Comparative study of post-transplant outcomes in hepatocellular carcinoma patients bridged or downstaged by transarterial chemoembolization or 90Y radioembolization (original) (raw)
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Liver Transplantation, 2005
The actual impact of transarterial chemoembolization before liver transplantation (LT) for hepatocellular carcinoma (HCC) on patient survival and HCC recurrence is not known. Between 1985 and 1998, 479 patients with HCC in 14 French centers were evaluated for LT. Among these 479 patients, this case-control study included 100 patients who received transarterial chemoembolization before LT (TACE group) and 100 control patients who did not receive chemoembolization (no-TACE group). Patients and controls were matched for the pre-LT tumor characteristics, the period of transplantation, the time spent on the waiting list, and pre-and posttransplantation treatments. Kaplan-Meier estimates were calculated 5 years after LT and were compared with the log-rank test. The mean waiting time before LT was 4.2 ؎ 3.2 months in the TACE group and 4.3 ؎ 4.4 months in the no-TACE group. The median number of TACE procedures was 1 (range: 1-12). Demographic data, median alpha-fetoprotein level (21.6 ng/mL and 22.0 ng/mL, respectively), and pre-and post-LT morphologic characteristics of the tumors did not differ in the TACE and no-TACE groups. Overall 5-year survival was 59.4% with TACE and 59.3% without TACE (ns). Survival rates did not differ significantly between the two groups with respect to the time on the waiting list, the tumor diameter, or the type of TACE (selective or nonselective). In the TACE group, 30 patients had tumor necrosis >80% on the liver explant with a 5-year survival rate of 63.2%, compared with 54.2% among their matched controls (P ؍ 0.9). In conclusion, with a mean waiting period of 4.2 months and 1 TACE procedure, pre-LT TACE does not influence post-LT overall survival and disease-free survival. (Liver Transpl 2005;11:767-775.) Abbreviations: LT, liver transplantation; HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization.
European Journal of Medical Research
BackgroundIn hepatocellular carcinoma (HCC) patients, intraarterial therapies are regularly employed as a bridge to liver transplantation to prevent tumor progression during waiting time. Objective of this study was to compare HCC recurrence after liver transplantation following TACE or radioembolization bridging treatment.MethodsWe retrospectively analyzed prospectively collected data on 131 consecutive HCC patients who underwent liver transplantation between January 2007 and December 2017 at our liver transplant center (radioembolizationn = 44, TACEn = 87). Multivariable logistic regression and cox proportional hazard regression models were used to evaluate factors associated with tumor recurrence and post-transplant survival.ResultsBetween groups, patients were comparable with regards to age and gender. In the radioembolization group, Milan criteria for HCC were met significantly less frequently (20.5% vs. 65.5%,p < 0.0001). Patients in the radioembolization group required sig...
Annals of Transplantation, 2017
BACKGROUND Bridging treatments are employed in liver transplant waitlist patients with hepatocellular carcinoma (HCC) because of the risk of tumor progression during the waiting time. Radioembolization is mostly employed in the control of large or multifocal HCCs when other locoregional treatment modalities cannot be applied because of the number or size of lesions. The purpose of this study was to evaluate our experience with the use of radioembolization as a bridge to transplantation and its effect on tumor recurrence and survival after liver transplantation. MATERIAL AND METHODS A retrospective review of 40 consecutive patients with HCC who underwent liver transplantation after radioembolization bridging treatment between January 2007 and December 2015 at the University Hospital Essen, Germany, was performed. Patients' characteristics, alpha-fetoprotein (AFP) levels, pathologic tumor response, tumor recurrence rate, and survival rates were examined through chart review. RESUL...
Journal of Vascular and Interventional Radiology, 2019
Purpose: To evaluate tumor response to transarterial chemoembolization as well as biologic characteristics of the tumor as predictors of recurrence after transplantation in patients with hepatocellular carcinoma (HCC) who were bridged or down-staged to liver transplantation. Materials and Methods: An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, single-institution retrospective analysis was performed on all patients with HCC who were treated with the use of conventional transarterial chemoembolization or transarterial chemoembolization with drug-eluting embolics (DEE) over a 12-year period and who subsequently underwent liver transplantation (n ¼ 142). Treatment response was based on modified Response Evaluation Criteria in Solid Tumors (mRECIST) imaging criteria and then correlated with tumor characteristics and recurrence. Of the 142 patients followed after transplantation, 127 had imaging after transarterial chemoembolization but before transplantation. Imaging response and post-transplantation recurrence were correlated with patient demographics, liver function, and tumor morphology. HCC recurred in 9 patients (mean time from transplantation, 526 days). Recurrence was analyzed with the use of univariate and multivariate statistics. Kaplan-Meier recurrence-free survival curves were calculated based on immediate imaging response before transplantation with the use of the log-rank test. Results: Before transplantation, 57% of patients (72/127) demonstrated complete response (CR) and 24% (31/127) showed partial response (PR). Complete pathologic necrosis occurred in 54% (39/72) of CR patients and 20% (6/31) of PR patients. Poor treatment response, defined as stable disease (SD) or progressive disease (PD), occurred in 18% of patients (24/127) before transplantation and was present in 67% of cases of recurrence (6/9; P < .001). Post-transplantation recurrence was present in 1.4% of patients (1/71) with CR and in 6.5% of patients (2/31) with PR. In patients with SD after transarterial chemoembolization, HCC recurred in 18.8% of transplant patients (3/16) and in 43% of patients (3/7) with PD. Larger pretreatment tumor size (P ¼ .05), higher Child-Pugh score (P ¼ .002), higher tumor grade at explantation (P ¼ .04), and lymphovascular invasion at explantation (P ¼ .008) also were associated with increased incidence of post-transplantation recurrence. Conclusions: Poor tumor response to transarterial chemoembolization before transplantation identifies patients at increased risk for post-transplantation recurrence. ABBREVIATIONS CR ¼ complete response, DEE ¼ drug-eluting embolics, HCC ¼ hepatocellular carcinoma, mRECIST ¼ modified Response Evaluation Criteria in Solid Tumors, PD ¼ progressive disease, PR ¼ partial response
World journal of gastroenterology : WJG, 2014
To define the histopathological features predictive of post-transplant hepatocellular carcinoma (HCC) recurrence after transarterial chemoembolization, applicable for recipient risk stratification. We retrospectively reviewed the specimens of all suspicious nodules (total 275) from 101 consecutive liver transplant recipients which came to our Pathology Unit over a 6-year period. All nodules were sampled and analyzed, and follow-up data were collected. We finally considered 11 histological variables for each patient: total number of nodules, number of viable nodules, size of the major nodule, size of the major viable nodule, occurrence of microscopic vascular invasion, maximum Edmondson's grade, clear cell/sarcomatous changes, and the residual neoplastic volume. Survival data were computed by means of the Kaplan-Meier procedure and analyzed by means of the Cox proportional hazards model. The multivariate linear regression and a k-means cluster analysis were also used in order to ...
Liver Transplantation, 2007
Supraselective transarterial chemoembolization (STACE) more efficiently targets chemotherapy delivered via the feeding arterial branches of the tumor than does conventional transarterial chemoembolization (TACE). However, the hypothesis of its greater efficacy compared with the latter is subject to controversy. The aim of the present study was to compare STACE to conventional TACE in a controlled study of candidates for liver transplantation (LT) for hepatocellular carcinoma (HCC). Patients were matched for factors associated with HCC recurrence and survival. Sixty patients were included: 30 who were treated with STACE and 30 treated with conventional TACE. The 2 groups were similar in terms of matched criteria. In the overall population (uni-and multinodular HCC), there was no marked difference between the 2 groups in 5-year disease-free survival: 76.8% vs. 74.8%. In sensitivity analysis of patients considered to be the best candidates for TACE (uninodular HCC Յ5 cm), there was a trend toward significance between STACE and TACE in 5-year disease-free survival: 87% vs. 64% (P ϭ 0.09). The only factor associated with complete tumor necrosis was STACE in the overall population (30.8% vs. 6.9%, P ϭ 0.02), with a similar trend in the subgroup of patients with a single nodule (33.3% vs. 6.7%, P ϭ 0.06), whereas the mean number of procedures was similar in the 2 groups (mean, 1.3 procedures; range 1-5 procedures; P ϭ NS). STACE is more efficient at inducing complete tumor necrosis in the liver. This study observed trends toward improvement in the disease-free survival of patients with uninodular HCC Յ5 cm. Future studies focusing on such patients are warranted. Liver Transpl 13: 665-671, 2007. Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and recent epidemiologic data indicate that in western countries, the mortality rate from HCC is progressively increasing and constitutes a public health challenge. Liver transplantation (LT) is considered to be a curative strategy for patients with both HCC and cirrhosis. However, the continuing high rate of tumor recurrence represents a major drawback. In addition, most liver transplant centers are confronted with a
Liver Transplantation, 2007
Patients with small hepatocellular carcinoma (HCC) can be cured by liver transplantation (LT). However, many patients drop out during the waiting time as a result of tumor progression. We prospectively investigated the effect of transarterial chemoembolization on long-term survival of 116 patients with HCC listed for LT. Intention-to-treat analysis revealed that patients with either complete or partial response to therapy (no vital tumor or devascularization of Ն30%, respectively) as assessed by computed tomographic scan before LT had far better 1-, 2-, and 5-year survival rates (100, 93.2, and 85.7%; and 93.8, 83.6, and 66.2%, respectively) compared with those with no response or with tumor progression (82.4, 50.7, and 19.3%). Posttransplant survival analysis showed a marked survival benefit according to transarterial chemoembolization response: patients with complete or partial response had 1-, 2-, and 5-year survival rates of 89.1, 85.1, and 85.1%, and 88.6, 77.4, and 63.9%, respectively, compared with 68.6, 51.4, and 51.4% for patients whose disease did not respond to therapy. Subgroup analysis, however, showed that these benefits were only seen in patients whose disease met the Milan criteria, but not in disease exceeding the Milan criteria but fitting the expanded University of California at San Francisco criteria. These patients were also more likely to drop out as a result of tumor progression while waiting for LT (dropout rate 12.1 vs. 2.9%) and to develop recurrent HCC (21.6 vs. 7.6%). Downstaged patients did even worse, with a dropout rate of 26.7% and a 5-year survival rate of only 25%. In conclusion, the response to preoperative chemoembolization may predict long-term outcome after LT. Liver Transpl 13:272-279, 2007.
The Egyptian Journal of Hospital Medicine, 2018
Background: liver transplantation (LT) has emerged as the optimal treatment for cirrhotic patients with Hepatocellular carcinoma (HCC) because it cures both tumor and underlying cirrhosis. HCC could be downstaged or controlled by various anticancer therapies, which might bring them chance of undergoing a curative treatment such as LT. Aim of the Work: it was to evaluate the outcomes of HCC downstaged patients using transarterial hepatic chemoembolization (TACE) therapy to allow eligibility for liver transplantation. Patients and Methods: the study included all the cirrhotic patients who underwent TACE for downstaging of HCC to become eligible for liver transplantation at the period from 2008 to 2017 in Ain Shams Specialized Hospital. Al the patients underwent TACE to meet the Milan criteria for liver transplantation. Results: the etiology of cirrhosis and HCC in our patients was primarily Hepatitis C virus which is endemic in our country. All the cases were not eligible for liver tr...
Liver Transplantation, 2003
Orthotopic liver transplantation (OLT) has been considered the best treatment option for patients with hepatocellular carcinoma (HCC). Because of a steadily increasing waiting time, a noteworthy proportion of patients are excluded from OLT because of tumor progression. A 20% and more dropout rate from the waiting list has recently been reported. In this prospective study, we evaluated the effect of preoperative transarterial chemoembolization (TACE) on preventing tumor progression while on the waiting list in patients meeting current selection criteria (solitary lesion < 5 cm, three lesions < 3 cm). In addition, we analyzed the outcome of a separate group of patients with advanced-stage HCC outside the selection criteria but with at least 50% tumor reduction after TACE (downstaging) to expand current criteria. Forty-eight patients met the selection criteria and were eligible for this study. Seven patients are still on the waiting list; 41 underwent OLT. None of these patients had to be removed from the list because of tumor progression after a mean waiting time of 178 days (23 patients >180 days). The 1-, 2-, and 5-year intention-to-treat survival was 98%, 98%, and 94%. The outcome after OLT was also excellent with 1-, 2-, and 5-year survival rates of 98%, 98%, and 93%. Tumor recurrence occurred only in 1 patient (2.4%). Fifteen patients with advanced-stage HCC were included in this study. Three developed a tumor progression and had to be removed from the list (20% dropout rate). Despite tumor reduction before OLT, these patients had a significantly less favorable outcome in the intention-to-treat analysis as well as in the posttransplantation survival. Tumor recurrence was seen in 30% of patients after OLT. In conclusion, TACE followed by OLT is associated with an excellent outcome in selected patients. Furthermore, TACE is highly efficacious in preventing tumor progression while waiting for OLT. Although TACE reduced tumor preoperatively, it failed to show a beneficial effect on patient survival in advanced-stage HCCs. (Liver Transpl 2003;9:557-563.) H epatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide, with an estimated annual incidence of about 1 million cases. 1-4 Liver cirrhosis, in particular caused by hepatitis B and C virus and iron overload states, constitutes the main risk factor for HCC. A variety of therapeutic modalities have been tried in the treatment of HCC, but orthotopic liver transplantation (OLT) has been considered as the only curative treatment option because OLT has been claimed to simultaneously cure the malignant disease and replace the premalignant cirrhotic liver. However, early experiences with OLT in the setting of HCC were disappointing, in particular because of a recurrence rate of up to 80% and consequently dismal long-term survival results. These were well below the survival rates of patients who underwent transplantation for nonmalignant disorders. 5,6 Several small studies, however, showed that early or incidentally found HCCs did not adversely affect patient survival and long-term outcome was comparable with that of benign diseases. In the first large study, Mazzaferro et al 9 showed that patients with small HCC (one solitary lesion Ͻ 5 cm or three lesions each Ͻ 3 cm) had an excellent long-term outcome with a 5-year survival rate of 70% and a recurrence rate below 15%. These results have been confirmed by several other groups. 10-13 A recent study, however, showed that these strict selection criteria can be further expanded without jeopardizing these excellent results. The hope to treat more patients with HCC successfully is tempered by the shortage of donors and a steadily increasing waiting time for OLT. Tumor progression has become one of the major concerns. Indeed, a recent intention-to-treat analysis showed that the reported excellent long-term outcome is curtailed and significantly hampered by the growing incidence of