259 Background: Hepatocellular carcinoma (HCC) is a complex and unique cancer. Arriving at the optimal treatment plan is best accomplished by a multidisciplinary tumor board (MDTB). We hypothesized that patients referred from outside institutions to our tertiary care center for MDTB review may face disparities in diagnosis and treatment. Methods: We performed chart review of incident HCC cases presented from 2/1/13-2/1/16 at an American College of Surgeons accredited MDTB that convenes weekly at a tertiary care, university-affiliated hospital. We examined variables such as demographics, originating institution, liver disease etiology, location of index imaging, date of first tumor board presentation, diagnostic method (imaging, biopsy, tumor board consensus), BCLC stage at diagnosis, initial treatment, and time to treatment. Results: 167 cases of HCC were referred from 37 outside institutions (outside cases); 127 cases originated from our institution (internal cases). The two groups were comparable in gender distribution, liver disease etiology, and BCLC stage at tumor board presentation. Compared to internal cases, outside cases were diagnosed less often by imaging (47% vs. 77%, p < 0.000001) and more often by biopsy (38% vs. 17%, p < 0.001) or MDTB consensus (16% vs. 6%, p < 0.05). When stratified by BCLC stage, this difference in diagnostic method persisted in early and mid-staged patients (Stages 0, A, B), but not in advanced staged patients. Outside cases were also more likely to receive tumor biopsy (33% vs. 9%, p < 0.05) and less likely to receive initial curative therapy (resection, ablation, transplantation) (22% vs. 32%, p < 0.05). There was no significant difference in time to treatment. Conclusions: Despite similar demographics and disease profiles compared to patients from our tertiary care center, patients referred from outside facilities for MDTB review more often required biopsies or MDTB consensus to diagnose HCC, and were less likely to receive curative therapy. Differences in HCC diagnostic imaging protocols across institutions may help explain these results. Further study will help identify disparities in receipt of curative therapy.
950 Effects of Probiotics on Intestinal Failure-Associated Liver Disease in Adult Patients Receiving Prolonged Parenteral Support: A Tertiary Care Center Experience
