Abstract No. 530 Association of radiological complete response following locoregional therapy prior to liver transplantation with long-term outcomes of hepatocellular carcinoma patients

Abstract

To evaluate the long-term outcomes of patients with hepatocellular carcinoma (HCC) who achieve complete vs. incomplete imaging response on pretransplant imaging studies following locoregional therapy (LRT) prior to orthotopic liver transplantation (OLT). Institutional database was reviewed to identify the patients listed for OLT with HCC (Mar1998-Dec2010). Patient and baseline tumor characteristics as well as type of LRT and post-transplant outcomes were recorded. Imaging response to LRT was evaluated on pretransplant contrast-enhanced CT or MRI based on mRECIST criteria. Survival analysis was performed using Kaplan-Meier estimation and log-rank test. 155 HCC patients were identified who received OLT following LRT for HCC. Posttreatment imaging was available in 109 (70%) patients while 46 patients (30%) were transplanted after LRT prior to any imaging study. Complete response was achieved in 65 patients (60%) versus incomplete response in 44 (40%). The table lists the baseline demographic, clinical and tumor characteristics of the study population at the time of diagnosis. Type of LRT was TACE in 55, RFA in 9, and sequential TACE and RFA in 1 patient for the complete response group compared to TACE in 34, RFA in 4, sequential TACE and RFA in 5 and radioembolization in 1 for the incomplete response group (p-value = 0.1). Mean progression-free survival from the time of listing was significantly better for HCC patients who achieved complete response after LRT (mean survival of 144 ± 8.4 vs. 131 ± 13.9 months, p-value = 0.04). 3, 5 and 7-year recurrence free survival after OLT was 81%, 74% and 65% for patients in the complete response group compared to 68%, 59% and 47% for patients with incomplete response (p value = 0.04). Achieving an imaging complete response following LRT prior to OLT for HCC is associated with better progression-free survival after being listed and improved recurrence free survival after liver transplant.Tabled 1Age at DiagnosisGender (Female)MELD ScoreDays on WaitlistMean Longest Diameter of Largest HCC at Diagnosis (mm)Mean Number of TumorsBCLC 0BCLC ABCLC BComplete response (n = 65)55.5 ± 1.110 (15%)10.3 ± 0.5242.4 ± 39.928.5 ± 1.31.5 ± 0.15 (8%)39 (60%)21 (32%)Incomplete response (n = 44)57.5 ± 1.18 (18%)10.1 ± 0.4227.2 ± 40.030.1 ± 1.71.7 ± 0.14 (9%)23 (52%)17 (39%)P Value0.20.70.80.80.40.060.7 Open table in a new tab