Abstracts / Digestive and Liver Disease 49S (2017) e19–e42
T-27
Clinical effectiveness of enhanced surveillance
in “super-high risk” cirrhotics as evaluated in
the ITA.LI.CA database
M. D’Elia 1 , G. Peserico 1 , F. Pelizzaro 1 ,
A. Meneghetti 1 , A. Imondi 1 , E. Giannini 2 ,
F. Trevisani 3 , F. Farinati 1
1 Department of Surgery, Oncology and
Gastroenterology, Section of Gastroenterology,
University of Padua, Padua, Italy
2 Department of Internal Medicine, Gastroenterology
Unit, University of Genoa, Genoa, Italy
3 Unità di Semeiotica Medica, Dipartimento di
Scienze Mediche e Chirurgiche, Alma Mater
Studiorum, Università di Bologna, Bologna, Italy
Background: Surveillance of cirrhotics in the secondary pre-
vention of HCC is mandatory but the ideal surveillance interval is
still under discussion. The Japanese guidelines consider HCV/HBV-
related cirrhotics as “super-high risk” patients, with shorter
doubling time, and indicate an enhanced surveillance (3–4
months).
Aims of the study: Were to evaluate the impact of a three-
months enhanced surveillance (3MS) in patients with viral cirrhosis
in terms of tumor stage, survival and direct costs.
Patients and methods: The multicenter ITA.LI.CA database
(5849 HCC patients) was used. Inclusion criteria were: cirrhosis,
viral etiology and diagnosis under surveillance (3MS versus 6MS).
Overall 1576 cirrhotics met the definition of “super-high risk”: 194
underwent 3MS, 1382 6MS. The survival analysis took into account
the lead time bias (LTB) (by Schwartz’s algorithm, Cancer 1961).
Results: The 3MS did not increase the proportion of lesions diag-
nosed as “very early” (p = 0.622) or within Milan Criteria (p = 0.067).
In the 3MS patients a greater portion of HCC were multifocal
(p = 0.025), probably due to an increased likelihood of the 3MS
to diagnose more aggressive tumors. The survival of the 3MS
patients was not significantly different, also when corrected for LTB
(p = 0.987), with actually a shorter survival in the 3MS group (35
months, 95% CI 32–38, vs 42 months, 95% CI 37–43). These results
were confirmed in the multivariate analysis. Micro-economic anal-
ysis estimated an increase of 1447 D in the costs for each HCC while
the cost for year of life saved was not computable.
Conclusions: In patients at “super-high risk” an enhanced 3MS
does not improve tumor stage, feasibility of curative treatments
and patients’ survival, with an increase in direct costs. It can be
concluded that “super-high risk” patients should be managed as all
the population at risk, as indicated by the European guidelines.
http://dx.doi.org/10.1016/j.dld.2017.01.065
e31
T-28
Lobe-specific oxidative stress and matrix
metalloproteinase activation in two animal
models of non-alcoholic fatty liver disease
(NAFLD)
V. Siciliano 1 , L.G. Di Pasqua 1 , C. Berardo 1 ,
V. Rizzo 2 , P. Richelmi 1 , S. Perlini 1 , A. Ferrigno 1 ,
G. Palladini 1 , M. Vairetti 1
1 Department of Internal Medicine and Therapeutics,
University of Pavia, Pavia, Italy
2 Department of Molecular Medicine, IRCCS
Policlinico San Matteo, University of Pavia, Pavia,
Italy
Introduction and aim: We previously demonstrated that in
models of ischemia/reperfusion and obstructive cholestasis a lobar
functional heterogeneity of the liver exists indicating that different
events occur in the different hepatic lobes (Palladini et al., 2012;
Ferrigno et al., 2014). In this study we evaluated the liver hetero-
geneity in two animal models of non-alcoholic fatty liver disease
(NAFLD).
Methods: NAFLD was induced in male Wistar rats by 4–8 week
MCD diet administration; 12-week old Obese (fa/fa) and Lean
(fa/−) male Zucker rats were also used. Serum hepatic enzymes
and TNF-alpha were quantified. Reactive oxygen species (ROS) and
malondialdehyde (MDA), index of oxidative stress, and matrix met-
alloproteinase activation (MMP-2, MMP-9) were evaluated using
liver samples from left lobe (LL), median lobe (ML) and right lobe
(RL).
Results: Liver injury in MCD and Zucker obese rats was con-
firmed by the increased hepatic enzymes release; an increase
in serum TNF-alpha occurred in MCD rats when compared with
Zucker obese rats. A lower MDA level was observed in the RL as
compared with the LL and ML in the MCD animals; the difference
was time dependent and more evident after 8 weeks. In Zucker rats,
higher MDA levels was found in LL both in Lean and Obese Zucker
rats. The same trend occurred in ROS formation both in MCD and
Zucker rats. A marked MMP-2 and MMP-9 activation occurred in
RL compared with LL and ML in MCD rats.
Conclusions: A lobar difference was detected for ROS, MDA and
MMPs activity both in MCD and Zucker rats, with higher oxida-
tive stress in the LL for all groups considered. On the contrary an
higher MMPs activation was found in RL when compared with LL
and ML. This study supports the growing evidence of a functional
heterogeneity among the liver lobes, also occurring in NAFLD rats.
http://dx.doi.org/10.1016/j.dld.2017.01.066
T-29
Vitamin D deficiency is an independent risk
factor and is predictor of infections in patients
affected by HCV-related liver cirrhosis
A.R. Buonomo, E. Zappulo, R. Scotto, B. Pinchera,
A.E. Maraolo, F. Borrelli, G. Di Filippo, G. Borgia,
I. Gentile
Department of Clinical Medicine and Surgery,
Section of Infectious Disease, University of Naples,
Naples, Italy
Introduction: Vitamin D has other biological effects than
calcium-fosforus omeostasis. Among these effects, it plays a keyrole
in native immunity stimulation and adaptive immunity regulation.