Excellent post-transplant survival in patients with intermediate stage hepatocellular carcinoma responding to neoadjuvant therapy
| Autor: | Stefan Schneeberger, Reto Bale, Bernhard Glodny, Manuel Maglione, Anna Luger, Anja Vikoler, Wolfgang Vogel, Ivo Graziadei, Kerstin Mülleder, Herbert Tilg, Patrizia Moser, Armin Finkenstedt, Johannes Petersen, Heinz Zoller, Manuela Portenkirchner, Christian Margreiter, Martin C. Freund |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Oncology medicine.medical_specialty Carcinoma Hepatocellular medicine.medical_treatment Kaplan-Meier Estimate Milan criteria Liver transplantation 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans Stage (cooking) Survival rate Neoadjuvant therapy Aged Retrospective Studies Hepatology business.industry Graft Survival Liver Neoplasms Middle Aged medicine.disease Neoadjuvant Therapy Liver Transplantation Survival Rate Transplantation Austria 030220 oncology & carcinogenesis Hepatocellular carcinoma Multivariate Analysis Disease Progression Female 030211 gastroenterology & hepatology Neoplasm Grading Neoplasm Recurrence Local business Progressive disease |
| Zdroj: | Liver International. 36:688-695 |
| ISSN: | 1478-3223 |
| Popis: | Background & Aims Current treatment guidelines preclude liver transplantation for patients with BCLC B (intermediate stage) HCC, and expanding transplantation criteria for selected patients beyond early stage HCC remains controversial. The aim of this study was to determine stage-dependent HCC recurrence and overall survival rates in transplant recipients and the impact of response to neoadjuvant treatment on outcome. Methods The CT/MRI scans of patients who underwent liver transplantation for HCC at our transplant centre during a time period of 12 years were reviewed by two radiologists to assess tumour stage and response to neoadjuvant treatment according to mRECIST. Results Of 174 HCC patients, 48 (28%) were BCLC intermediate stage. Neoadjuvant treatment was performed in 94% of patients. When patients were stratified according to tumour stage, no significant difference in overall survival was observed between very early or early and intermediate stage. When stratified according to treatment response, patients with complete response had a 5-year overall survival of 87%, which was significantly higher than in patients with progressive disease (62%, P = 0.02). HCC recurrence in intermediate stage patients without disease progression after neoadjuvant treatment was equal to that in patients with very early or early stage HCC. Tumour grading, histological and radiological evidence of vascular invasion, but not tumour stage were identified as independent risk factors for HCC recurrence. Conclusions Liver transplantation may be an option for selected patients with BCLC intermediate stage HCC and complete response after neoadjuvant treatment because of excellent long-term survival and low recurrence rates. |
| Databáze: | OpenAIRE |
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