Journal article
Impact of Pretransplant Bridging Locoregional Therapy for Patients With Hepatocellular Carcinoma Within Milan Criteria Undergoing Liver Transplantation Analysis of 3601 Patients From the US Multicenter HCC Transplant Consortium
Annals of surgery, Vol.266(3), pp.525-535
09/01/2017
DOI: 10.1097/SLA.0000000000002381
PMID: 28654545
Abstract
Objective: To evaluate the effect of pretransplant bridging locoregional therapy (LRT) on hepatocellular carcinoma (HCC) recurrence and survival after liver transplantation (LT) in patients meeting Milan criteria (MC).
Summary Background Data: Pre-LT LRT mitigates tumor progression and waitlist dropout in HCC patients within MC, but data on its impact on post-LT recurrence and survival remain limited.
Methods: Recurrence-free survival and post-LT recurrence were compared among 3601 MC patients with and without bridging LRT utilizing competing risk Cox regression in consecutive patients from 20 US centers (2002-2013).
Results: Compared with 747 LT recipients not receiving LRT, 2854 receiving LRT had similar 1, 3, and 5-year recurrence-free survival (89%, 77%, 68% vs 85%, 75%, 68%; P = 0.490) and 5-year post-LT recurrence (11.2% vs 10.1%; P = 0.474). Increasing LRT number [3 LRTs: hazard ratio (HR) 2.1, P < 0.001; 4+ LRTs: HR 2.5, P < 0.001), and unfavorable waitlist alphafetoprotein trend significantly predicted post-LT recurrence, whereas LRT modality did not. Treated patients achieving complete pathologic response (cPR) had superior 5-year RFS (72%) and lower post-LT recurrence (HR 0.52, P < 0.001) compared with both untreated patients (69%; P = 0.010; HR 1.0) and treated patients not achieving cPR (67%; P = 0.010; HR 1.31, P = 0.039), who demonstrated increased recurrence compared with untreated patients in multivariate analysis controlling for pretransplant and pathologic factors (HR 1.32, P = 0.044).
Conclusions: Bridging LRT in HCC patients within MC does not improve post-LT survival or HCC recurrence in the majority of patients who fail to achieve cPR. The need for increasing LRT treatments and lack of alphafetoprotein response to LRT independently predict post-LT recurrence, serving as a surrogate for underlying tumor biology which can be utilized for prioritization of HCC LT candidates.
Details
- Title: Subtitle
- Impact of Pretransplant Bridging Locoregional Therapy for Patients With Hepatocellular Carcinoma Within Milan Criteria Undergoing Liver Transplantation Analysis of 3601 Patients From the US Multicenter HCC Transplant Consortium
- Creators
- Vatche G. Agopian - David Geffen School of Medicine at UCLAMichael P. Harlander-Locke - David Geffen School of Medicine at UCLARichard M. Ruiz - Baylor University Medical CenterGoran B. Klintmalm - Baylor University Medical CenterSrinath Senguttuvan - Baylor University Medical CenterSander S. Florman - Icahn School of Medicine at Mount SinaiBrandy Haydel - Icahn School of Medicine at Mount SinaiMaarouf Hoteit - University of PennsylvaniaMatthew H. Levine - University of PennsylvaniaDavid D. Lee - Mayo Clinic in FloridaC. Burcin Taner - Mayo Clinic in FloridaElizabeth C. Verna - Columbia UniversityKarim J. Halazun - Columbia UniversityRita Abdelmessih - Columbia UniversityAmit D. Tevar - University of PittsburghAbhinav Humar - University of PittsburghFederico Aucejo - Cleveland ClinicWilliam C. Chapman - Washington University in St. LouisNeeta Vachharajani - Washington University in St. LouisMindie H. Nguyen - Stanford UniversityMarc L. Melcher - Stanford UniversityTrevor L. Nydam - University of DenverConstance Mobley - Houston MethodistR. Mark Ghobrial - Houston MethodistBeth Amundsen - Harvard UniversityJames F. Markmann - Harvard UniversityAlan N. Langnas - University of Nebraska Medical CenterCarol A. Carney - University of Nebraska Medical CenterJennifer Berumen - University of California, San DiegoAlan W. Hemming - University of California, San DiegoDebra L. Sudan - Duke UniversityJohnny C. Hong - Medical College of WisconsinJoohyun Kim - Medical College of WisconsinMichael A. Zimmerman - Medical College of WisconsinAbbas Rana - Baylor College of MedicineMichael L. Kueht - Baylor College of MedicineChristopher M. Jones - University of Louisville HospitalThomas M. Fishbein - Georgetown UniversityRonald W. Busuttil - David Geffen School of Medicine at UCLA
- Resource Type
- Journal article
- Publication Details
- Annals of surgery, Vol.266(3), pp.525-535
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/SLA.0000000000002381
- PMID
- 28654545
- ISSN
- 0003-4932
- eISSN
- 1528-1140
- Number of pages
- 11
- Language
- English
- Date published
- 09/01/2017
- Academic Unit
- Surgery
- Record Identifier
- 9984322825602771
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