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.
Complete pathologic response to pretransplant locoregional therapy for hepatocellular carcinoma defines cancer cure after liver transplantation: analysis of 501 consecutively treated patients.Ann Surg. 2015 Sep;262(3):536-45; discussion 543-5. doi: 10.1097/SLA.0000000000001384. Ann Surg. 2015. PMID: 26258323
Impact of Pretransplant Bridging Locoregional Therapy for Patients With Hepatocellular Carcinoma Within Milan Criteria Undergoing Liver Transplantation: Analysis of 3601 Patients From the US Multicenter HCC Transplant Consortium.Ann Surg. 2017 Sep;266(3):525-535. doi: 10.1097/SLA.0000000000002381. Ann Surg. 2017. PMID: 28654545 Clinical Trial.
Liver Transplantation Outcomes in a U.S. Multicenter Cohort of 789 Patients with Hepatocellular Carcinoma Presenting Beyond Milan Criteria.Hepatology. 2020 Mar 2. doi: 10.1002/hep.31210. Online ahead of print. Hepatology. 2020. PMID: 32124453
Therapies for patients with hepatocellular carcinoma awaiting liver transplantation: A systematic review and meta-analysis.Hepatology. 2018 Jan;67(1):381-400. doi: 10.1002/hep.29485. Epub 2017 Nov 29. Hepatology. 2018. PMID: 28859222 Review.
Predictors of intermediate-term survival with destination locoregional therapy of hepatocellular cancer in patients either ineligible or unwilling for liver transplantation.J Gastrointest Oncol. 2017 Oct;8(5):885-889. doi: 10.21037/jgo.2017.07.05. J Gastrointest Oncol. 2017. PMID: 29184693 Free PMC article. Review.
Cited by 1 article
Recent advances in liver transplantation for cancer: The future of transplant oncology.JHEP Rep. 2019 Jul 30;1(5):377-391. doi: 10.1016/j.jhepr.2019.07.004. eCollection 2019 Nov. JHEP Rep. 2019. PMID: 32039389 Free PMC article. Review.