title: Pre-liver transplantation locoregional adjuvant therapy for hepatocellular carcinoma as a strategy to improve longterm survival.
abstract: BACKGROUND
  Preorthotopic liver transplantation locoregional therapy (LRT) for hepatocellular carcinoma (HCC) reduces drop-out rates in patients awaiting orthotopic liver transplantation (OLT). In this study, we investigated the efficacy of LRT as a strategy to improve longterm survival after transplantation.
  
  
  METHODS
  A retrospective analysis of prospectively collected data identified 100 patients with HCC who underwent OLT between 1985 and 2005. Of these, 46 received LRT in the form of transarterial chemoembolization, radiofrequency ablation, percutaneous ethanol injection, or a combination of these.
  
  
  RESULTS
  The 1-, 3-, and 5-year survivals, regardless of LRT, were 81.3%, 66.1%, and 61.3%, respectively. Demographic data and waiting time for OLT were similar between LRT and untreated groups. Pre-OLT radiologic stage was comparable (LRT: 2.11 +/- 0.74 versus Untreated: 2.39 +/- 0.94; p = 0.16). At the time of transplantation, the LRT group had notable tumor downstaging (1.50 +/- 1.34 versus 2.49 +/- 1.17; p = 0.008). The LRT group had better 5-year survival (82.4% versus 51.8%; p = 0.01), but this improvement was observed in patients with HCC stages II, III, and IV (77.6% versus 37.4%; p = 0.016). Sixteen LRT patients, and none untreated, revealed complete tumor necrosis with no viable tumor cells on explant pathology (pT0). These patients did not experience any longterm recurrence, in contrast to those with similar pre-OLT tumors.
  
  
  CONCLUSIONS
  OLT is a viable treatment option for primary HCC. LRT substantially downstages the primary tumor and improves longterm survival in patients with advanced disease. Complete tumor necrosis with LRT is associated with excellent longterm recurrence-free survival.
authors.affiliation: Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, 660 S, Euclid Avenue, St Louis, MO 63110, USA.
authors.forename: Ankit
authors.initials: A
authors.lastname: Bharat
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Brown
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Crippin
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Gould
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Lowell
authors.forename: Surendra
authors.initials: S
authors.lastname: Shenoy
authors.forename: Niraj M
authors.initials: NM
authors.lastname: Desai
authors.forename: William C
authors.initials: WC
authors.lastname: Chapman
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D015331:Cohort Studies; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012189:Retrospective Studies; D012997:Solvents / Q000008:administration & dosage; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D012997:Solvents; D000431:Ethanol