Liver Transplantation Outcomes in a U.S. Multicenter Cohort of 789 Patients With Hepatocellular Carcinoma Presenting Beyond Milan Criteria

Autor: James F. Markmann, Amit D. Tevar, Mindie H. Nguyen, Christopher M. Jones, Sander Florman, Johnny C. Hong, Federico Aucejo, Abhinav Humar, Joohyun Kim, Abbas Rana, Jennifer Berumen, Beth Amundsen, Daniela Markovic, Richard Ruiz, Trevor L. Nydam, Michael L. Kueht, Debra L. Sudan, C. Burcin Taner, David D. Lee, Brandy Haydel, Ani Kardashian, Vatche G. Agopian, Alan Norman Langnas, Matthew H. Levine, Neeta Vachharajani, William C. Chapman, Marc L. Melcher, Goran B. Klintmalm, Maarouf Hoteit, Elizabeth C. Verna, Michael A. Zimmerman, Constance M. Mobley, Karim J. Halazun, Thomas M. Fishbein, Carol A. Carney, Ronald W. Busuttil, Mark Ghobrial, Alan W. Hemming
Rok vydání: 2020
Předmět:
Ablation Techniques
Male
0301 basic medicine
medicine.medical_specialty
Carcinoma
Hepatocellular
Tissue and Organ Procurement
Waiting Lists
medicine.medical_treatment
Liver transplantation
Milan criteria
Severity of Illness Index
Gastroenterology
Disease-Free Survival
End Stage Liver Disease
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Carcinoma
Humans
Neoplasm Staging
Retrospective Studies
Hepatology
business.industry
Liver Neoplasms
Hazard ratio
Retrospective cohort study
Middle Aged
medicine.disease
Neoadjuvant Therapy
United States
Liver Transplantation
Tumor Burden
Transplantation
030104 developmental biology
Liver
Hepatocellular carcinoma
Female
Radiotherapy
Adjuvant
030211 gastroenterology & hepatology
Neoplasm Recurrence
Local
business
Liver cancer
Follow-Up Studies
Zdroj: Hepatology. 72:2014-2028
ISSN: 1527-3350
0270-9139
DOI: 10.1002/hep.31210
Popis: The Organ Procurement and Transplantation Network recently approved liver transplant (LT) prioritization for patients with hepatocellular carcinoma (HCC) beyond Milan Criteria (MC) who are down-staged (DS) with locoregional therapy (LRT). We evaluated post-LT outcomes, predictors of down-staging, and the impact of LRT in patients with beyond-MC HCC from the U.S. Multicenter HCC Transplant Consortium (20 centers, 2002-2013).Clinicopathologic characteristics, overall survival (OS), recurrence-free survival (RFS), and HCC recurrence (HCC-R) were compared between patients within MC (n = 3,570) and beyond MC (n = 789) who were down-staged (DS, n = 465), treated with LRT and not down-staged (LRT-NoDS, n = 242), or untreated (NoLRT-NoDS, n = 82). Five-year post-LT OS and RFS was higher in MC (71.3% and 68.2%) compared with DS (64.3% and 59.5%) and was lowest in NoDS (n = 324; 60.2% and 53.8%; overall P 0.001). DS patients had superior RFS (60% vs. 54%, P = 0.043) and lower 5-year HCC-R (18% vs. 32%, P 0.001) compared with NoDS, with further stratification by maximum radiologic tumor diameter (5-year HCC-R of 15.5% in DS/5 cm and 39.1% in NoDS/5 cm, P 0.001). Multivariate predictors of down-staging included alpha-fetoprotein response to LRT, pathologic tumor number and size, and wait time12 months. LRT-NoDS had greater HCC-R compared with NoLRT-NoDS (34.1% vs. 26.1%, P 0.001), even after controlling for clinicopathologic variables (hazard ratio [HR] = 2.33, P 0.001) and inverse probability of treatment-weighted propensity matching (HR = 1.82, P 0.001).In LT recipients with HCC presenting beyond MC, successful down-staging is predicted by wait time, alpha-fetoprotein response to LRT, and tumor burden and results in excellent post-LT outcomes, justifying expansion of LT criteria. In LRT-NoDS patients, higher HCC-R compared with NoLRT-NoDS cannot be explained by clinicopathologic differences, suggesting a potentially aggravating role of LRT in patients with poor tumor biology that warrants further investigation.
Databáze: OpenAIRE
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