Abstract
No distinct guidelines are available regarding the effect of pretransplant locoregional treatment (LRT) in hepatocellular carcinoma (HCC) staging system. The aim of this study was to investigate the prognosis of pathologic downstaging (PDS) by the exclusion of total necrosis after liver transplantation. We conducted a study of 326 HCC patients who underwent liver transplantation between September 2005 and December 2016. Two hundred twenty-two patients received pretransplant LRT and 102 patients did not. Among the former group, 74 (33.0%) achieved PDS while 150 (67.0%) showed unchanged T stage after the exclusion of total necrosis. Five-year HCC recurrent free survival (RFS) of PDS group (85.1%) was similar to that of the no LRT group (88.8%) but higher than that of the non-PDS group (68.9%; P < 0.001). Based on T stage adjusted with total necrosis and PDS status, RFS was similar in the PDS T1 (82.4%) and non-PDS T1 (86.5%) groups. Non-PDS T2 cancers had worse outcome regardless of the Milan (P = 0.982) or University of California San Francisco criteria (P = 0.466). On preoperative examination, parameters like less than 1 viable tumor, less than 1 cm of tumor size, and less than 20 ng/mL of serum alpha fetoprotein were associated with PDS. This study showed that PDS by LRT was associated with favorable outcome in HCC patients after liver transplantation.
Highlights
Liver transplantation (LT) has been a primary treatment option for unresectable hepatocellular carcinoma (HCC) since the Milan criteria was introduced[1]
locoregional treatment (LRT) has been widely performed as a bridging therapy before LT in HCC patients because the majority of LT candidates present with more advanced stages than the Milan criteria[11]
Two prospective studies showed that LRT for properly selected patients resulted in comparable outcome to conventional criteria[5,7], the exact prediction of HCC recurrence based on liver pathology is still necessary
Summary
Liver transplantation (LT) has been a primary treatment option for unresectable hepatocellular carcinoma (HCC) since the Milan criteria was introduced[1]. Locoregional treatment (LRT) was applied to patients with large tumour burden for achieving equivalent outcome as those initially within the criteria for LT4,5. Several studies estimated the effectiveness of LRT based on the radiologic criteria[6,7]. Precise prediction and early detection of tumour recurrence after LT is desirable to achieve the best treatment outcome[9]. Heretofore, the method of consensus for determining the prognosis of HCC after LT was the American Joint Committee on Cancer staging system[6], other recurrence prediction models based on explant pathology have been developed[10]. The aim of this study was to investigate the consequence of pathologic downstaging (PDS; reduced T stage by the exclusion of totally necrotic mass) in terms of post-transplant outcomes for HCC
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