Journal article
Pathologic Response to Pretransplant Locoregional Therapy is Predictive of Patient Outcome After Liver Transplantation for Hepatocellular Carcinoma: Analysis From the US Multicenter HCC Transplant Consortium
Annals of surgery, Vol.271(4), pp.616-624
04/2020
DOI: 10.1097/SLA.0000000000003253
PMID: 30870180
Abstract
The aim of the study was to determine the rate, predictors, and impact of complete pathologic response (cPR) to pretransplant locoregional therapy (LRT) in a large, multicenter cohort of hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT).
LRT is used to mitigate waitlist dropout for patients with HCC awaiting LT. Degree of tumor necrosis found on explant has been associated with recurrence and overall survival, but has not been evaluated in a large, multicenter study.
Comparisons were made among patients receiving pre-LT LRT with (n = 802) and without (n = 2637) cPR from the United States Multicenter HCC Transplant Consortium (UMHTC), and multivariable predictors of cPR were identified using logistic regression.
Of 3439 patients, 802 (23%) had cPR on explant. Compared with patients without cPR, cPR patients were younger; had lower Model for End-stage Liver Disease (MELD) scores, AFP levels, and neutrophil-lymphocyte ratios (NLR); were more likely to have tumors within Milan criteria and fewer LRT treatments; and had significantly lower 1-, 3-, and 5-year incidence of post-LT recurrence (1.3%, 3.5%, and 5.2% vs 6.2%, 13.5%, and 16.4%; P < 0.001) and superior overall survival (92%, 84%, and 75% vs 90%, 78%, and 68%; P < 0.001). Multivariable predictors of cPR included age, sex, liver disease diagnosis, MELD, AFP, NLR, radiographic Milan status, and number of LRT treatments (C-statistic 0.67).
For LT recipients with HCC receiving pretransplant LRT, achieving cPR portends significantly lower posttransplant recurrence and superior survival. Factors predicting cPR are identified, which may help prioritize patients and guide LRT strategies to optimize posttransplant cancer outcomes.
Details
- Title: Subtitle
- Pathologic Response to Pretransplant Locoregional Therapy is Predictive of Patient Outcome After Liver Transplantation for Hepatocellular Carcinoma: Analysis From the US Multicenter HCC Transplant Consortium
- Creators
- Joseph DiNorcia - University of California, Los AngelesSander S Florman - Mount Sinai HospitalBrandy Haydel - Mount Sinai HospitalParissa Tabrizian - Mount Sinai HospitalRichard M Ruiz - Baylor University Medical CenterGoran B Klintmalm - Baylor University Medical CenterSrinath Senguttuvan - Baylor University Medical CenterDavid D Lee - Department of Transplantation; Mayo Clinic; Jacksonville; FLC Burcin Taner - Department of Transplantation; Mayo Clinic; Jacksonville; FLElizabeth C Verna - Columbia UniversityKarim J Halazun - NewYork–Presbyterian HospitalMaarouf Hoteit - University of PennsylvaniaMatthew H Levine - University of PennsylvaniaWilliam C Chapman - Washington University in St. LouisNeeta Vachharajani - Washington University in St. LouisFederico Aucejo - Cleveland ClinicMindie H Nguyen - Stanford UniversityMarc L Melcher - Stanford UniversityAmit D Tevar - University of Pittsburgh Medical CenterAbhinav Humar - University of Pittsburgh Medical CenterConstance Mobley - Methodist HospitalMark Ghobrial - Houston MethodistTrevor L Nydam - University of Colorado DenverBeth Amundsen - Massachusetts General HospitalJames F Markmann - Massachusetts General HospitalJennifer Berumen - University of California, San DiegoAlan W Hemming - University of California, San DiegoAlan N Langnas - University of Nebraska Medical CenterCarol A Carney - University of Nebraska Medical CenterDebra L Sudan - Duke University Medical CenterJohnny 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 LouisvilleThomas 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
- Annals of surgery, Vol.271(4), pp.616-624
- DOI
- 10.1097/SLA.0000000000003253
- PMID
- 30870180
- ISSN
- 0003-4932
- eISSN
- 1528-1140
- Language
- English
- Date published
- 04/2020
- Academic Unit
- Surgery
- Record Identifier
- 9984322815802771
Metrics
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