000			04996nam a22006497a 4500
008			190621s20192019 xxu||||| |||| 00| 0 eng d
022			_a1051-0443
040			_aOvid MEDLINE(R)
099			_a31109853
245			_aBridging Hepatocellular Carcinoma to Transplant: Transarterial Chemoembolization Response, Tumor Biology, and Recurrence after Transplantation in a 12-Year Transplant Cohort.
251			_aJournal of Vascular & Interventional Radiology. 30(7):995-1003, 2019 Jul.
252			_aJ Vasc Interv Radiol. 30(7):995-1003, 2019 Jul.
252			_zJ Vasc Interv Radiol. 2019 May 17
253			_aJournal of vascular and interventional radiology : JVIR
260			_c2019
260			_fFY2020
265			_saheadofprint
265			_sppublish
266			_d2019-06-21
268			_aJournal of Vascular & Interventional Radiology. 2019 May 17
269			_fFY2019
520			_aCONCLUSIONS: Poor tumor response to transarterial chemoembolization before transplantation identifies patients at increased risk for post-transplantation recurrence.
520			_aCopyright (c) 2019 SIR. Published by Elsevier Inc. All rights reserved.
520			_aMATERIALS AND METHODS: An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, single-institution retrospective analysis was performed on all patients with HCC who were treated with the use of conventional transarterial chemoembolization or transarterial chemoembolization with drug-eluting embolics (DEE) over a 12-year period and who subsequently underwent liver transplantation (n = 142). Treatment response was based on modified Response Evaluation Criteria in Solid Tumors (mRECIST) imaging criteria and then correlated with tumor characteristics and recurrence. Of the 142 patients followed after transplantation, 127 had imaging after transarterial chemoembolization but before transplantation. Imaging response and post-transplantation recurrence were correlated with patient demographics, liver function, and tumor morphology. HCC recurred in 9 patients (mean time from transplantation, 526 days). Recurrence was analyzed with the use of univariate and multivariate statistics. Kaplan-Meier recurrence-free survival curves were calculated based on immediate imaging response before transplantation with the use of the log-rank test.
520			_aPURPOSE: To evaluate tumor response to transarterial chemoembolization as well as biologic characteristics of the tumor as predictors of recurrence after transplantation in patients with hepatocellular carcinoma (HCC) who were bridged or down-staged to liver transplantation.
520			_aRESULTS: Before transplantation, 57% of patients (72/127) demonstrated complete response (CR) and 24% (31/127) showed partial response (PR). Complete pathologic necrosis occurred in 54% (39/72) of CR patients and 20% (6/31) of PR patients. Poor treatment response, defined as stable disease (SD) or progressive disease (PD), occurred in 18% of patients (24/127) before transplantation and was present in 67% of cases of recurrence (6/9; P < .001). Post-transplantation recurrence was present in 1.4% of patients (1/71) with CR and in 6.5% of patients (2/31) with PR. In patients with SD after transarterial chemoembolization, HCC recurred in 18.8% of transplant patients (3/16) and in 43% of patients (3/7) with PD. Larger pretreatment tumor size (P = .05), higher Child-Pugh score (P = .002), higher tumor grade at explantation (P = .04), and lymphovascular invasion at explantation (P = .008) also were associated with increased incidence of post-transplantation recurrence.
546			_aEnglish
650			_a*Carcinoma, Hepatocellular/th [Therapy]
650			_a*Chemoembolization, Therapeutic
650			_a*Liver Neoplasms/th [Therapy]
650			_a*Liver Transplantation
650			_a*Neoplasm Recurrence, Local
650			_aCarcinoma, Hepatocellular/dg [Diagnostic Imaging]
650			_aCarcinoma, Hepatocellular/pa [Pathology]
650			_aChemoembolization, Therapeutic/ae [Adverse Effects]
650			_aFemale
650			_aHumans
650			_aLiver Neoplasms/dg [Diagnostic Imaging]
650			_aLiver Neoplasms/pa [Pathology]
650			_aLiver Transplantation/ae [Adverse Effects]
650			_aMale
650			_aMiddle Aged
650			_aNeoplasm Staging
650			_aProgression-Free Survival
650			_aRetrospective Studies
650			_aRisk Assessment
650			_aRisk Factors
650			_aTime Factors
650			_aTumor Burden
651			_aMedStar Washington Hospital Center
656			_aRadiology
657			_aJournal Article
700			_aLacayo, Eduardo
790			_aBuckley D, Cardella J, Caridi T, Cohen E, Field D, Kallakury B, Kim AY, Lacayo E, Lynskey G, Pavlus J, Sandow T, Spies J
856			_uhttps://dx.doi.org/10.1016/j.jvir.2018.12.736 _zhttps://dx.doi.org/10.1016/j.jvir.2018.12.736
942			_cART _dArticle
999			_c4326 _d4326