Pathologic Response to Pretransplant Locoregional Therapy is Predictive of Patient Outcome After Liver Transplantation for Hepatocellular Carcinoma
| Autor: | Constance M. Mobley, Maarouf Hoteit, Debra L. Sudan, David D. Lee, Thomas M. Fishbein, Carol A. Carney, Michael L. Kueht, Alan W. Hemming, Vatche G. Agopian, Karim J. Halazun, Federico Aucejo, Matthew H. Levine, Johnny C. Hong, Amit D. Tevar, Sander Florman, Joseph DiNorcia, Alan N. Langnas, James F. Markmann, Abbas Rana, Goran B. Klintmalm, Joohyun Kim, Elizabeth C. Verna, Richard Ruiz, C. Burcin Taner, Trevor L. Nydam, Beth Amundsen, Mindie H. Nguyen, Abhinav Humar, Ronald W. Busuttil, Neeta Vachharajani, Daniela Markovic, Parissa Tabrizian, Marc L. Melcher, Srinath Senguttuvan, William C. Chapman, Jennifer Berumen, R. Mark Ghobrial, Brandy Haydel, Michael A. Zimmerman, Christopher M. Jones |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Carcinoma Hepatocellular Time Factors medicine.medical_treatment education Milan criteria Liver transplantation Risk Assessment Gastroenterology 03 medical and health sciences Liver disease 0302 clinical medicine Risk Factors Internal medicine medicine Carcinoma Humans Neoadjuvant therapy Survival analysis business.industry Liver Neoplasms Middle Aged medicine.disease Survival Analysis Neoadjuvant Therapy United States Liver Transplantation Tumor Burden 030220 oncology & carcinogenesis Hepatocellular carcinoma Cohort Disease Progression Female 030211 gastroenterology & hepatology Surgery Neoplasm Recurrence Local business |
| Zdroj: | Annals of Surgery. 271:616-624 |
| ISSN: | 1528-1140 0003-4932 |
| DOI: | 10.1097/sla.0000000000003253 |
| Popis: | OBJECTIVE The aim of the study was to determine the rate, predictors, and impact of complete pathologic response (cPR) to pretransplant locoregional therapy (LRT) in a large, multicenter cohort of hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT). BACKGROUND LRT is used to mitigate waitlist dropout for patients with HCC awaiting LT. Degree of tumor necrosis found on explant has been associated with recurrence and overall survival, but has not been evaluated in a large, multicenter study. METHODS Comparisons were made among patients receiving pre-LT LRT with (n = 802) and without (n = 2637) cPR from the United States Multicenter HCC Transplant Consortium (UMHTC), and multivariable predictors of cPR were identified using logistic regression. RESULTS Of 3439 patients, 802 (23%) had cPR on explant. Compared with patients without cPR, cPR patients were younger; had lower Model for End-stage Liver Disease (MELD) scores, AFP levels, and neutrophil-lymphocyte ratios (NLR); were more likely to have tumors within Milan criteria and fewer LRT treatments; and had significantly lower 1-, 3-, and 5-year incidence of post-LT recurrence (1.3%, 3.5%, and 5.2% vs 6.2%, 13.5%, and 16.4%; P < 0.001) and superior overall survival (92%, 84%, and 75% vs 90%, 78%, and 68%; P < 0.001). Multivariable predictors of cPR included age, sex, liver disease diagnosis, MELD, AFP, NLR, radiographic Milan status, and number of LRT treatments (C-statistic 0.67). CONCLUSIONS For LT recipients with HCC receiving pretransplant LRT, achieving cPR portends significantly lower posttransplant recurrence and superior survival. Factors predicting cPR are identified, which may help prioritize patients and guide LRT strategies to optimize posttransplant cancer outcomes. |
| Databáze: | OpenAIRE |
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