Impact of Pre-Liver Transplant Treatments on the Imaging Accuracy of HCC Staging and Their Influence on Outcomes

The outcome of liver transplantation (LT) for hepatocarcinoma (HCC) is strongly influenced by HCC staging, which is based on radiological examinations in a pre-LT setting; concordance between pre-LT radiological and definitive pathological staging remains controversial. To address this issue, we ret...

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Bibliographic Details
Published in:	Cancers 2024-03, Vol.16 (5), p.1043
Main Authors:	Franchi, Eloisa, Dondossola, Daniele Eliseo, Marini, Giulia Maria Francesca, Iavarone, Massimo, Del Prete, Luca, Di Benedetto, Clara, Donato, Maria Francesca, Antonelli, Barbara, Lampertico, Pietro, Caccamo, Lucio
Format:	Article
Language:	eng
Subjects:	Ablation Antimitotic agents Antineoplastic agents Care and treatment concordance Diagnosis hepatocarcinoma Hepatocellular carcinoma Histology Liver Liver cancer Liver diseases liver transplant Liver transplantation Medical research Medicine, Experimental Nodules Pathology Patients Radiology Statistical analysis Surveillance Survival Transplantation Transplants & implants Tumors
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Summary:	The outcome of liver transplantation (LT) for hepatocarcinoma (HCC) is strongly influenced by HCC staging, which is based on radiological examinations in a pre-LT setting; concordance between pre-LT radiological and definitive pathological staging remains controversial. To address this issue, we retrospectively analyzed our LT series to assess concordance between radiology and pathology and to explore the factors associated with poor concordance and outcomes. We included all LTs with an HCC diagnosis performed between 2013 and 2018. Concordance (Co group) was defined as a comparable tumor burden in preoperative imaging and post-transplant pathology; otherwise, non-concordance was diagnosed (nCo group). Concordance between radiology and pathology was observed in 32/134 patients (Co group, 24%). The number and diameter of the nodules were higher when nCo was diagnosed, as was the number of pre-LT treatments. Although concordance did not affect survival, more than three pre-LT treatments led to a lower disease-free survival. Patients who met the Milan Criteria (Milan-in patients) were more likely to receive ≥three prior treatments, leading to a lower survival in multi-treated Milan-in patients than in other Milan-in patients. In conclusion, the concordance rate between the pre-LT imaging and histopathological results was low in patients with a high number of nodules. Multiple bridging therapies reduce the accuracy of pre-LT imaging in predicting HCC stages and negatively affect outcomes after LT.
ISSN:	2072-6694 2072-6694