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Multicenter Study of Staging and Therapeutic Predictors of Hepatocellular Carcinoma Recurrence Following Transplantation
Author(s) -
Welling Theodore H.,
Eddinger Kevin,
Carrier Kristen,
Zhu Danting,
Kleaveland Tyler,
Moore Derek E.,
Schaubel Douglas E.,
Abt Peter L.
Publication year - 2018
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25194
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , hazard ratio , proportional hazards model , milan criteria , gastroenterology , cohort , carcinoma , liver disease , oncology , transplantation , surgery , confidence interval
Orthotopic liver transplantation (OLT) and resection are effective treatments for hepatocellular carcinoma (HCC). However, optimizing OLT and limiting HCC recurrence remains a vexing problem. New HCC Model for End‐Stage Liver Disease and allocation algorithms provide greater observation of HCC patients, many while receiving local‐regional treatments. Potential benefits of local‐regional treatment for limiting HCC recurrence after OLT remain incompletely understood. Therefore, we aimed to define HCC‐specific prognostic factors affecting recurrence in a contemporary, multicenter cohort of HCC patients undergoing OLT and specifically whether local‐regional therapies limited recurrence. We identified 441 patients undergoing OLT for HCC at 3 major transplant centers from 2008 to 2013. Cox regression was used to analyze covariate‐adjusted recurrence and mortality rates after OLT. “Bridging” or “downstaging” therapy was used in 238 (54%) patients with transarterial chemoembolization (TACE) being used in 170 (71%) of treated patients. The survival rate after OLT was 88% and 78% at 1 and 3 years, respectively, with HCC recurrence (28% of deaths) significantly increasing the mortality rate (hazard ratio [HR], 19.87; P < 0.001). Tumor size, not tumor number, either at presentation or on explant independently predicted HCC recurrence (HR, 1.36 and 1.73, respectively; P < 0.05) with a threshold effect noted at 4.0‐cm size. Local‐regional therapy (TACE) reduced HCC recurrence by 64% when adjusting for presenting tumor size (HR, 0.36; P < 0.05). Explant tumor size and microvascular invasion predicted mortality (HR, 1.19 and 1.51, respectively; P < 0.05) and pathologic response to therapy (TACE or radiofrequency ablation) significantly decreased explant tumor size (0.56‐1.62 cm diameter reduction; P < 0.05). In conclusion, HCC tumor size at presentation or explant is the most important predictor for HCC recurrence after OLT. Local‐regional therapy to achieve a pathologic response (decreasing tumor size) can limit HCC recurrences after OLT. Liver Transplantation 00 000–000 2018 AASLD.