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The best candidates for transarterial chemotherapy in patients with hepatocellular carcinoma awaiting liver transplantation: a cohort‐based characterization of dropout times
Author(s) -
JANG J. W.,
CHOI J. Y.,
BAE S. H.,
KIM C. W.,
CHO S. H.,
YOON S. K.,
YANG J. M.,
HAN J. Y.,
LEE Y. S.,
KIM D. G.
Publication year - 2007
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2007.03345.x
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , cohort , dropout (neural networks) , gastroenterology , multivariate analysis , transplantation , chemotherapy , retrospective cohort study , surgery , oncology , machine learning , computer science
Summary Background Although transarterial chemotherapy is used to retard tumour progression for hepatocellular carcinoma (HCC) patients awaiting orthotopic liver transplantation (OLT), information regarding the acceptable waiting time and appropriate patient selection for the therapy is lacking. Aim To examine dropout times and determine the best candidates for pre‐transplant transarterial therapy in a cohort study. Methods In total, 180 consecutive HCC candidates receiving pre‐transplant chemo‐lipiodolization were included in the study. Results Overall, 70 (38.9%) patients dropped off the waiting list during the median follow‐up of 19 months. According to the Child–Pugh (C–P) classification, the estimated dropout rates at 1 and 2 years were 17.2% and 44.8% for the C–P A group and 33.4% and 81.3% for the C–P B/C group, respectively. C–P B/C patients experienced more frequent dropouts than C–P A patients ( P < 0.001). Risk factor analysis identified C–P classification to be the strongest predictor of dropout ( P < 0.001). On multivariate analysis, alpha‐fetoprotein (AFP) >100 ng/mL, tumour size >3 cm and multiple nodules remained independently predictive of dropout for C–P A group (all P < 0.05). Candidates with none of these factors were found to be at the lowest risk of dropout, with only a 22.5% dropout rate up to 41 months. Conclusions This study suggests that Child–Pugh A patients with one nodule <3 cm and AFP < 100 ng/mL may be the best candidates for pre‐transplant chemo‐lipiodolization, with the lowest dropout rate. However, comparative studies with other therapeutic options are needed to assess the definitive role of transarterial therapy in this setting.