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Elevated Lung Shunt Fraction as an Independent Predictor of Local Disease Progression and Metastasis in Hepatocellular Carcinoma.

T. Sandow,1 D. DeVun,1 P. Gulotta,1 H. Bohorquez,2 D. Kirsch.1

1Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
2Department of Transplant Surgery, Ochsner Clinic Foundation, New Orleans, LA.

Meeting: 2016 American Transplant Congress

Abstract number: A182

Keywords: Hepatocellular carcinoma, Prognosis, Radiologic assessment

Session Information

Date: Saturday, June 11, 2016

Session Name: Poster Session A: Liver - Hepatocellular Carcinoma and Cholangiocarcinoma Malignancies

Session Time: 5:30pm-7:30pm

 Presentation Time: 5:30pm-7:30pm

Location: Halls C&D

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Purpose: To establish a relationship between lung shunt fraction (LSF) and local disease progression as well as the development of metastatic disease.

Materials and Methods: A retrospective analysis was performed on 52 patients with HCC who underwent pre-radioembolization angiography assessment, which includes the calculation of LSF, as well as preprocedure and postprocedure follow-up imaging. Demographic variables are noted in Table 1.

Patient Demographics
Mean follow-up, days 245
Mean age, years 67
Sex, male/female 38/14

Tumor characteristics

Mean diameter of largest lesion, cm

Tumor location

Right

Left

Bilobar

Number of lesions

1

2

3

4

5 or more

 

5.7

 

31 patients

8 patients

13 patients

 

28 patients

10 patients

6 patients

3 patients

5 patients

Mean AFP level at time of angiography, ng/mL

Mean AFP level at time of follow-up imaging, ng/mL

1,302

2,654

Results: Patients with higher LSFs were more likely to develop metastatic disease and demonstrate tumor growth. The mean LSF in patients with metastatic disease on follow-up exam was almost double the LSF of patients without metastatic disease (18.3% vs. 9.3%, p = 0.001). Patients with elevated LSFs were also more likely to develop intrahepatic disease progression (15.6% vs. 8.5%, p = 0.003). Lower LSFs signal a better prognosis with LSF <8% corresponding to a negative predictive value of 74% for local disease progression and 95% for the development of metastasis. Multiple logistic regression analysis demonstrates that LSF is an independent predictor of local disease progression (OR = 1.2, p = 0.03) and new metastasis (OR = 1.2, p=0.01) in patients with HCC.

Multivariate Comparisons with Local Disease Progression and New Metastasis
  Local Disease Progression Metastasis
Age OR=0.99, p=0.78 OR=1.1, p=0.26
Sex, Male OR=0.26, p=0.14 OR=1.3, p=0.80
Largest Lesion Size OR=1.1, p=0.45 OR=1.0, p=0.94
Number of Lesions OR=1.3, p=0.37 OR=1.2, p=0.63
LSF OR=1.2, p=0.03 OR=1.2, p=0.01
AFP at Time of LSF Assessment OR=1.0, p=0.73 OR=1.0, p=0.49

Conclusion: Noting that patients with elevated LSFs were more likely to develop local disease progression and metastatic disease, LSF demonstrates vascular behavior and biologic tumor characteristics that may be an important prognostic marker in select patients.

CITATION INFORMATION: Sandow T, DeVun D, Gulotta P, Bohorquez H, Kirsch D. Elevated Lung Shunt Fraction as an Independent Predictor of Local Disease Progression and Metastasis in Hepatocellular Carcinoma. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Sandow T, DeVun D, Gulotta P, Bohorquez H, Kirsch D. Elevated Lung Shunt Fraction as an Independent Predictor of Local Disease Progression and Metastasis in Hepatocellular Carcinoma. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/elevated-lung-shunt-fraction-as-an-independent-predictor-of-local-disease-progression-and-metastasis-in-hepatocellular-carcinoma/. Accessed March 4, 2021.

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