). After measurement of PVP a dual liver perfusion (portal vein [PV]: hepatic artery [HA] 32:8 ml/min) was used. WHVP, HA and PV perfusion pressure, were measured as previously described. After stabilization flow-pressure curves were performed using different flows either through the PV (flow changes, 30 20 ml/min) or HA (5 15 ml/min) with changes every 2 minutes. Results: PVP (p = 0.013) and WHVP (p < 0.04) were higher in cirrhotic animals (n = 25). Exp 1: In response to changes in PV flow absolute decreases in PVP were correlated to absolute decreases in WHVP (cirrhosis: r = 0.61, p = 0.001; control: n.s.). Exp 2: Response to changes in HAF: absolute changes in WHVP correlated to absolute changes in PVP (cirrhosis: r =0.84, p > 0.001 (Figure); normal: r=0.58, p=0.04). While changes in PVP were greater than in controls (p < 0.03) in cirrhotic animals, changes in WHVP were similar in both groups. v=O.84 p>O.O01

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SURVEILLANCE P R O G R A M FOR EARLY DETECTION OF HEPATOCELLULAR C A R C I N O M A IN JAPAN. RESULT OF SPECIALIZED DEPARTMENT OF LIVER DISEASE

E. Ando 1, R. Kuromatsu1, M. Tanaka 3, N. Fukushima1, A. Takada 1, S. Sumie 1, S. Nagaoka 1, K. Inoue 1, J. Akiyoshi 1, J. Kurogi 1, N. Tajiri 1, T. Torimura 1, T. Ueno 2, M. Sata 1. 1Department of Medicine IL Kurume

University School of Medicine, 2Center of the 21th Century Center of Excellence Program for Medical Science, Kurume University School of Medicine, Kurume-shi, Fukuoka-ken, Japan," 3Department of Internal Medicine, Kurume University Medical Center, Japan Background and Aims: Surveillance of cirrhotic patients enables early detection of hepatocellular carcinoma (HCC) and possibly prolongs survival. The aim of this study was to explore whether early-stage HCC can be detected earlier in a specialized Department of Liver Disease than in other institutions. Methods: The study subjects were 574 patients with HCC. Patients were subdivided into three groups according to the manner of HCC detection: Group A: HCC was detected in 91 patients during periodic examination at Kurume University School of Medicine; Group B: HCC was detected in 301 patients during periodic examination at other institutions; Group C: HCC was detected incidentally or because of symptoms in 182 patients. Results: The HCC detected in group A was significantly of smaller size (20.4mm) compared with groups B (27.1mm, p20 ng/mL) only in 22 out of 44 patients (50%; median level: 19.8 ng/mL). Co-detection of both SCCA and AFP IgM complexes allowed to identify 70.5% of patients (31/44), while the overall positivity reached 91% (40/44) when also AFP measurements were included. Conclusions: Compared to AFP determination, improvement in diagnosis of primary liver cancer can be achieved by co-determination of SCCA IgM and AFP IgM complexes (70.5% sensitivity). Inclusion of AFP determination further increases the positive rate of correct diagnosis to 91%.

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NATURAL HISTORY OF UNTREATED HEPATOCELLULAR C A R C I N O M A (HCC) ON CIRRHOSIS: SURVIVAL ANALYSIS AND PROGNOSTIC FACTORS IN 559 PATIENTS

L. Benvegnu'1 , M. Gios 1, E Pasin 1, A. Di Nolfo 2, R Del Poggio 3, G. Rapaccini 4, E Farinati 5, M. Zoli 6, E Borzio 7, E.G. Giannini 8, E. Caturelli 9, A. Alberti 1, M. Bernardi 6, E Trevisani6. 1Dpt. of Clinical

and Experimentale Medicine, University of Padova, Italy," 2Dpt. of Medicine, Hospital of Seriate, Italy," 3Dpt. of Medicine, Hospital of Treviglio, Italy," 4Dpt. of Medicine, University Cattolica of Roma, Italy," 5Dpt. of Surgical and Gastroenterological Science, University of Padova, Italy," 6Dpt. of Internal Medicine, Cardioangilogy and Hepatology, University of Bologna, Italy," 7Dpt. of Medicine, Hospital of Milano, Italy," aGastroenterology Unit, Department of Internal Medicine, University of Genova, Italy," 9 Gas'trointestinal Unit, "Beleolle" Hospital, Viterbo, Italy The natural history of untreated HCC is still partially understood, particularly at early stage, because the majority of patients are submitted to some treatment procedures. We have therefore evaluated outcome and prognostic factors in a large group of 559 patients with HCC and cirrhosis, included between 1988 and 2004, who were not treated or underwent only symptomatic therapy. There were 417 males (74.6%) and 142 females (25.4%), and mean age was 66.0• years. Chil&Pugh stage of cirrhosis was A in 249 (44.5%) patients, B in 205 (36.7%) and C in 105 (18.8%). At diagnosis tumor was unifocal in 182 (32.6%) patients (