Response to transarterial chemoembolization may serve as selection criteria for hepatocellular carcinoma liver transplantation
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Jianyong Lei1,2,6, Jinjing Zhong4, Yefang Luo5, Lunan Yan1, Jinqiang Zhu2, Wentao Wang1, Bo Li1, Tianfu Wen1, Jiaying Yang3 and Liver Surgery Group
1Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
2Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
3Transplantation Center,West China Hospital of Sichuan University, Chengdu, China
4Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
5West China School of Medicine, Sichuan University, Chengdu, China
6Present address: Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
Wentao Wang, email: [email protected]
Keywords: hepatocellular carcinoma, liver transplantation, transarterial chemoembolization, selection
Received: April 04, 2017 Accepted: August 02, 2017 Published: August 24, 2017
Aims: This study sought to extend the inclusion criteria for hepatocellular carcinoma (HCC) liver transplantation (LT), particularly addressing the safety and effectiveness of pre-LT transarterial chemoembolization (TACE).
Materials and Methods: Our study included 115 patients with HCC who underwent LT after TACE. The response measured after each TACE session was based on the mRECIST criteria: complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD). We defined CR and PR patients as responders (64 cases) and SD and PD patients as non-responders (51 cases).
Results: The majority of responders could be identified after the first or second TACE sessions (57 cases, 89.1%). Overall survival rates at 1, 3 and 5 years were 95.3%, 89.1% and 75.0%, respectively, in the responder group, and these rates were much higher than those in the non-responder group (86.3%, 66.7% and 54.9%, P=10.016). In addition, the tumor-free survival rate in the responder group was also higher than in the non-responder group (P=0.009). In the responder group, a statistically improved long-term outcome was observed in patients whose HCC did not satisfy the Milan criteria (P<0.05). Univariate and multivariate Cox analyses showed that achieving CR or PR was the best predictor of survival and tumor-free survival following TACE.
Conclusion: The response to TACE, particularly following the first two sessions, primarily and robustly predicted overall and tumor-free survival in HCC patients, particularly those whose HCC did not satisfy the Milan criteria.
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