Elevated Lung Shunt Fraction as an Independent Predictor of Local Disease Progression and Metastasis in Hepatocellular Carcinoma.
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
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).
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.« Back to 2016 American Transplant Congress