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ILCA 2013 Washington, DC. Abstract No. ILCA2013-1142

Impact of Screening on Staging and Survival of Hepatocellular Carcinoma (HCC) in HIV/HCV-Coinfected Patients.

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ILCA 2013 Washington, DC. Abstract No. ILCA2013-1142

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  1. Impact of Screening on Staging and Survival of Hepatocellular Carcinoma (HCC) in HIV/HCV-Coinfected Patients Maaz B. Badshah1, 10, Beatriz Mínguez 2, Ting-Yi Chen 3, Luciana Kikuchi 4, Marianne Harris 5, Maritxell Ventura 2, Mamta K. Jain 6, Emma Page 7, Lynn E. Taylor 8, Rena K. Fox 9, Mark Nelson 7, Judith A. Aberg 3, Norbert Bräu10, Liver Cancer in HIV Study Group 1Indiana University School of Medicine, Indianapolis, IN, USA, 2Hospital Universitario Val D'Hebrón, Barcelona, Spain, 3Bellevue Hospital Center & NYU School of Medicine, New York, NY, USA, 4Universidade de São Paulo, São Paulo-SP, Brazil, 5St. Paul's Hospital & University of British Columbia, Vancouver, BC, Canada, 6University of Texas Southwestern Medical Center, Dallas, TX, USA, 7Chelsea and Westminster Hospital & Imperial College, London, United Kingdom, 8Miriam Hospital & Brown University, Providence, RI, 9University of California San Francisco, San Francisco, CA ,10Bronx VA Medical Center, Bronx, NY & Sinai School of Medicine, New York, NY, USA Patients Characteristics HCC Therapy Multi-Variable Cox Regression Analysis • Background • Current recommendations for HCC screening in HCV-infected patients with cirrhosis (liver sonography every 6 months) are based on expert opinions. • No data are available for the effectiveness of HCC screening in HIV/HCV-coinfected patients. • Methods • Retrospective analysis in 38 centers in 8 countries: Canada, United States, Brazil. Argentina, United Kingdom. German, Spain, Australia • All HCC cases in HIV/HCV-coinfected patients 1992 – 2011 with data on initial presentation : • N=167 • Patients were divided unto two groups: • Screened n = 95 • asymptomatic, diagnosis was made through screening procedure:, i.e. abnormal screening AFP or imaging studies • Unscreened n = 72 • symptomatic, diagnosis was made through work-up of symptoms, not screening results • Analysis of tumor characteristics, staging, therapy, and survival • Estimation of lead time of screened pts. using tumor doubling time method: • Lead Time (T) = Tumor Doubling Time * 3log (median tumor size unscreened/screened) * 1/ log(2) • (Schwartz M, Cancer, 1961 ) • Here: T = 112 days * 3log (5.0 cm/3.0 cm) * 1/ log(2) = 248 days (8.12 mo) • Published median HCC tumor doubling time in HIV-negative: 112 days (Okada S, Hepatogastroenterology, 1993; Chang S, Am J Roentgenol, 2005) Survival HCC Tumor Characteristics • Conclusions • Many HIV/HCV-coinfected patients with HCC were not diagnosed through screening • An HCC diagnosis through screening was associated with earlier HCC stages, more HCC therapy, and independently predicted survival • In recent years, more patients were diagnosed through screening Median survival: At Risk Screen 95 26 18 8 4 3 2 2 1 1 0 Screen 14.1 months No Screen 72 9 3 2 1 1 0 No Screen 3.9 months HCC Staging Screening Rates over Time To contribute your cases of HCC in HIV patients for further studies, please contact us at: Norbert Bräunorbert.brau@va.gov or visit us at:www.HCCinHIV.org ILCA 2013 Washington, DC. Abstract No. ILCA2013-1142

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