Circulating Tumor Cell Is a Clinical Indicator of Pretransplant Radiofrequency Ablation for Patients with Hepatocellular Carcinoma

Introduction. It is of great significance to confirm reliable indicators for the guidance of pretransplant radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). In this study, we aim to investigate whether circulating tumor cell (CTC) status is a clinical indicator for RFA before liver transplantation (LT) in HCC patients. Method. CTC analyses were measured in 79 HCC patients. Clinical outcomes including progression-free (PFS) and overall survival (OS) were compared and analyzed between patients with and without pretransplant RFA. Result. Forty-two patients were detected as CTC-positive and 18 patients received pretransplant RFA. Recurrence was correlated with CTC count ( P = 0.024 ), tumor number ( P = 0.035 ), liver cirrhosis ( P = 0.001 ), Milan criteria ( P = 0.003 ), and University of California San Francisco (UCSF) criteria ( P = 0.001 ). Kaplan–Meier analysis revealed that patients with CTC-positive had a lower PFS rate ( P = 0.0257 ). For CTC-positive patients, the PFS rate of the pretransplant RFA group was significantly higher than the non-pretransplant RFA group (100% vs. 46.7%, P = 0.0236 ). For CTC-negative patients, both PFS rate and OS rate were similar and without significant differences. In multivariate analysis, pretransplant RFA was the independent factor for PFS ( P = 0.025 ). Conclusion. Pretransplant CTC status can guide the administration of pretransplant RFA in HCC patients which can improve PFS in CTC-positive HCC patients.

Circulating Tumor Cell is a Clinical Indicator of Pretransplant Radiofrequency Ablation for Patients with Hepatocellular Carcinoma

Introduction: It is of great significance to confirm reliable indicators for the guidance of pretransplant radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). In this study, we aim to investigate whether circulating tumor cell (CTC) status is clinical indicator for RFA before liver transplantation (LT) in HCC patients. Method: 79 HCC patients with pretransplant CTC analysis were enrolled in this retrospective study. Clinical outcomes including recurrence and survival were compared and analyzed between patients with and without pretransplant RFA. Result Forty-two patients were detected as CTC- positive and 18 patients received pretransplant RFA. Recurrence was correlated with CTC count (P = 0.024), tumor number (P = 0.035), liver cirrhosis (P = 0.001), Milan criteria (P = 0.003) and University of California San Francisco (UCSF) criteria (P = 0.001). Kaplan-Meier analysis revealed that patients with CTC-positive had higher recurrence rate (P = 0.0257). For CTC-positive patients, the recurrence rate of pretransplant RFA group were significantly lower than non- pretransplant RFA group (0 vs. 46.7%, P = 0.0236). For CTC-negative patients, both recurrence rate and OS rate were similar and without significantly differences. In multivariate analysis, pretransplant RFA was the independent factor for recurrence (P = 0.025). Conclusion Pretransplant CTC status can guide the administration of pretransplant RFA in HCC patients which can reduce recurrence in CTC-positive HCC patients.

Outcome of early and intermediate-stage hepatocellular carcinoma (HCC): A single institution experience at MGUH.

328 Background: Liver transplant (LT) remains the best curative standard for HCC within Milan criteria (Milan). Nonsurgical locoregional treatments, including TACE and ablation, offer a bridge to surgical management and attempt to downstage or maintain patients (pts) within Milan pending liver transplant and donor organ availability. We investigated clinical factors that predict successful downstaging of HCC and liver transplant. Methods: In this single-institutional retrospective analysis, pts with early-intermediate stage HCC within Milan (control) vs beyond Milan were evaluated for clinical outcome. Clinical factors including treatment and response, demographics, TACE distribution (number of treatments, timing, and response), and status of liver transplantation (timing and if received) were correlated to overall survival (OS). OS was calculated using the Kaplan-Meier method. Results: HCC pts (n = 343) considered for LT or downstage to LT were included in the study: 75% male, 13% African American, 55% Caucasian, and 14% Asian. 12% of pts had HBV, 53% had HCV, 2% had both HBV and HCV. 221 pts were diagnosed within Milan vs 122 beyond Milan, in which 36% (n = 44) were still within UCSF criteria (UCSF). 43% of those diagnosed within Milan ultimately received LT vs 16% of those diagnosed beyond Milan. 49% of pts (n = 60) initially beyond Milan were downstaged to within Milan, via TACE, wherein 27% received LT; this group accounted for 13% all LT. However, in the subset of pts beyond Milan but within UCSF, 68% were downstaged to within Milan, wherein 40% received LT. In pts initially within Milan, 21% (n = 47) progressed beyond Milan, but 40% of this subset was downstaged back to within Milan. Pts both within and beyond Milan had a median of 2 TACE procedures. Differences in the rates of LT relative to the number of TACE were significant (p = 0.022) for pts initially within Milan; for < / = 2 TACE, 54% had LT; for > 2 TACE, 26% had LT. Similar comparison was nonsignificant for pts initially beyond Milan (p = 0.95); rates of LT for < / = 2 TACE and > 2 TACE were 17% and 16% respectively. Median OS for non-LT recipients was 5 years vs not reached for LT recipients ( > 70% alive at 8 years, p < 0.001). Pts initially beyond Milan but within UCSF criteria had similar OS vs those initially within Milan (both 75% at 4 years), but OS was worse (50% at 4 years) for those beyond UCSF (p = 0.024). Conclusions: Liver transplantation significantly increased OS in early-intermediate stage HCC. Increased number of TACE procedures was associated with decreased likelihood of ultimate LT in pts initially diagnosed within Milan, particularly when they had > 2 TACE. Pts initially beyond Milan but within UCSF criteria had similar OS vs those initially within Milan; this former subset had a good chance of being downstaged to Milan and ultimately receive LT. Additional clinical factors that predict successful downstaging of HCC and LT are being investigated.

The Long-term Outcomes of Hepatic Resection Between Single Tumor and Multiple Tumors of HCC Meeting UCSF Criteria

Object: Searching the hepatectomy of hepatocellular carcinoma (HCC) within UCSF is limited. The study aims to compare the long-term surgical outcomes between single and multiple tumors to find an effective and safe treatment for the patients within UCSF criteria.Methods: We have enrolled 1006 patients meeting UCSF criteria, including 744 patients with single tumor and 262 patients with multiple tumors undergoing hepatic resection (HR). We divided the patients into two groups: single tumor group and multiple tumor group. By comparing the long-term outcomes between these two groups and analyzing the risk factors by the log-rank test and cox proportional hazards model in two groups.Results: The 1-, 3-, and 5-year OS rates in the single tumor group were significantly higher than the multiple tumors group (96.2%, 65.3% and 40.1% versus 93.1%, 47.6% and 22.5%, respectively, p<0.001). The 1-, 3- and 5-year RFS rates were 91.4%, 46.2%, and 24.6% in the single group and 90.8%, 31.1% and 13.0%, respectively (p<0.001). And the anatomic resection and MVI were the independent risk factors for single tumor, but it didn’t work for multiple tumors. The independent risk factors of multiple tumors are the diameter more than 2cm of the maximum tumor and the tumors located in different segments.Conclusion: The surgical resection will obtain a better outcomes for the HCC with single tumor meeting UCSF criteria than the multiple tumors. And the anatomic resection should be applied for the patients with single tumor, if possible.

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

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.