Open AccessLiver cancer understaging in liver transplantation in the current era of radiologic imaging and newer generation locoregional therapies
Author(s) -
Hannah M. Lee,
Donna K. McClish,
Binu John,
Sarah G. Winks,
Ryan Clayton,
Somaya Albhaisi,
Allawy Allawy,
Samarth Patel,
Emma C. Fields,
Scott Matherly,
Brian J. Strife,
Chandra Bhati,
Vishal Sharma,
Richard K. Sterling
Publication year - 2022
Publication title -
hepatoma research
Language(s) - English
Resource type - Journals
eISSN - 2454-2520
pISSN - 2394-5079
DOI - 10.20517/2394-5079.2021.139
Subject(s) - medicine , concordance , hepatocellular carcinoma , milan criteria , liver transplantation , stage (stratigraphy) , retrospective cohort study , transplantation , oncology , paleontology , biology
Background: Discordance in hepatocellular carcinoma (HCC) staging between pre-transplant imaging and explant pathology is associated with an increased risk of recurrence and death. Our aim was to evaluate variables that predicted concordance/discordance in the era of new generation locoregional therapies (LRT) and improved radiologic technology in diagnosis. Methods: A single-center retrospective study was performed on patients who received a liver transplant for HCC between 2008-2019. Pre- and post-LT variables, including type of LRT, downstaging (DS), transplant time period, and radiologic response to LRT, were analyzed for concordance/discordance. Kaplan-Meier analysis was used to assess post-LT survival. Results: Of 146 patients transplanted within Milan Criteria (MC), discordance rates (understaged) were 45%. Discordance was associated with ≥ 3 HCC lesions at diagnosis but not newer generation LRT (transarterial radioembolization/ stereotactic body radiation therapy), traditional LRT or combination. No differences in discordance were seen between transplant periods (2008-2013 vs. 2014-2019), but those within MC in the earlier period had higher concordance rates. A trend was observed between DS and discordance. Conclusion: HCC stage discordance remains common and poorly predictable. Discordance was associated with three or more HCC lesions at the time of diagnosis. Patients within MC transplanted between 2008-2013 was associated with concordance, while a trend was noted between DS and discordance. No other pre- or post- LT variables predicted discordance/ concordance. Discordance was associated with decreased survival.