Open AccessDownstaging prior to liver transplantation for hepatocellular carcinoma: advisable but at the price of an increased risk of cancer recurrence – a retrospective study
Author(s) -
Toso Christian,
Meeberg Glenda,
Andres Axel,
Shore Carolina,
Saunders Colleen,
Bigam David L.,
Shapiro Andrew Mark James,
Compag Philippe,
Berney Thierry,
Majno Pietro,
Kneteman Norman
Publication year - 2019
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13337
Subject(s) - milan criteria , medicine , liver transplantation , hepatocellular carcinoma , transplantation , gastroenterology , retrospective cohort study , carcinoma , surgery
Summary The use of downstaging prior to liver transplantation for hepatocellular carcinoma ( HCC ) still needs refinement. This study included patients with HCC listed for transplantation according to the Total Tumour Volume ( TTV ) ≤115 cm 3 and alpha fetoprotein ( AFP ) ≤400 ng/ml criteria, with and without previous downstaging. Overall, 455 patients were listed, and 286 transplanted. Post‐transplant follow‐up was 38.5 ± 1.7 months. Patients downstaged to TTV 115/ AFP 400 ( n = 29) demonstrated similar disease‐free survivals ( DFS , 74% vs. 80% at 5 years, P = 0.949), but a trend to more recurrences (14% vs. 5.8%, P = 0.10) than those always within TTV 115/ AFP 400 ( n = 257). Similarly, patients downstaged to Milan criteria ( n = 80) demonstrated similar DFS (76% vs. 86% at 5 years, P = 0.258), but more recurrences (11% vs. 1.7%, P = 0.001) than those always within Milan ( n = 177). Among patients downstaged to Milan, those originally beyond TTV 115/ AFP 400 ( n = 27) had similar outcomes as those originally beyond Milan, but within TTV 115/ AFP 400 ( n = 53). However, the likelihood of being within Milan at transplant was lower for patients with more advanced original HCC s ( P < 0.0001). Overall, despite an expected increase in post‐transplant HCC recurrence, similar survivals can be achieved with and without downstaging, using the TTV 115/ AFP 400 transplantation criteria, and including patients with advanced original HCC s. Downstaging should continue to be performed.