721 Presenting Features and Outcomes of Hepatocellular Carcinoma Are Worse in Patients With Non-Viral Liver Disease

Introduction: Although several staging systems exist for HCC, the most widely accepted system is the Barcelona Clinic Liver Cancer (BCLC) staging system. All patients with vascular invasion and/or distant metastases are categorized as BCLC C with similar with prognosis and treatment. The aim of this study is to compare the clinical presentation and prognosis of HCC patients who present with BCLC C. Methods: We conducted a retrospective analysis of a prospective database of patients diagnosed with HCC between January 2005 and December 2011. All patients who presented with extrahepatic metastasis (EHM) or vascular invasion (VI), consisting of either a portal venous or hepatic venous thrombus, at presentation were included for analysis. Patients with either a Child Pugh score C or ECOG performance . 2 were excluded from analysis. Demographics, tumor characteristics, treatment regimens, and survival were compared between the following groups of patients: patients with both VI and EHM (group C1), patients with VI but without EHM (group C2), and patients with EHM but without VI (group C3). Differences between groups were determined with oneway ANOVA and Chi-squared tests. Survival curves were generated using Kaplan-Meier plots.Results: Of the 448 patients diagnosed with HCC, 130 patients presented at BCLC C stage, 45 patients in group C1, 54 patients in group C2, and 31 patients in group C3. There was no difference in age, gender, race/ethnicity, presence of symptoms, or etiology of cirrhosis between the three groups of patients. Patients with both EHM and VI (Group C1) had a significantly higher AFP than the other groups (mean, 93491+/164819,19488+/-49375, and 13948+/-5248, p,0.001). These patients also had significantly worse survival than those with VI or EHM alone (2.3 mths vs. 5.9 mths, p ,0.001). Patients with VI alone (group C2) and those with EHM alone (group C3) had similar survival (5.7 vs. 6.1 mo, p= 0.62). On multivariate analysis treatment, AFP , 400 ng/ml, absence of both EHM and VI, and lack of symptoms on presentation were associated with prolonged overall survival. Conclusion: Patients with BCLC stage C tumors comprise a heterogeneous group of patients with different prognoses. Patients who present with both VI and EHM have significantly worse prognosis than those who present with VI or EHM alone.