Liver Transplantation for Hepatocellular Carcinoma With No Viable Tumor Cells as a Result of Locoregional Therapy.

Abstract Background: The ultimate goal of locoregional therapy (LRT) to the liver is to induce total tumor necrosis. Trans-arterial chemoembolization (TACE) is the mainstay bridging therapy for patients with hepatocellular carcinoma (HCC) waiting for liver transplantation (LT). However, tumor response rate is variable. The purpose of this study was to correlate HCC radiological appearance with level of tumor necrosis during explant analysis from patients undergoing LT who received pre-LT TACE. Methods: From January 2000 to December 2018, a total of 66 patients with HCC who had been treated prior to LT by means of TACE were analyzed. Diagnosis of HCC was made based on AASLD guidelines and confirmed via histopathology explant analysis. Radiologic tumor response after TACE was based on modified Response Evaluation Criteria in Solid Tumors (mRECIST). Degree of tumor necrosis was determined by histopathology analysis of liver explants. HCC radiological appearances on CT before TACE were assessed and correlated with histological findings after LT. Results: Eighty nine TACE procedures (1.35±0.67; 1-4) were performed, of which 18 were repeated TACE (27.3%) procedures. In 56.1% of the patients, ≥90% (near-complete) tumor necrosis was achieved. Concordance between mRECIST criteria and pathology was observed in 63% of the patients, with an underestimation of tumor response in 18 (27%) patients and an overestimation in 6 (9.1%). Near-complete tumor necrosis upon pathological analysis was associated with tumor hyper-enhancement in the arterial phase (P=0.002), “typical tumor enhancement” (P=0.010) and smooth tumor margins (p=0.011). The multivariate analysis showed that well circumscribed HCCs with smooth margins and arterial hyper-enhancement independently correlated with post-TACE near-complete histological tumor necrosis. Conclusion s : The well circumscribed HCC lesions with arterial hyper-enhancement are more susceptible to TACE than lesions with arterial phase iso or hypo-enhancement and lesions with infiltrative appearance. Pre-TACE CT imaging may ease the selection of an optimal treatment strategy for bridging patients with HCC to liver transplantation.

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Clinical efficacy of locoregional therapy prior to living donor liver transplantation for hepatocellular carcinoma based on UCSF criteria

10.21203/rs.2.13167/v1 ◽

2019 ◽

Author(s):

Tsung-Han Wu ◽

Chih-Hsien Cheng ◽

Chen-Fang Lee ◽

Ting-Jung Wu ◽

Hong-Shiue Chou ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

San Francisco ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Locoregional Therapy ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Regional Therapy ◽

Ucsf Criteria

Abstract Background The study analyzed the loco-regional therapy outcomes prior to living donor liver transplantation (LDLT), to provide additional information for decision-making regarding therapeutic strategy for hepatocellular carcinoma (HCC) patients. Methods A total of 308 consecutive patients undergoing LDLTs for HCC between August 2004 and December 2018 were retrospectively analyzed. Patients subjected to loco-regional therapy prior to LT were grouped and the outcomes were compared. Results Overall, HCC recurrence after LDLT were detected in 38 patients (12.3%) during the follow-up period. By the end of the study, 205 patients, 6 of whom with recurrent HCC, were alive. Patients who had radiological imaging beyond the University of California at San Francisco (UCSF) criteria had significant inferior outcomes for both recurrence-free survival (RFS, p = 0.0005) and overall survival (OS, p = 0.0462) despite receiving loco-regional therapy as down-staging intention. Moreover, patients with profound tumor necrosis (TN) had a superior RFS at 3 and 5 years (97.4% and 93.8%, respectively), compared with others. Conclusion LDLT gains a satisfactory result based on the expanded UCSF criteria for HCC. However, the loco-regional therapy prior to LDLT does not seem to provide benefit unless a profound TN is noted.

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Outcome of Locoregional Therapy for Hepatocellular Carcinoma (HCC) Before Liver Transplantation

Gastroenterology ◽

10.1016/s0016-5085(11)63980-2 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-961

Author(s):

Galal El-Gazzaz ◽

Rafael A. Ibarra ◽

Juan Sanabria ◽

KV Narayanan Menon ◽

Charles M. Miller ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Locoregional Therapy

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Abstract No. 530 Association of radiological complete response following locoregional therapy prior to liver transplantation with long-term outcomes of hepatocellular carcinoma patients

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2018.01.575 ◽

2018 ◽

Vol 29 (4) ◽

pp. S222-S223

Author(s):

P. Habibollahi ◽

S Pourhassan Shamchi ◽

S. Hunt ◽

T. Gade ◽

S. Stavropoulos ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Complete Response ◽

Locoregional Therapy ◽

Long Term Outcomes

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Association of Complete Radiologic and Pathologic Response following Locoregional Therapy before Liver Transplantation with Long-Term Outcomes of Hepatocellular Carcinoma: A Retrospective Study

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2018.11.037 ◽

2019 ◽

Vol 30 (3) ◽

pp. 323-329 ◽

Cited By ~ 2

Author(s):

Peiman Habibollahi ◽

Sara Pourhassan Shamchi ◽

John M. Choi ◽

Terence P. Gade ◽

S. William Stavropoulos ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Retrospective Study ◽

Pathologic Response ◽

Locoregional Therapy ◽

Long Term Outcomes

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HALTHCC as a novel tumor response metric in patients with hepatocellular carcinoma undergoing locoregional therapy while awaiting liver transplantation

HPB ◽

10.1016/j.hpb.2018.02.022 ◽

2018 ◽

Vol 20 ◽

pp. S12-S13

Author(s):

K. Sasaki ◽

D.J. Firl ◽

S. Kimura ◽

J. McVey ◽

F. Fontan ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Tumor Response ◽

Locoregional Therapy

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Liver Transplantation for Extended Criteria Hepatocellular Carcinoma Using Stable Response to Locoregional Therapy and Alpha-Fetoprotein as Selection Criteria

Visceral Medicine ◽

10.1159/000506752 ◽

2020 ◽

Vol 36 (6) ◽

pp. 506-515

Author(s):

Markus Bo Schoenberg ◽

Hubertus Johann Wolfgang Anger ◽

Julian Nikolaus Bucher ◽

Gerald Denk ◽

Enrico Narciso De Toni ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Selection Criteria ◽

Validation Cohort ◽

Alpha Fetoprotein ◽

Long Term Results ◽

Locoregional Therapy ◽

Internal Validation ◽

Dynamic Selection ◽

Transplant Candidates

Introduction: Current practice to only prioritize hepatocellular carcinoma (HCC) that fulfill the Milan criteria (INMC) is changing, since it causes the exclusion of patients who could benefit from liver transplantation. To select patients outside MC (OUTMC) for transplantation, we implemented extended selection criteria without up-front morphometric restrictions containing surrogate parameters of tumor biology. Methods: OUTMC patients were considered without restrictions of morphometrics and received locoregional treatment after interdisciplinary consultation. Our dynamic selection criteria for OUTMC patients required (INMUC): (1) treatment response over (2) at least 6 months and (3) alpha-fetoprotein ≤400 ng/mL over the entire evaluation period. Patients with INMC tumors served as control and internal validation cohort. Results: 31 of 170 liver transplant candidates were OUTMC. Of these, 8 dropped out. The remaining 23 patients met the selection criteria and underwent transplantation. Recurrence-free survival was higher in patients transplanted INMC compared to those OUTMC INMUC (92.2% vs. 70.8%; p = 0.026) after 5 years of follow-up. Overall survival showed no significant difference (p = 0.552). With dynamic selection of transplant candidates, recurrence could also be predicted for the INMC patients as internal validation cohort (c-index: 0.896; CI 0.588–0.981, p = 0.005). Conclusion: Dynamic selection criteria for the stratification of patients with OUTMC HCCs is feasible and allows for excellent long-term results and acceptable tumor recurrence rates comparable to INMC patients.

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