Tu2027 Endoscopic Versus Percutaneous Drainage for Management of Hilar Cholangiocarcinoma

Abstract

Background: The incidence of hepatocellular carcinoma (HCC) has increased significantly in United States over the last few decades in parallel with the epidemic of nonalcoholic fatty liver disease (NAFLD). Limited data suggest that HCC could arise in steatotic livers without the presence of cirrhosis. The aim of the current study was to characterize patients with NAFLD presenting with HCC in non-cirrhotic liver (NCL) compared to those with HCC in association with liver cirrhosis (LC). Methods: A retrospective analysis was performed on all patients with HCC and NAFLD diagnosis seen at our institution between 2003 and 2012. We characterized the patients with respect to demographic, clinical, histological and tumor features. Comparisons between the NCL and LC groups were done using t-test, Mann Whitney U test, and Chi square test as appropriate. P value 5 cm) (77.8% vs. 23 %), and receive hepatic resection as the modality for HCC treatment (66.7% vs. 17%); and were less likely to receive loco-regional therapy (16.7% vs. 51.1%) or liver transplant (0% vs. 72.3%), p value < 0.001 for all. Furthermore, 62% of patients without cirrhosis had HCC recurrence compared to only 12.5% in patients with cirrhosis (p < 0.001) and had worse survival with mortality rate of 41.7% at last follow up for the HCC-NCL group compared to 27.7% in the cirrhotic group (p = 0.008). Conclusion: Patients with HCC in the absence of liver cirrhosis are more likely to present at an older age with larger tumor and have higher rates of tumor recurrence. Studies to assess the cost-effectiveness of HCC surveillance in this group should be conducted.