Bridging Locoregional Therapy Prolongs Survival in Patients Listed for Liver Transplant with Hepatocellular Carcinoma

Cardiovasc Intervent Radiol. 2017 Mar;40(3):410-420. doi: 10.1007/s00270-016-1505-0. Epub 2016 Nov 29.

Abstract

Background and aims: To evaluate the long-term survival benefit of bridging locoregional therapy (LRT) prior to orthotopic liver transplantation (OLT) in patients with hepatocellular carcinoma (HCC) within Milan criteria.

Methods: Our transplant center registry was studied for all HCC patients within the Milan criteria who were listed for OLT from 1998 to 2013. Baseline clinical characteristics and median overall survival (OS) were calculated and stratified by LRT, OLT status, and wait times. Survival analysis was conducted using Kaplan-Meier estimation and log-rank test.

Results: Of 265 listed, 205 underwent OLT (mean follow-up 7.6 years). Of 205, 111 received bridging LRT (A), and 94 did not (B). Both were similar in demographics and tumor characteristics (p > 0.05). Median OS from HCC for A/B were 86.4 vs. 68.9 months (p = 0.01). Median OS from OLT for A/B were 74.6 vs. 63.6 months (p = 0.03). On multivariate analysis, independent predictors for survival from HCC were bridging LRT (p = 0.002) and high wait time (p = 0.008); independent predictors for survival from OLT were bridging LRT (p = 0.005) and high wait time (p = 0.005). Of 60 who were listed but did not undergo transplant, 44 received LRT (C) and 16 received best supportive care (D). Median OS from HCC for C/D were 37.1 vs. 24.8 months (p = 0.03).

Conclusions: Bridging LRT and high wait times were independent positive prognostic factors for survival from HCC diagnosis and OLT.

Keywords: Ablation; Embolization; Hepatocellular carcinoma (HCC); Liver transplantation; Locoregional therapy (LRT); Milan criteria; Overall survival.

Publication types

  • Comparative Study
  • Guideline

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / pathology*
  • Carcinoma, Hepatocellular / surgery*
  • Catheter Ablation*
  • Chemoembolization, Therapeutic*
  • Combined Modality Therapy
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Liver Neoplasms / pathology*
  • Liver Neoplasms / surgery*
  • Liver Transplantation / methods*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Retrospective Studies
  • Tissue and Organ Procurement
  • Waiting Lists
  • Young Adult
  • Yttrium Radioisotopes / therapeutic use*

Substances

  • Yttrium Radioisotopes