Liver transplant mortality and morbidity following preoperative radiotherapy for hepatocellular carcinoma
| Autor: | Stephen Abel, N. Thai, Alexander V. Kirichenko, Tadahiro Uemura, Shaakir Hasan, Vivek Verma, Joseph M. Herman, Eugene J. Koay |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Carcinoma Hepatocellular medicine.medical_treatment Gastroenterology 03 medical and health sciences 0302 clinical medicine Internal medicine Carcinoma Humans Medicine Chemoembolization Therapeutic Stage (cooking) Retrospective Studies Hepatology business.industry Mortality rate Liver Neoplasms Retrospective cohort study medicine.disease Liver Transplantation Radiation therapy Transplantation 030220 oncology & carcinogenesis Hepatocellular carcinoma Propensity score matching 030211 gastroenterology & hepatology Morbidity business |
| Zdroj: | HPB. 22:770-778 |
| ISSN: | 1365-182X |
| DOI: | 10.1016/j.hpb.2019.10.006 |
| Popis: | Background Radiotherapy (RT) can be used for tumor downstaging and as a bridge to transplantation in hepatocellular carcinoma (HCC), but its effect on surgical complications is unknown. Therefore, we investigated post-transplant mortality and acute readmission rates in HCC with and without preoperative RT using the National Cancer Database (NCDB). Methods After exclusion, 11,091 transplant patients were analyzed, 165 of whom received RT prior to transplant. Multivariable binomial logistic regression analysis identified characteristics associated with use of RT, and factors associated with increased 30/90-day mortality and 30-day readmission, following propensity matching. Results Although RT (median 40 Gy in 5 fractions) was more often delivered to larger tumors and advanced stages, it resulted in 59% downstaging rate, 39% pathologic complete response rate, and a median of 4 additional months to transplantation. Crude 30/90-day mortality rates were both 1.2% with preoperative RT, compared to 2.7% and 4.4% without. The 30-day readmission rate was 5.5% with RT and 10.7% without it. Propensity matched analysis demonstrated no statistical differences in 30/90-day mortality and a lower 30-day readmission rate with preoperative RT. Age >58, stage III disease, lack of transarterial chemoembolization, and shorter time to transplant independently predicted higher 90-day mortality. Conclusion Preoperative RT for HCC did not increase postoperative mortality or length of stay following liver transplant. |
| Databáze: | OpenAIRE |
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