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Excellent post‐transplant survival in patients with intermediate stage hepatocellular carcinoma responding to neoadjuvant therapy
Author(s) -
Finkenstedt Armin,
Vikoler Anja,
Portenkirchner Manuela,
Mülleder Kerstin,
Maglione Manuel,
Margreiter Christian,
Moser Patrizia,
Vogel Wolfgang,
Bale Reto,
Freund Martin,
Luger Anna,
Tilg Herbert,
Petersen Johannes,
Schneeberger Stefan,
Graziadei Ivo,
Zoller Heinz,
Glodny Bernhard
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12966
Subject(s) - medicine , stage (stratigraphy) , hepatocellular carcinoma , liver transplantation , neoadjuvant therapy , grading (engineering) , transplantation , gastroenterology , oncology , cancer , paleontology , civil engineering , breast cancer , engineering , biology
Background & Aims Current treatment guidelines preclude liver transplantation for patients with BCLC B (intermediate stage) HCC , and expanding transplantation criteria for selected patients beyond early stage HCC remains controversial. The aim of this study was to determine stage‐dependent HCC recurrence and overall survival rates in transplant recipients and the impact of response to neoadjuvant treatment on outcome. Methods The CT / MRI scans of patients who underwent liver transplantation for HCC at our transplant centre during a time period of 12 years were reviewed by two radiologists to assess tumour stage and response to neoadjuvant treatment according to mRECIST . Results Of 174 HCC patients, 48 (28%) were BCLC intermediate stage. Neoadjuvant treatment was performed in 94% of patients. When patients were stratified according to tumour stage, no significant difference in overall survival was observed between very early or early and intermediate stage. When stratified according to treatment response, patients with complete response had a 5‐year overall survival of 87%, which was significantly higher than in patients with progressive disease (62%, P = 0.02). HCC recurrence in intermediate stage patients without disease progression after neoadjuvant treatment was equal to that in patients with very early or early stage HCC . Tumour grading, histological and radiological evidence of vascular invasion, but not tumour stage were identified as independent risk factors for HCC recurrence. Conclusions Liver transplantation may be an option for selected patients with BCLC intermediate stage HCC and complete response after neoadjuvant treatment because of excellent long‐term survival and low recurrence rates.