Lack of benefit of pre-transplant locoregional hepatic... : Liver Transplantation (original) (raw)

Original Articles

Lack of benefit of pre-transplant locoregional hepatic therapy for hepatocellular cancer in the current MELD era

Porrett, Paige M.1; Peterman, Heather2; Rosen, Mark3; Sonnad, Seema1; Soulen, Michael3; Markmann, James F.1; Shaked, Abraham1; Furth, Emma2; Reddy, Rajender K.4; Olthoff, Kim1,corr1

1_The University of Pennsylvania Department of Surgery, Philadelphia, PA_

2_The University of Pennsylvania Department of Pathology, PA_

3_The University of Pennsylvania Department of Radiology, Philadelphia, PA_

4_The University of Pennsylvania Department of Medicine, Philadelphia, PA_

corr1Department of Surgery, University of Pennsylvania, 3400 Spruce Street, 2 Dulles Pavilion, Philadelphia, PA 19103

Email: [email protected]

Received 24 July 2005; Accepted 17 October 2005

Published online 15 February 2006 in Wiley InterScience (www.interscience.wiley.com).

No financial support was provided for this work from any source.

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Abstract

The potential for disease progression in patients awaiting liver transplantation for hepatocellular carcinoma (HCC) has encouraged many centers to employ pre-transplant radiofrequency ablation or chemoembolization in an attempt to control tumor burden while patients are on the wait list. Despite general acceptance by the transplant community, few objective data demonstrate pre-transplant treatment efficacy or improved post-transplant outcomes in HCC patients listed with Model for End-Stage Liver Disease (MELD) exception points. To evaluate the utility of pre-transplant therapy in the current MELD era, we retrospectively compared 31 treated patients (T) with 33 untreated (U) controls. Study endpoints included patient and disease-free survival, tumor recurrence, explant tumor viability, and the ability of MRI to detect viable tumor after therapy. Both cohorts had similar demographic, radiographic, and pathologic characteristics, although untreated patients waited longer for transplantation [119 (U) vs. 54 (T) days after MELD assignment, (P = .05); range: 1 day to 21 months]. Only 20% of treated tumors demonstrated complete ablation (necrosis) as defined by histologic examination of the entire lesion. Only 55% of lesions with histologic viable tumor were detected by MRI after pre-transplant therapy. After 36 months of follow-up, there was no difference between the treated and untreated groups in overall survival (84 vs. 91%), disease free survival (74% vs. 85%), cancer recurrence (23% vs. 12%), or mortality from cancer recurrence (57% vs. 25%) (P > 0.1). In conclusion, viable tumor frequently persists after pre-transplant locoregional therapy, and neoadjuvant treatment does not appear to improve post-transplant outcomes in the current MELD era. Liver Transpl 12:665–673, 2006. © 2006 AASLD.