BACKGROUND: We aimed to evaluate the risk of recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) for patients undergoing pre-transplant tumor downstaging with trans-arterial chemo-embolization (TACE). METHODS/MATERIALS: This is a retrospective analysis of a prospectively collected single-center data base. Inclu sion criteria called for: adult recipients (>18 years); primary LT from deceased donor; pre-transplant TACE with one post-TACE cont rast-enhanced radiology, and availability of explant pathology and clinical data. Radiology was reviewed and response to TACE assessed as per mRECIST criteria. The variables associated with the risk of HCC recurrence were identified and patients were further stratified according to number of risk factors. RESULTS: From August 1996 to December 2010, 216 patients underwe nt TACE before LT. Fifty-two patients were excluded due to lack of post-TACE control radiology and 164 entered the present analysis (M/F: 148/16; median age: 57 years). Median follow-up of the entire population was 5.5 years (ranges: 3.0–9.7). Exceeding Milan criteria (p = 0.006), post-TACE AFP >200 ng/ml (p = 0.09), and lack of a complete post-TACE radiological response (p = 0.08) were associated with a higher risk of post-transplant HCC recurrence. The 5-year HCC recurrence rate was 0%, 5.0% and 22.6% for patients with no risk factor (= 36), 1 (= 86) or 2–3 risk factors (n = 42), respectively (p < 0.0001). CONCLUSIONS: Combination of tumor stage (Milan versus beyond Milan), biology (AFP) and response to TACE allow for better patient stratification and might be used to guide liver graft allocation for patients wit h HCC.
Tumor downstaging and the risk of HCC recurrence after liver transplantation
De Simone P;Campani D;Bartolozzi C;Filipponi F.
2013-01-01
Abstract
BACKGROUND: We aimed to evaluate the risk of recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) for patients undergoing pre-transplant tumor downstaging with trans-arterial chemo-embolization (TACE). METHODS/MATERIALS: This is a retrospective analysis of a prospectively collected single-center data base. Inclu sion criteria called for: adult recipients (>18 years); primary LT from deceased donor; pre-transplant TACE with one post-TACE cont rast-enhanced radiology, and availability of explant pathology and clinical data. Radiology was reviewed and response to TACE assessed as per mRECIST criteria. The variables associated with the risk of HCC recurrence were identified and patients were further stratified according to number of risk factors. RESULTS: From August 1996 to December 2010, 216 patients underwe nt TACE before LT. Fifty-two patients were excluded due to lack of post-TACE control radiology and 164 entered the present analysis (M/F: 148/16; median age: 57 years). Median follow-up of the entire population was 5.5 years (ranges: 3.0–9.7). Exceeding Milan criteria (p = 0.006), post-TACE AFP >200 ng/ml (p = 0.09), and lack of a complete post-TACE radiological response (p = 0.08) were associated with a higher risk of post-transplant HCC recurrence. The 5-year HCC recurrence rate was 0%, 5.0% and 22.6% for patients with no risk factor (= 36), 1 (= 86) or 2–3 risk factors (n = 42), respectively (p < 0.0001). CONCLUSIONS: Combination of tumor stage (Milan versus beyond Milan), biology (AFP) and response to TACE allow for better patient stratification and might be used to guide liver graft allocation for patients wit h HCC.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
