04996nam a22006497a 4500
190621s20192019 xxu||||| |||| 00| 0 eng d
1051-0443
Ovid MEDLINE(R)
31109853
Bridging Hepatocellular Carcinoma to Transplant: Transarterial Chemoembolization Response, Tumor Biology, and Recurrence after Transplantation in a 12-Year Transplant Cohort.
Journal of Vascular & Interventional Radiology. 30(7):995-1003, 2019 Jul.
J Vasc Interv Radiol. 30(7):995-1003, 2019 Jul.
J Vasc Interv Radiol. 2019 May 17
Journal of vascular and interventional radiology : JVIR
2019
FY2020
aheadofprint
ppublish
2019-06-21
Journal of Vascular & Interventional Radiology. 2019 May 17
FY2019
CONCLUSIONS: Poor tumor response to transarterial chemoembolization before transplantation identifies patients at increased risk for post-transplantation recurrence.
Copyright (c) 2019 SIR. Published by Elsevier Inc. All rights reserved.
MATERIALS 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.
PURPOSE: 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.
RESULTS: 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.
English
*Carcinoma, Hepatocellular/th [Therapy]
*Chemoembolization, Therapeutic
*Liver Neoplasms/th [Therapy]
*Liver Transplantation
*Neoplasm Recurrence, Local
Carcinoma, Hepatocellular/dg [Diagnostic Imaging]
Carcinoma, Hepatocellular/pa [Pathology]
Chemoembolization, Therapeutic/ae [Adverse Effects]
Female
Humans
Liver Neoplasms/dg [Diagnostic Imaging]
Liver Neoplasms/pa [Pathology]
Liver Transplantation/ae [Adverse Effects]
Male
Middle Aged
Neoplasm Staging
Progression-Free Survival
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Tumor Burden
MedStar Washington Hospital Center
Radiology
Journal Article
Lacayo, Eduardo
Buckley D, Cardella J, Caridi T, Cohen E, Field D, Kallakury B, Kim AY, Lacayo E, Lynskey G, Pavlus J, Sandow T, Spies J
https://dx.doi.org/10.1016/j.jvir.2018.12.736
https://dx.doi.org/10.1016/j.jvir.2018.12.736
ART
Article
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Article
authcat
authcat
2019-06-21
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31109853
31109853
2019-06-21
2019-06-21
ART
4326
4326