Journal article
Liver Transplantation Outcomes in a U.S. Multicenter Cohort of 789 Patients With Hepatocellular Carcinoma Presenting Beyond Milan Criteria
Hepatology (Baltimore, Md.), Vol.72(6), pp.2014-2028
12/2020
DOI: 10.1002/hep.31210
PMID: 32124453
Abstract
The Organ Procurement and Transplantation Network recently approved liver transplant (LT) prioritization for patients with hepatocellular carcinoma (HCC) beyond Milan Criteria (MC) who are down-staged (DS) with locoregional therapy (LRT). We evaluated post-LT outcomes, predictors of down-staging, and the impact of LRT in patients with beyond-MC HCC from the U.S. Multicenter HCC Transplant Consortium (20 centers, 2002-2013).
Clinicopathologic characteristics, overall survival (OS), recurrence-free survival (RFS), and HCC recurrence (HCC-R) were compared between patients within MC (n = 3,570) and beyond MC (n = 789) who were down-staged (DS, n = 465), treated with LRT and not down-staged (LRT-NoDS, n = 242), or untreated (NoLRT-NoDS, n = 82). Five-year post-LT OS and RFS was higher in MC (71.3% and 68.2%) compared with DS (64.3% and 59.5%) and was lowest in NoDS (n = 324; 60.2% and 53.8%; overall P < 0.001). DS patients had superior RFS (60% vs. 54%, P = 0.043) and lower 5-year HCC-R (18% vs. 32%, P < 0.001) compared with NoDS, with further stratification by maximum radiologic tumor diameter (5-year HCC-R of 15.5% in DS/<5 cm and 39.1% in NoDS/>5 cm, P < 0.001). Multivariate predictors of down-staging included alpha-fetoprotein response to LRT, pathologic tumor number and size, and wait time >12 months. LRT-NoDS had greater HCC-R compared with NoLRT-NoDS (34.1% vs. 26.1%, P < 0.001), even after controlling for clinicopathologic variables (hazard ratio [HR] = 2.33, P < 0.001) and inverse probability of treatment-weighted propensity matching (HR = 1.82, P < 0.001).
In LT recipients with HCC presenting beyond MC, successful down-staging is predicted by wait time, alpha-fetoprotein response to LRT, and tumor burden and results in excellent post-LT outcomes, justifying expansion of LT criteria. In LRT-NoDS patients, higher HCC-R compared with NoLRT-NoDS cannot be explained by clinicopathologic differences, suggesting a potentially aggravating role of LRT in patients with poor tumor biology that warrants further investigation.
Details
- Title: Subtitle
- Liver Transplantation Outcomes in a U.S. Multicenter Cohort of 789 Patients With Hepatocellular Carcinoma Presenting Beyond Milan Criteria
- Creators
- Ani Kardashian - University of California, Los AngelesSander S Florman - Mount Sinai HospitalBrandy Haydel - Mount Sinai HospitalRichard M Ruiz - Baylor University Medical CenterGoran B Klintmalm - Baylor University Medical CenterDavid D Lee - Department of Transplantation; Mayo Clinic; Jacksonville; FLC Burcin Taner - Mayo Clinic in FloridaFederico Aucejo - Cleveland ClinicAmit D Tevar - University of Pittsburgh Medical CenterAbhinav Humar - University of Pittsburgh Medical CenterElizabeth C Verna - Columbia UniversityKarim J Halazun - NewYork–Presbyterian HospitalWilliam C Chapman - Washington University in St. LouisNeeta Vachharajani - Washington University in St. LouisMaarouf Hoteit - University of PennsylvaniaMatthew H Levine - University of PennsylvaniaMindie H Nguyen - Stanford UniversityMarc L Melcher - Stanford UniversityAlan N Langnas - University of Nebraska Medical CenterCarol A Carney - University of Nebraska Medical CenterConstance Mobley - Methodist HospitalMark Ghobrial - Houston MethodistBeth Amundsen - Massachusetts General HospitalJames F Markmann - Massachusetts General HospitalDebra L Sudan - Duke UniversityChristopher M Jones - University of LouisvilleJennifer Berumen - University of California, San DiegoAlan W Hemming - University of California, San DiegoJohnny C Hong - Medical College of WisconsinJoohyun Kim - Medical College of WisconsinMichael A Zimmerman - Medical College of WisconsinTrevor L Nydam - University of Colorado DenverAbbas Rana - Baylor College of MedicineMichael L Kueht - Baylor College of MedicineThomas M Fishbein - Georgetown UniversityDaniela Markovic - David Geffen School of Medicine at UCLARonald W Busuttil - University of California, Los AngelesVatche G Agopian - University of California, Los Angeles
- Resource Type
- Journal article
- Publication Details
- Hepatology (Baltimore, Md.), Vol.72(6), pp.2014-2028
- DOI
- 10.1002/hep.31210
- PMID
- 32124453
- ISSN
- 0270-9139
- eISSN
- 1527-3350
- Language
- English
- Date published
- 12/2020
- Academic Unit
- Surgery
- Record Identifier
- 9984322957802771
Metrics
28 Record Views