title: Response to preoperative chemoembolization correlates with outcome after liver transplantation in patients with hepatocellular carcinoma.
abstract: Patients with small hepatocellular carcinoma (HCC) can be cured by liver transplantation (LT). However, many patients drop out during the waiting time as a result of tumor progression. We prospectively investigated the effect of transarterial chemoembolization on long-term survival of 116 patients with HCC listed for LT. Intention-to-treat analysis revealed that patients with either complete or partial response to therapy (no vital tumor or devascularization of > or =30%, respectively) as assessed by computed tomographic scan before LT had far better 1-, 2-, and 5-year survival rates (100, 93.2, and 85.7%; and 93.8, 83.6, and 66.2%, respectively) compared with those with no response or with tumor progression (82.4, 50.7, and 19.3%). Posttransplant survival analysis showed a marked survival benefit according to transarterial chemoembolization response: patients with complete or partial response had 1-, 2-, and 5-year survival rates of 89.1, 85.1, and 85.1%, and 88.6, 77.4, and 63.9%, respectively, compared with 68.6, 51.4, and 51.4% for patients whose disease did not respond to therapy. Subgroup analysis, however, showed that these benefits were only seen in patients whose disease met the Milan criteria, but not in disease exceeding the Milan criteria but fitting the expanded University of California at San Francisco criteria. These patients were also more likely to drop out as a result of tumor progression while waiting for LT (dropout rate 12.1 vs. 2.9%) and to develop recurrent HCC (21.6 vs. 7.6%). Downstaged patients did even worse, with a dropout rate of 26.7% and a 5-year survival rate of only 25%. In conclusion, the response to preoperative chemoembolization may predict long-term outcome after LT.
authors.affiliation: Divisions of Gastroenterology and Hepatology, Medical University of Innsbruck, Austria.
authors.forename: Gunda
authors.initials: G
authors.lastname: Millonig
authors.forename: Ivo W
authors.initials: IW
authors.lastname: Graziadei
authors.forename: Martin C
authors.initials: MC
authors.lastname: Freund
authors.forename: Werner
authors.initials: W
authors.lastname: Jaschke
authors.forename: Sylvia
authors.initials: S
authors.lastname: Stadlmann
authors.forename: Ruth
authors.initials: R
authors.lastname: Ladurner
authors.forename: Raimund
authors.initials: R
authors.lastname: Margreiter
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Vogel
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011300:Preoperative Care; D015996:Survival Rate; D016896:Treatment Outcome; D014850:Waiting Lists