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Impact of Pretransplant Bridging Locoregional Therapy for Patients With Hepatocellular Carcinoma Within Milan Criteria Undergoing Liver Transplantation: Analysis of 3601 Patients From the US Multicenter HCC Transplant Consortium. Ann Surg 2017 09;266(3):525-535

Date

06/28/2017

Pubmed ID

28654545

DOI

10.1097/SLA.0000000000002381

Scopus ID

2-s2.0-85021298428   56 Citations

Abstract

OBJECTIVE: To evaluate the effect of pretransplant bridging locoregional therapy (LRT) on hepatocellular carcinoma (HCC) recurrence and survival after liver transplantation (LT) in patients meeting Milan criteria (MC).

SUMMARY BACKGROUND DATA: Pre-LT LRT mitigates tumor progression and waitlist dropout in HCC patients within MC, but data on its impact on post-LT recurrence and survival remain limited.

METHODS: Recurrence-free survival and post-LT recurrence were compared among 3601 MC patients with and without bridging LRT utilizing competing risk Cox regression in consecutive patients from 20 US centers (2002-2013).

RESULTS: Compared with 747 LT recipients not receiving LRT, 2854 receiving LRT had similar 1, 3, and 5-year recurrence-free survival (89%, 77%, 68% vs 85%, 75%, 68%; P = 0.490) and 5-year post-LT recurrence (11.2% vs 10.1%; P = 0.474). Increasing LRT number [3 LRTs: hazard ratio (HR) 2.1, P < 0.001; 4+ LRTs: HR 2.5, P < 0.001), and unfavorable waitlist alphafetoprotein trend significantly predicted post-LT recurrence, whereas LRT modality did not. Treated patients achieving complete pathologic response (cPR) had superior 5-year RFS (72%) and lower post-LT recurrence (HR 0.52, P < 0.001) compared with both untreated patients (69%; P = 0.010; HR 1.0) and treated patients not achieving cPR (67%; P = 0.010; HR 1.31, P = 0.039), who demonstrated increased recurrence compared with untreated patients in multivariate analysis controlling for pretransplant and pathologic factors (HR 1.32, P = 0.044).

CONCLUSIONS: Bridging LRT in HCC patients within MC does not improve post-LT survival or HCC recurrence in the majority of patients who fail to achieve cPR. The need for increasing LRT treatments and lack of alphafetoprotein response to LRT independently predict post-LT recurrence, serving as a surrogate for underlying tumor biology which can be utilized for prioritization of HCC LT candidates.

Author List

Agopian VG, Harlander-Locke MP, Ruiz RM, Klintmalm GB, Senguttuvan S, Florman SS, Haydel B, Hoteit M, Levine MH, Lee DD, Taner CB, Verna EC, Halazun KJ, Abdelmessih R, Tevar AD, Humar A, Aucejo F, Chapman WC, Vachharajani N, Nguyen MH, Melcher ML, Nydam TL, Mobley C, Ghobrial RM, Amundsen B, Markmann JF, Langnas AN, Carney CA, Berumen J, Hemming AW, Sudan DL, Hong JC, Kim J, Zimmerman MA, Rana A, Kueht ML, Jones CM, Fishbein TM, Busuttil RW

Authors

Joohyun Kim MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin
Michael A. Zimmerman MD, FACS Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Ablation Techniques
Adolescent
Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular
Combined Modality Therapy
Databases, Factual
Female
Follow-Up Studies
Humans
Liver Neoplasms
Liver Transplantation
Male
Middle Aged
Neoplasm Recurrence, Local
Proportional Hazards Models
Retrospective Studies
Survival Analysis
Treatment Outcome
Young Adult
jenkins-FCD Prod-486 e3098984f26de787f5ecab75090d0a28e7f4f7c0