Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging

Prospective study of 200 patients with hepatocellular carcinoma (HCC) that underwent liver transplant (LT) after drug-eluting beads transarterial chemoembolization (DEB-TACE) for downstaging versus bridging. Overall survival and tumor recurrence rates were calculated, eligibility for LT, time on the...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2019-10, Vol.25 (37), p.5687-5701
Main Authors: Affonso, Breno Boueri, Galastri, Francisco Leonardo, da Motta Leal Filho, Joaquim Mauricio, Nasser, Felipe, Falsarella, Priscila Mina, Cavalcante, Rafael Noronha, de Almeida, Marcio Dias, Felga, Guilherme Eduardo Gonçalves, Valle, Leonardo Guedes Moreira, Wolosker, Nelson
Format: Article
Language:English
Subjects:
Adult
Aged
Antineoplastic Agents - administration & dosage
Carcinoma, Hepatocellular - mortality
Carcinoma, Hepatocellular - pathology
Carcinoma, Hepatocellular - therapy
Chemoembolization, Therapeutic - methods
Disease-Free Survival
Female
Humans
Kaplan-Meier Estimate
Liver Neoplasms - mortality
Liver Neoplasms - pathology
Liver Neoplasms - therapy
Liver Transplantation - standards
Liver Transplantation - statistics & numerical data
Male
Middle Aged
Neoadjuvant Therapy - methods
Neoplasm Recurrence, Local - epidemiology
Neoplasm Recurrence, Local - prevention & control
Neoplasm Staging
Postoperative Period
Prospective Studies
Prospective Study
Time Factors
Treatment Outcome
Waiting Lists
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Summary:Prospective study of 200 patients with hepatocellular carcinoma (HCC) that underwent liver transplant (LT) after drug-eluting beads transarterial chemoembolization (DEB-TACE) for downstaging versus bridging. Overall survival and tumor recurrence rates were calculated, eligibility for LT, time on the waiting list and radiological response were compared. After TACE, only patients within Milan Criteria (MC) were transplanted. More patients underwent LT in bridging group. Five-year post-transplant overall survival, recurrence-free survival has no difference between the groups. Complete response was observed more frequently in bridging group. Patients in DS group can achieve post-transplant survival and HCC recurrence-free probability, at five years, just like patients within MC in patients undergoing DEB-TACE. To determine long-term outcomes of patients with HCC that underwent LT after DEB-TACE for downstaging bridging. Prospective cohort study of 200 patients included from April 2011 through June 2014. Bridging group included patients within MC. Downstaging group (out of MC) was divided in 5 subgroups (G1 to G5). Total tumor diameter was ≤ 8 cm for G1, 2, 3, 4 ( = 42) and was > 8 cm for G5 ( = 22). Downstaging ( = 64) and bridging ( = 136) populations were not significantly different. Overall survival and tumor recurrence rates were calculated by the Kaplan-Meier method. Additionally, eligibility for LT, time on the waiting list until LT and radiological response were compared. After TACE, only patients within MC were transplanted. More patients underwent LT in bridging group 65.9% ( = 0.001). Downstaging population presented: higher number of nodules 2.81 ( = 0.001); larger total tumor diameter 8.09 ( = 0.001); multifocal HCC 78% ( = 0.001); more post-transplantation recurrence 25% ( = 0.02). Patients with maximal tumor diameter up to 7.05 cm were more likely to receive LT ( = 0.005). Median time on the waiting list was significantly longer in downstaging group 10.6 mo ( = 0.028). Five-year post-transplant overall survival was 73.5% in downstaging and 72.3% bridging groups ( = 0.31), and recurrence-free survival was 62.1% in downstaging and 74.8% bridging groups ( = 0.93). Radiological response: complete response was observed more frequently in bridging group ( = 0.004). Tumors initially exceeding the MC down-staged after DEB-TACE, can achieve post-transplant survival and HCC recurrence-free probability, at five years, just like patients within MC in patient
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v25.i37.5687