TY - JOUR
T1 - Neoadjuvant transarterial chemoembolization improves survival after liver transplant in patients with hepatocellular carcinoma
AU - Werner, John D.
AU - Frangakis, Constantine
AU - Ruck, Jessica M.
AU - Hong, Kelvin
AU - Philosophe, Benjamin
AU - Cameron, Andrew M.
AU - Saberi, Behnam
AU - Gurakar, Ahmet
AU - Georgiades, Christos
N1 - Publisher Copyright:
© Başkent University 2019.
PY - 2019
Y1 - 2019
N2 - Objectives: Our aims were to determine whether transarterial chemoembolization before liver transplant for hepatocellular carcinoma improves posttransplant survival and whether patients downstaged by transarterial chemoembolization within Milan criteria have a posttransplant survival benefit. Materials and Methods: In this retrospective analysis of prospectively collected data, survival rates of 87 patients treated with and 68 patients not treated with transarterial chemoembolization before liver transplant were compared using 2-sample t tests and multivariate Cox regression. We also compared posttransplant survival of patients within Milan criteria versus those downstaged after transarterial chemoembolization. We controlled for disease severity by assessing, among other variables, tumor diameter before and at transplant and alpha-fetoprotein levels before transplant and transarterial chemoembolization. Results: Overall 1-, 3-, and 5-year survival rates were 84%, 71%, and 63%, respectively. These rates were 91%, 78%, and 73% for patients who received and 76%, 63%, and 54% for patients who did not receive transarterial chemoembolization. Hazard ratios were 0.56 for having versus not having transarterial chemoembolization (P =.04), 1.06 for total tumor diameter on explantation (P =.01), 1.5 for largest tumor > 3 cm (P =.15), and 2.9 for pretransplant alpha-fetoprotein > 659 ng/mL (P =.006). A higher end-stage liver disease score correlated with poorer overall survival (hazard ratio = 1.53; P <.001). Laboratory values, lipiodol uptake, imaging response, and downstaging into Milan criteria were not correlated with survival. Conclusions: Patients with hepatocellular carcinoma who were treated with neoadjuvant transarterial chemoembolization had better survival rates posttransplant than those not treated with transarterial chemoembolization. A high pretransplant alpha-fetoprotein level was negatively correlated with survival. Patients downstaged to Milan criteria after transarterial chemoembolization fared equally well versus those who met Milan criteria initially. Pretreatment with transarterial chemoembolization was positively correlated with survival posttransplant, with patients having a 44% reduction in posttransplant mortality.
AB - Objectives: Our aims were to determine whether transarterial chemoembolization before liver transplant for hepatocellular carcinoma improves posttransplant survival and whether patients downstaged by transarterial chemoembolization within Milan criteria have a posttransplant survival benefit. Materials and Methods: In this retrospective analysis of prospectively collected data, survival rates of 87 patients treated with and 68 patients not treated with transarterial chemoembolization before liver transplant were compared using 2-sample t tests and multivariate Cox regression. We also compared posttransplant survival of patients within Milan criteria versus those downstaged after transarterial chemoembolization. We controlled for disease severity by assessing, among other variables, tumor diameter before and at transplant and alpha-fetoprotein levels before transplant and transarterial chemoembolization. Results: Overall 1-, 3-, and 5-year survival rates were 84%, 71%, and 63%, respectively. These rates were 91%, 78%, and 73% for patients who received and 76%, 63%, and 54% for patients who did not receive transarterial chemoembolization. Hazard ratios were 0.56 for having versus not having transarterial chemoembolization (P =.04), 1.06 for total tumor diameter on explantation (P =.01), 1.5 for largest tumor > 3 cm (P =.15), and 2.9 for pretransplant alpha-fetoprotein > 659 ng/mL (P =.006). A higher end-stage liver disease score correlated with poorer overall survival (hazard ratio = 1.53; P <.001). Laboratory values, lipiodol uptake, imaging response, and downstaging into Milan criteria were not correlated with survival. Conclusions: Patients with hepatocellular carcinoma who were treated with neoadjuvant transarterial chemoembolization had better survival rates posttransplant than those not treated with transarterial chemoembolization. A high pretransplant alpha-fetoprotein level was negatively correlated with survival. Patients downstaged to Milan criteria after transarterial chemoembolization fared equally well versus those who met Milan criteria initially. Pretreatment with transarterial chemoembolization was positively correlated with survival posttransplant, with patients having a 44% reduction in posttransplant mortality.
KW - Alpha-fetoprotein
KW - Chemoembolization
KW - Hepatocellular carcinoma
KW - Locoregional therapy
KW - Milan criteria
UR - http://www.scopus.com/inward/record.url?scp=85072767750&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85072767750&partnerID=8YFLogxK
M3 - Article
C2 - 30251938
AN - SCOPUS:85072767750
SN - 1304-0855
VL - 17
SP - 638
EP - 643
JO - Experimental and Clinical Transplantation
JF - Experimental and Clinical Transplantation
IS - 5
ER -