AASLD Abstracts with CCA. The major determinants of survival include ECOG score, CA19-9, tumor size and extrahepatic metastasis. Sa1869 Is There a Morbidity and Survival Benefit for Metal Over Plastic Stents in Managing Malignant Distal Biliary Strictures? A Meta-Analysis and Systematic Review Harsha Moole, Michael D. Cashman, Fritz-Henry Volmar, Sonu Dhillon, Matthew L. Bechtold, Srinivas R. Puli Background: Palliation for inoperable malignant distal biliary strictures can be achieved with metallic and plastic biliary stents. There have been recent retrospective studies and randomized controlled trials that evaluated the mortality and morbidity in patients with metal versus plastic stents. This is a meta-analysis to pool the evidence for survival benefit and morbidity in metallic versus plastic stents in patients with malignant distal biliary strictures. Aim: Compare survival benefit and morbidity in patients with distal biliary strictures managed with metallic stents versus plastic stents. Method: Study Selection Criteria: Studies using metallic and plastic stents for palliation in patients with malignant distal biliary stricture / obstruction. Data collection & extraction: Articles were searched in Medline, Pubmed, Ovid journals, CINAH, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials & Database of Systematic Reviews. Two reviewers independently searched and extracted data. Any differences were resolved by mutual agreement. Statistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity among studies was tested using Cochran's Q test based upon inverse variance weights. Results: Initial search identified 1376 reference articles, of which 91 were selected and reviewed. 10 studies (N=892) for metallic and plastic stents which met the inclusion criteria were included in this analysis. Pooled analysis by fixed effects showed an overall survival/ time to death in metallic stent group to be 157.3 days (95% CI = 148.9 to 165.6) compared to 120.6 days (95% CI = 114.3 to 126.9) in plastic stent group. Metal stents had a pooled complication rate of 3.83 % (95% CI = 3.52 to 4.14) compared to 2.17 % (95% CI = 1.91 to 2.42) for plastic stents. The pooled effects estimated by fixed and random effect models were similar. The p for chi- squared heterogeneity for all the pooled accuracy estimates was > 0.10. Conclusions: In our meta-analysis of patients with malignant distal biliary strictures managed with palliative stenting, metallic stents might be associated with longer overall survival period compared to plastic stents. Metallic stenting seems to have marginally higher percentage of complications when compared to plastic stenting. Sa1870 Cirrhosis Is Underrecognized in Patients Subsequently Diagnosed With HCC Fasiha Kanwal, Megan Walker, Yvonne H. Sada, Sahil Mittal, Zhigang Duan, Hashem B. El-Serag, Jessica Davila Background: Hepatocellular cancer (HCC) is a rapidly increasing, highly fatal cancer. Cirrho- sis is the precursor lesion for most HCCs. However, compensated cirrhosis can often be asymptomatic and remain unrecognized for years. We sought to quantify the extent to which cirrhosis is unrecognized in patients with HCC as well as its association with HCC stage at diagnosis. Methods: We conducted a national cross-sectional study of a randomly selected sample of HCC cases diagnosed in the Veterans Affairs healthcare system during 2006 and 2009. We reviewed the electronic medical records for confirmation of HCC and HCC stage (BCLC criteria). Two reviewers used explicit criteria based on histopathology, abdominal imaging, non-invasive fibrosis biomarkers, and laboratory tests to classify patients as having cirrhosis. A third reviewer independently abstracted data from the providers' notes for any mention of cirrhosis as a possible diagnosis up to 3 years prior to the HCC date. We used multivariable logistic regression to examine the association between prior cirrhosis recognition and early stage of HCC while adjusting for patients' demographics (age, race), comorbidity, etiology of liver disease (HCV, HBV, alcohol, nonalcoholic fatty liver disease, NAFLD), and healthcare utilization. To identify subgroups at risk for unrecognized cirrhosis, we conducted separate models with recognition of cirrhosis as the dependent variable; independent variables included demographics, comorbidity, etiology and severity (Child Class) of liver disease, rural residence, healthcare utilization, and geographic region. Results: Of the 1500 patients with HCC, 1201 had evidence of cirrhosis based on explicit review. Of these, 96 (24.6%) did not have any mention of cirrhosis diagnosis prior to HCC; only 10 (3.4%) of these patients had early stage HCC. In contrast, 167 of 905 patients (18.4%) with recognized cirrhosis had early stage HCC (unadj OR=6.47, 95% CI=3.37-12.43). The effect of cirrhosis recognition on HCC stage did not change after adjusting for pre-specified covariates (adj OR=4.53, 95% CI=2.28-8.95). Older patients (OR=0.39, 95% CI=0.27-0.57), African Americans (OR=0.35, 95% CI=0.23-0.53), patients with alcohol or NAFLD (OR= 0.45, 95% CI=0.28-0.71; OR=0.16, 95% CI=0.08-0.30, respectively), HIV (OR=0.31, 95% CI=0.13-0.70), and fewer comorbidities (OR=0.27, 95% CI=0.17-0.43) had higher odds of unrecognized cirrhosis than the comparison groups. Conclusions: In at least one fourth of patients with HCC, cirrhosis was not recognized prior to HCC diagnosis. Those with unrecognized cirrhosis had a higher risk of advanced HCC stage at the time of diagnosis. Our data underscore the need for developing new strategies to identify patients with cirrhosis, particularly focusing on older patients, African Americans, those with non-viral risk factors, and comorbid HIV. S-1030 AASLD Abstracts Sa1871 Local Recurrences and Complications After Percutaneous Radiofrequency Ablation of Hepatocellular Carcinoma: Analysis Focused on Tumor Locations Junichi Toshimori, Kazuhiro Nouso, Shinichiro Nakamura, Nozomu Wada, Yuki Morimoto, Yasuto Takeuchi, Kenji Kuwaki, Tetsuya Yasunaka, Hideki Onishi, Fusao Ikeda, Hidenori Shiraha, Akinobu Takaki, Kazuhide Yamamoto Aims: The purpose of this study was to investigate the predisposing factors for local recurrence and complications after percutaneous radiofrequency ablation (RFA) of hepatocellular carci- noma (HCC). Methods: Between April 2001 and July 2011, consecutive 397 HCC patients treated with RFA was enrolled. The ablated nodules were 1455. Predisposing factors for overall recurrence and local recurrence especially focused on tumor locations and complica- tions were examined. Results: Survival of the patients at 1, 3, and 5 years were 97.4%, 85.3% and 70.1 %, respectively and the rates of recurrence were 23.8%, 56.2% and 68.0%, respectively. Local recurrence was observed in 113 of 1455 nodules. One-, 3- and 5-year local recurrence rates were 2.2%, 7.4% and 9.5%, respectively. Multivariate analysis revealed that large tumor (>2cm), tumor locations (adjacent to the main portal branch or hepatic vein), and small ablation margin (<3mm) were independent predisposing factors for local recurrence after RFA (HR=1.70-2.81). Tumor location (adjacent to the major portal branch, vein, bile duct, or diaphragm) was also designated as a risk factor for liver damage after RFA. Conclusions: HCC adjacent to major portal vein or hepatic duct has higher risk for local recurrence and for complications so that special cautions must be needed to apply RFA to the HCCs near vessels even when the tumors were located at easy-to-puncture site. The predisposing factors for local recurrence after RFA HCC, hepatocellular carcinoma; RFA, radio-frequency ablation; C.I., confidence interval; TACE, transcatheter arterial chemoembolization; major branch, the main trunk, first or second order branches of the portal vein; minor branch, distal to third order branch of the portal vein. Sa1872 Biomolecolar Markers Fail to Assist the Prognostic Evaluation of Hepatocellular Carcinoma Luigi Addario, Filippo Lampasi, Francesco P. Picciotto, MariaTeresa Tartaglione, Alfonso Galeota Lanza, Massimo De Luca, Raffaella Tortora, Gabriella Cordone, Giuseppina Marino Marsilia, Emanuela Assentato, Mafalda Caputo, Wanda Utech, Giovan Giuseppe Di Costanzo Background: The increasing recognition of biological heterogeneity of hepatocellular carci- noma (HCC) has led some researchers to hypothesize that molecular markers can be used for prognostic evaluation of this neoplasm. The aim of this study was to evaluate the expression of molecular indicators of hepatic progenitor cells (Cytokeratin 7 and 19), cellular proliferation (ki67) and angiogenesis (CD34), and their correlation with the clinical and pathological outcomes of patients with HCC. Material and methods HCCs from 104 patients (79 males, median age 66 yrs, range 15-82 yrs) had CK7, CK19, Ki 67, CD 34 immunohistochemical evaluation. HCC was classified according to BCLC staging system and to the Edmondson - Steiner's classification (ESC). Number and size of liver tumors were evaluated on specimens of liver resection, explanted livers or guided liver biopsy. Results Cirrhosis was virus related in 75% (HCV 63.5% and HBV 11.5%). Median tumor size was 35.5 mm (IQR 25- 50). HCC was multifocal in 25 % of cases. BCLC class A/B/C/ D was 53.8%, 28.8%, 6.7%, 10.6% respectively. ESC grading was I-III in 85.6% of patients. Follow-up median time was 24 months (IQR 8.25- 43). Three out of four patients died of tumor progression or liver failure. HCC recurrence occurred after a median time of 31 months (IQR 20- 65) especially in surgical resections. Positivity for CD34 staining was