Can response to locoregional therapy help predict longterm survival after liver transplantation for hepatocellular carcinoma? A systematic review

Abstract

For a selected group of patients with hepatocellular carcinoma (HCC), liver transplantation (LT) represents the best chance of a cure. Organ shortages necessitate an efficient allocation of resources and careful prioritization on the transplantation waiting list. In this review, we aim to collate and evaluate the published evidence for using response to locoregional therapies (LRTs), measured by modified Response Evaluation Criteria in Solid Tumors (mRECIST), as a predictor of longterm survival after LT. Our aim was to assess whether response to LRTs before LT for HCC, as measured by the Response Evaluation Criteria in Solid Tumors (RECIST) or mRECIST criteria, can help predict recurrence-free and/or longterm survival outcomes. We searched MEDLINE, Embase, and the Cochrane database. We included randomized controlled trials (RCTs), cohort, case control, and case series studies. Poster and conference abstracts were included. Studies were required to use RECIST or mRECIST criteria when assessing tumor response and were limited to LT for HCC only. A total of 15 records were included in the final systematic review: 7 published manuscripts and 8 conference abstracts. No RCTs were identified. Several included articles were conference abstracts with limited data available. No RCTs were found, and no meta-analysis was undertaken. Several retrospective cohort studies were identified that demonstrated statistically significant differences in survival and recurrence between different RECIST criteria after LT. Liver Transplantation 23 375-385 2017 AASLD.

The mRECIST Classification Provides Insight into Tumor Biology for Patients With Hepatocellular Carcinoma Awaiting Liver Transplantation

“…The role of the mRECIST criteria in understanding HCC tumor biology for patients on the waiting list has yet to be fully elucidated. (19) In our review of 772 HCC patients listed for transplant, initial response to LRT as classified by mRECIST provided significant insight into the HCC tumor biology both on the waiting list as well as after transplant. Patients who do not have PD have 8.2 times the odds of being transplanted over those who do experience PD.…”

Reframing the approach to patients with hepatocellular carcinoma: Longitudinal assessment with hazard associated with liver transplantation for HCC (HALTHCC) improves ablate and wait strategy

“…Continuous risk modeling enables an assessment of overall response to courses of repetitive LRT. Currently, post‐LRT assessment has revolved around the mRECIST criteria, which consider only tumor morphological response . Although mRECIST is widely accepted, its utility is limited; complete response and progressive disease generally portend disparate outcomes, partial response and stable disease are poorly discriminated .…”

Response to transarterial chemoembolization may serve as selection criteria for hepatocellular carcinoma liver transplantation

“…Lai Q, et al [ 37 ] has performed a multiple center analysis in European, and the results is consistent with ours’, meanwhile, we are performing a analysis with multiple centers from China mainland with larger patient number. Meanwhile, A recent meta analysis have reviewed 15 studies [ 38 ], and demonstrated statistically significant differences in survival and recurrence between different RECIST criteria after LT.…”