12:00 – 13:30 Saturday, 11 September 2010

Luncheon workshop 1: Controversies in pathology: Mixed HCC and CC
Chairs: Pierre Bedossa, MD, PhD (France) and Tania Roskams, MD (Belgium)

Background:
Beside primary liver carcinomas with typical liver or biliary cell differentiation (hepatocellular carcinoma and cholangiocarcinoma), there is a wide range of primary malignant epithelial cells of the liver with intermediate phenotype that needs better definition and recognition.

Learning Objectives:

  1. To recognize the main pathological criteria and the updated histiological classification of primary epithelial liver cancers in adult,
  2. To recognize liver carcinoma with intermediate/mixed phenotype, their morphological, immunohistochemical and molecular criteria
  3. To integrate these variants into the histogenesis of epithelial cells of the liver

Programme Outline:
This workshop will present, based on the updated WHO classification of liver tumors, the histological subtypes that do not fall into classical hepatocellular and cholangiocarcinomas. Criteria for diagnosis will be discussed in detail and these subtypes will be illustrated by case studies. Entities such as hepato-cholangiocarcinoma, cholangiolocarcinoma and hepatocellular carcinoma with CK-19 expression will be illustrated.

The clinical and prognostic relevance of their recognition will be underlined. These variants will be integrated in the context of recent molecular approaches such as gene expression studies. Finally, the phenotype of the intermediate/mixed form will be discussed according to basic concepts such as cancer stem cells and histogenesis of epithelial cells in the liver during embryogenesis.

12:00 – 13:30 Saturday, 11 September 2010

Luncheon workshop 2: Molecular Signatures and prognosis
Chairs: Yujin Hoshida, MD (USA) and Ju-Seog Lee, MD (USA)

Background:
Recently emerging genomics technologies have enabled flexible generation of molecular signatures with rich biological information linked to patient prognosis. However, the path toward their clinical deployment is still unclear and not similarly flexible. Whereas one of major obstacles is uncertainty in appropriate deployment platform, there is a substantial concern on generalizability of the prognostic relevance of the signatures, which arises from considerable clinical heterogeneity across patient series employed to discover the signatures. Flaws in study design and difference in platforms used in different studies often enhance this problem. A consensus framework is needed to ensure quality of molecular prognosis research in HCC and facilitate clinical application of the signatures.

Learning Objectives:

  1. Overview prognostic molecular signatures in HCC
  2. Understand issues in prognosis research in HCC: clinical heterogeneity according to geographic sites and patterns of recurrence specific to HCC
  3. Understand issues affecting quality of prognostic molecular signature research

Programme Outline:

  1. Introduction
    Speaker: Yujin Hoshida, MD (USA)
  2. Prognostic molecular signatures of HCC tumor
    Speaker: Ju-Seog Lee, MD (USA)
  3. Prognostic molecular signatures of diseased liver
    Speaker: Yujin Hoshida, MD (USA)
  4. Issues in prognostic studies in HCC: consideration on consensus framework of molecular prognosis research in HCC
    Speaker: Yujin Hoshida, MD (USA)

12:00 – 13:30 Saturday, 11 September 2010

Luncheon workshop 3: Surgical advancements in HCC
Chairs: David Geller, MD (USA) and Vincenzo Mazzaferro, MD (Italy)

Background:
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. The only cure for HCC is hepatic resection or liver transplantation. For hepatic resection, progress has been made with minimally invasive approaches of laparoscopic liver resection for HCC, even in the setting of cirrhosis. A better understanding of outcomes after liver transplantation for HCC has established the “Metroticket” Approach to Liver Transplantation for HCC.

Laparoscopic liver resection for Hepatocellular Carcinoma (HCC).
Laparoscopic liver resection has been performed in over 3,000 patients worldwide, with ~50% of cases being done for malignancy. Hepatocellular carcinoma (HCC) is the most common tumor resected from the liver with a minimally invasive approach. Advantages of laparoscopic liver resection surgery include smaller incisions, less blood loss, less post-operative pain and narcotic requirement, faster return to diet, and shorter hospital length of stay. Numerous reports document the safety and efficacy of laparoscopic liver resection for HCC. Five-year overall survival rates after laparoscopic liver resection for HCC are reported in the 50-75% range, which is comparable to survival data after open hepatic resection. Although no randomized trial comparing laparoscopic to open hepatic resection has been reported, many case-cohort matched studies indicate comparable cancer outcomes for laparoscopic resection of HCC. Further, when used as a bridge to transplantation, the subsequent transplant operation was shown to be less complicated in patients that had undergone prior laparoscopic liver resection, compared to prior open liver resection.  In summary, laparoscopic hepatic resection for HCC should be considered in well-selected patients.

Learning Objectives:

  1. To summarise the technical aspects and outcomes of laparoscopic liver resection for HCC.
  2. To define the current indications and results of the “Metroticket” approach to liver transplantation for HCC.

Programme Outline:

  1. Laparoscopic liver resection for HCC.
    David Geller, MD (Pittsburgh, USA)
  2. The “Metroticket” Approach to Liver Transplantation for HCC.
    Vincenzo Mazzaferro, MD (Milano, Itlay)
  3. Group discussion

12:00 – 13:30 Saturday, 11 September 2010

Luncheon workshop 4: Novel concepts in HCC staging
Chairs: Jordi Bruix, MD (Spain) and Masatoshi Kudo, MD, PhD (Japan)

Background:
There are 3 types of HCC staging; TNM staging, liver function staging, and integrated staging, which includes both TNM staging and liver function staging.  Regarding the integrated staging, there are several staging systems, which includes BCLC staging, CLIP scoring system, JIS scoring staging, CUPI, GRETCH staging etc.  There are 2 roles in staging system; treatment allocation and prediction of prognosis.

Learning Objectives:

  1. Participants will be able to review the existing literature on the TNM staging and liver function staging.
  2. Participants will be able to understand which TNM staging is suitable in each region or country.
  3. Participants will be able to understand which staging system is suitable for deciding treatment option and prognostic prediction.
  4. Participants will be able to understand whether tumor biology marker is important for staging or not.

Programme Outline:

  1. Concept of HCC staging , BCLC staging
    Speaker: Jordi Bruix (Spain)
  2. Comparison of each staging system
    Speaker: Masatoshi Kudo (Japan)

12:00 – 13:30 Saturday, 11 September 2010

Luncheon workshop 5: Locoregional Arterial Therapy for Hepatocellular Carcinoma
Chairs: Jean-François Geschwind, MD (USA) and Riad Salem, MD (USA)

Background:
The incidence of hepatocellular carcinoma (HCC) is increasing 1. Surgery is the only definitive curative option available 2. It is responsible for over half a million deaths annually.

Most HCC patients are not surgical candidates. The use of chemotherapeutic agents has limited role in the treatment of hepatocellular carcinoma 3. Interventional oncology has established its role in the management of liver tumors. Image-guided therapies minimize the rates of systemic toxicity with an increased tumoricidal effect. These therapies have been shown to have a palliative role and may also prove to have a potentially curative role.

The unique predominant blood supply of normal hepatic parenchyma is by the portal vein while the hepatic tumors are supplied by the hepatic artery. This allows transarterial delivery of high doses of therapeutics to liver tumors. This is the rationale for embolic therapies.

Learning Objectives:

  1. Learn about indications for chemoembolization and radioembolization
  2. Learn about the new developments in drug delivery with drug-eluting beads
  3. Learn about the rationale for new clinical trials involving chemo/radioembolization

Programme Outline:
This workshop will review the basic indications and long-term clinical results for conventional and precision chemoembolization, as well as radioembolization4-6. The role of Sorafenib, a multitargeted receptor tyrosine kinase inhibitor demonstrating survival benefit, will be discussed. Combinations studies including both locoregional therapy and Sorafenib will also be addressed. Ongoing and future clinical trials will be summarized.