Abstract
AimsThis study sought to extend the inclusion criteria for hepatocellular carcinoma (HCC) liver transplantation (LT), particularly addressing the safety and effectiveness of pre-LT transarterial chemoembolization (TACE).Materials and MethodsOur study included 115 patients with HCC who underwent LT after TACE. The response measured after each TACE session was based on the mRECIST criteria: complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD). We defined CR and PR patients as responders (64 cases) and SD and PD patients as non-responders (51 cases).ResultsThe majority of responders could be identified after the first or second TACE sessions (57 cases, 89.1%). Overall survival rates at 1, 3 and 5 years were 95.3%, 89.1% and 75.0%, respectively, in the responder group, and these rates were much higher than those in the non-responder group (86.3%, 66.7% and 54.9%, P=0.016). In addition, the tumor-free survival rate in the responder group was also higher than in the non-responder group (P=0.009). In the responder group, a statistically improved long-term outcome was observed in patients whose HCC did not satisfy the Milan criteria (P<0.05). Univariate and multivariate Cox analyses showed that achieving CR or PR was the best predictor of survival and tumor-free survival following TACE.ConclusionThe response to TACE, particularly following the first two sessions, primarily and robustly predicted overall and tumor-free survival in HCC patients, particularly those whose HCC did not satisfy the Milan criteria.
Highlights
Hepatocellular carcinoma (HCC) is the thirdleading cause of cancer-related deaths worldwide, with approximately 750,000 new cases of liver cancer [1] and 1 million deaths [2] reported each year
Univariate and multivariate Cox analyses showed that achieving complete response (CR) or partial response (PR) was the best predictor of survival and tumor-free survival following transarterial chemoembolization (TACE)
In 1996, Mazzaderro et al.[5] demonstrated that patients with cirrhosis and a single hepatocellular carcinoma (HCC) of up to 5cm or up to three tumors of which none were larger than 3cm and with no evidence of macrovascular invasion or extrahepatic spread showed a 4-year post-transplant survival that was similar to patients with non-malignant disease; in addition, the 5-year survival rate was 61.1% in comparison to the previously observed rate of 25.3% in 1987
Summary
Hepatocellular carcinoma (HCC) is the thirdleading cause of cancer-related deaths worldwide, with approximately 750,000 new cases of liver cancer [1] and 1 million deaths [2] reported each year. The selection items for HCC LT primarily include data on tumor histology, including tumor number, diameter, volume, histological level and microvascular invasion [5,6,7,8] (e.g., the Milan criteria, the UCSF criteria and the Hangzhou criteria), serum biomarkers such as alpha-fetoprotein (AFP) and micro-RNAs [7, 9] (e.g., the Hangzhou criteria) and the response to transarterial chemoembolization(TACE) [10] None of these biological features are routinely available or definitively characterized prior to transplantation [11]. We hypothesized that changes in tumor features resulting from pre-transplant adjuvant TACE may constitute a superior criterion for predicting tumor recurrence; this study was conducted to evaluate the efficacy and safety of pre-LT adjuvant TACE when used as an inclusion criterion
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