Pathologic complete response to chemoembolization improves survival outcomes after curative surgery for hepatocellular carcinoma: predictive factors of response

Yang, Ki Hwa; Sung, Pil Soo; You, Young K.; Kim, Dong G.; Oh, Jeill; Chun, Ho Jong; Jang, Jeong Won; Bae, Si Hyun; Choi, Jong Young; Yoon, Seung Kew

doi:10.1016/j.hpb.2019.04.017

Cited by 16 publications

(11 citation statements)

References 35 publications

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“…A single tumor and tumor size ≤5 cm have been reported to associate significantly with tumor PR >90% (24,25). In addition, avid tumor enhancement, AFP<100 ng/mL, and a longer time between the first TACE procedure and liver resection were all related to PR >90% (26,27). Furthermore, development of >90% lesion necrosis was reported to be due to a relatively simple blood supply to HCC and presence of a feeding vessel larger than 0.9 mm in diameter on pre-TACE visceral angiogram (26,28).…”

Section: Discussionmentioning

confidence: 99%

Impact of pathological response after preoperative transcatheter arterial chemoembolization (TACE) on incidences of microvascular invasion and early tumor recurrence in hepatocellular carcinoma: a multicenter propensity score matching analysis

Yang¹,

Dang²,

Lü³

et al. 2022

Hepatobiliary Surg Nutr

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Background: To study the influence of pathological responses (PR) after transcatheter arterial chemoembolization (TACE) on incidences of microvascular invasion (MVI) and early recurrence in hepatocellular carcinoma (HCC) patients.Methods: Between 2013 to 2015, consecutive HCC patients who underwent liver resection with "curative" intent at three hospitals were enrolled in this study. Patients with different areas of PR after preoperative TACE were compared with those without preoperative TACE on the incidences of MVI, early recurrence rates and patterns of recurrence before and after propensity score matching (PSM).Results: Of 1,970 patients, 737 patients who received preoperative TACE were divided into three groups according to the areas of PR: ≥90% (n=226), 60-90% (n=447), and <60% (n=64). PR ≥90% was an independent protective factor of incidences of MVI [odds ratio (OR), 0.144; 95% confidence interval (CI), 0.082-0.245, P<0.001) and early recurrence (HR, 0.742; 95% CI, 0.561-0.963, P=0.032); while PR<60% was an independent risk factor of incidences of MVI (OR, 6.076; 95% CI, 3.004-11.728, P<0.001) and early recurrence (HR, 1.428; 95% CI, 1.095-1.929; P=0.009). Furthermore, patients with PR <60% were significantly more likely to develop multiple intrahepatic recurrences involving multiple hepatic segments when compared with patients without preoperative TACE.Conclusions: This study indicated the area of PR after TACE was closely associated with the incidences of MVI and early tumor recurrence. Patients with PR <60% were at significantly higher risks of having more MVI, early and multiple tumor recurrences

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Section: Discussionmentioning

confidence: 99%

Impact of pathological response after preoperative transcatheter arterial chemoembolization (TACE) on incidences of microvascular invasion and early tumor recurrence in hepatocellular carcinoma: a multicenter propensity score matching analysis

Yang¹,

Dang²,

Lü³

et al. 2022

Hepatobiliary Surg Nutr

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“…Hence, it is crucial to determine which pre‐transplant factors can serve as surrogate markers of aggressive tumor biology. Response to LRTs has been suggested to predict clinical outcomes, 13,14 but identifying the highest risk subset of patients who receive LRTs remains challenging. We show here that the threshold of receiving more than five LRTs was an important predictor of poor overall survival and recurrence‐free survival, even after adjusting for known predictors of survival like tumor stage, time to transplant, alfa‐fetoprotein (AFP), vascular invasion and radiologic response.…”

Section: Discussionmentioning

confidence: 99%

“…6,11,12 Hence, it is crucial to determine which pre-transplant factors can serve as surrogate markers of aggressive tumor biology. Response to LRTs has been suggested to predict clinical outcomes, 13,14 We which likely limits the delivery of chemotherapeutic agents to the target. 15 On the other hand, each subsequent LRT may also be selecting resistant clones within these tumors, since we found that most tumors which required ≥5 LRTs were likely to show progressive disease during subsequent therapies.…”

Section: F I G U R Ementioning

confidence: 99%

Impact of Bridging Locoregional Therapies for Hepatocellular Carcinoma on Post‐transplant Clinical Outcome

Adeniji

Arjunan

Prabhakar

et al. 2020

Clinical Transplantation

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Long waiting times due to ongoing organ shortage have led to increased utilization of locoregional therapies (LRTs) to bridge patients with hepatocellular carcinoma (HCC) to liver transplantation (LT). We performed this study to evaluate the impact of LRTs on post-LT outcomes. We conducted a retrospective study of patients who were transplanted for HCC at Stanford University Hospital between 2008 and 2018 (n = 302). We found that receipt of ≥5 LRTs was an independent and significant predictor of poor overall 5-year survival (58.3% vs. 83.3%; HR 2.26, p = .03), poor recurrence-free 5-year survival (51.9% vs. 80.4%; HR 2.12, p = .03), and was associated with higher rates of recurrence (25.0% vs. 7.4%, p = .001). Moreover, recurrent HCC was more likely to be the cause of death (58.3% vs. 41.7%, p = .04) in patients who received ≥5 LRTs. Also, patients who required ≥5 LRTs showed an overall lower rate of radiological complete response (46.9% vs. 97.8%, p = .001) and were more likely to have more advanced pathological stage tumors in the explant (65.6% vs. 29.6%, p < .001). In conclusion, receipt of ≥5 bridging LRTs prior to LT is associated with worse post-transplant clinical outcomes.

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“…Blood tests, including tumor markers such as alpha-fetoprotein and des-gamma carboxyprothrombin, were performed monthly during the 1 st year after LT. Liver dynamic CT/MRI using liver-specific contrast agents (Primovist) was performed every 3 months during the 1 st year, every 6 months during the 2 nd year, and every 1 year thereafter. If recurrence of HCC was suspicious, additional studies such as fMRI or positron emission tomography–computed tomography (PET-CT) was performed as previously described ( Yang et al, 2019 ).…”

Section: Methodsmentioning

confidence: 99%

“…Compared to other surgical or ablative procedures, LT is accountable for a 10 years recurrence-free survival rate of more than 70% in hepatocellular carcinoma (HCC) cases ( Sung et al, 2017 ; Rodriguez-Peralvarez et al, 2018 ; Sho et al, 2020 ). On the other hand, tumors recur in approximately 20% of patients who undergo LT, and this proportion is even higher in cases with over-Milan criteria or with pathological microvascular invasion ( Sung et al, 2017 ; Yang et al, 2019 ; Nishida, 2020 ). The likelihood of HCC recurrence can be diminished by tapering immunosuppressants ( Vivarelli et al, 2008 ; Dumortier et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Real-Life Experience of mTOR Inhibitors in Liver Transplant Recipients in a Region Where Living Donation Is Predominant

et al. 2021

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Background: Mammalian target of rapamycin (mTOR) inhibitors, such as everolimus and sirolimus, may be efficacious in preserving renal function in liver transplantation (LT) recipients while preventing hepatocellular carcinoma (HCC) recurrence.Materials and Methods: In this study, we retrospectively evaluated the safety, efficacy, and renoprotective effects of mTOR inhibitors in LT recipients. Among the 84 patients enrolled, mTOR inhibitor was commenced during the first year after LT. Renal function was measured by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation.Results: Regarding the type of mTOR inhibitor, everolimus was used in 71 patients and sirolimus in 13 patients. Concomitant tacrolimus was used in 63 patients (75.0%). For total enrolled patients, kidney function did not significantly change during 12 months after initiation of mTOR inhibitors, although tacrolimus-withdrawn patients (n = 21) showed better kidney function compared to tacrolimus-minimized patients (n = 63) after conversion. However, a significant improvement in kidney function was observed in the eGFR <60 ml/min/1.73 m2 group (n = 19) 12 months after initiation of mTOR inhibitors, for both patient groups with early + mid starters (n = 7, stating within 1 year after LT) and late starters (n = 12, starting over 1 year after LT). mTOR inhibitors were safely administered without serious adverse events that led to drug discontinuation.Conclusion: We demonstrated that patients with renal impairment showed significant improvement in renal function regardless of the timing of mTOR inhibitor start, suggesting that switch to mTOR inhibitors may be beneficial when renal function declines.

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Pathologic complete response to chemoembolization improves survival outcomes after curative surgery for hepatocellular carcinoma: predictive factors of response

Cited by 16 publications

References 35 publications

Impact of pathological response after preoperative transcatheter arterial chemoembolization (TACE) on incidences of microvascular invasion and early tumor recurrence in hepatocellular carcinoma: a multicenter propensity score matching analysis

Impact of pathological response after preoperative transcatheter arterial chemoembolization (TACE) on incidences of microvascular invasion and early tumor recurrence in hepatocellular carcinoma: a multicenter propensity score matching analysis

Impact of Bridging Locoregional Therapies for Hepatocellular Carcinoma on Post‐transplant Clinical Outcome

Real-Life Experience of mTOR Inhibitors in Liver Transplant Recipients in a Region Where Living Donation Is Predominant

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