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

Abstract

Aims: This 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 Methods: Our 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).Results: The 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.Conclusion: The 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.

Impact of pretreatments on outcomes after living donor liver transplantation for hepatocellular carcinoma

“…Response to non-transplant therapies is a useful indicator in the selection of suitable candidates for LT among patients undergoing pretreatments for HCC. Lei et al reported that good responders to TACE (complete response or partial response), particularly after the first two sessions, may be submitted for LT even if patients have HCC exceeded the Milan criteria [28], and Bhat et al reported that the percentage drop in alpha-fetoprotein after TACE was a positive predictor of improved overall survival after LT [29]. Our data show that patients with repeated pretreatments have a risk of HCC recurrence after LT (Fig.…”

“…Lei et al. reported that good responders to TACE (complete response or partial response), particularly after the first two sessions, may be submitted for LT even if patients have HCC exceeded the Milan criteria , and Bhat et al. reported that the percentage drop in alpha‐fetoprotein after TACE was a positive predictor of improved overall survival after LT .…”

Bridging to liver transplantation patients with a hepatocellular carcinoma within Milan criteria: how worth is it?

“…To some extent, the correlation between increased recurrence and higher number of local ablative procedures observed by Agopian and colleagues may be misleading as it underscores the presence of multiple or difficult to cure tumors that in the end are more than prone to recur. The reassuring message of Dr. Agopian and associates report is to confirm that achieving a complete radiological response after a limited number of TACE associates to a better outcome after transplantation (13) whereas a complete radiological response to the first TACE in one study was the strongest independent predictor of MC maintenance (12). Needless to say, these findings contrast with experiences in patients with an intermediate stage of HCC where a progressively better response to serial TACE courses was the strong predictor of patient survival (14).…”

Association between Time to Local Tumor Control and Treatment Outcomes Following Repeated Loco-Regional Treatment Session in Patients with Hepatocellular Carcinoma: A Retrospective, Single-Center Study

“…Previous studies that examined the association between early LTC and long-term clinical outcomes have shown conflicting results [7,[9][10][11][12]. To date, there has been little agreement on whether a lack of early tumor control should lead to a change in treatment strategy (e.g., discontinuation of locoregional treatment with subsequent systemic therapy) [13,14]. In addition, experience with neoplasms other than HCC shows that the time interval between initiation of treatment and tumor control significantly impacts patient outcomes, indicating that more research is needed to optimize locoregional therapy in HCC patients [15,16].…”