Bland embolization versus chemoembolization of hepatocellular carcinoma before transplantation

There is conflicting literature regarding the superiority of transarterial chemoembolization (TACE) versus bland transarterial embolization (TAE), and this has not been well studied before transplantation. Twenty‐five TAE patients were matched in a 1:2 ratio with TACE patients by the initial radiogr...

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Published in:Liver transplantation 2014-05, Vol.20 (5), p.536-543
Main Authors: Kluger, Michael D., Halazun, Karim J., Barroso, Ryan T., Fox, Alyson N., Olsen, Sonja K., Madoff, David C., Siegel, Abby B., Weintraub, Joshua L., Sussman, Jonathan, Brown, Robert S., Cherqui, Daniel, Emond, Jean C.
Format: Article
Language:English
Subjects:
Adult
Aged
Carcinoma, Hepatocellular - surgery
Case-Control Studies
Chemoembolization, Therapeutic - methods
Disease-Free Survival
End Stage Liver Disease - surgery
Female
Humans
Kaplan-Meier Estimate
Liver Neoplasms - surgery
Liver Transplantation - methods
Male
Middle Aged
Neoplasm Recurrence, Local
Retrospective Studies
Time Factors
Treatment Outcome
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Summary:There is conflicting literature regarding the superiority of transarterial chemoembolization (TACE) versus bland transarterial embolization (TAE), and this has not been well studied before transplantation. Twenty‐five TAE patients were matched in a 1:2 ratio with TACE patients by the initial radiographic tumor size and number in a retrospective, case‐controlled study. The patients were otherwise treated according to the same protocols. The method of embolization was chosen on the basis of interventionalist practices at 2 sites within the program. Kaplan‐Meier survival analyses at 1 and 3 years were the primary endpoints. There were no significant demographic differences between the groups. The mean adjusted Model for End‐Stage Liver Disease scores at transplantation and waiting times were not significantly different between the TAE and TACE patients (MELD scores: 26 ± 3 versus 24 ± 3 points, P = 0.12; waiting times: 13 ± 8 versus 11 ± 10 months, P = 0.43). TAE patients (16%) were less likely than TACE patients (40%) to require 2 procedures (P = 0.04). Explant tumors were completely necrotic for 36% of the TAE patients and for 26% of the TACE patients. The 3‐year overall survival rates were 78% for the TAE patients and 74% for the TACE patients (P = 0.66), and the 3‐year recurrence‐free survival rates were 72% for the TAE patients and 68% for the TACE patients (P = 0.67). On an intention‐to‐treat basis, there was no significant risk of wait‐list dropout associated with TAE or TACE (P = 0.83). In conclusion, there were no significant differences in wait‐list dropout or in overall or recurrence‐free survival between HCC patients undergoing TAE and HCC patients undergoing TACE before transplantation. Liver Transpl 20:536–543, 2014. © 2014 AASLD.
ISSN:1527-6465
1527-6473
DOI:10.1002/lt.23846