Patients without hepatocellular carcinoma progression after transarterial chemoembolization benefit from liver transplantation.
OBJECTIVE
To assess the outcome of patients, who underwent transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) and subsequently liver transplantation (OLT) irrespective of tumor size when no tumor progression was observed.


METHODS
Records, imaging studies and pathology of 84 patients with HCC were reviewed. Ten patients were not treated at all, 67 patients had TACE and 35 of them were listed for OLT. Tumor progression was monitored by ultrasound and AFP level every 6 wk. Fifteen patients showed signs of tumor progression without transplantation. The remaining 20 patients underwent OLT. Further records of 7 patients with HCC seen in histological examination after OLT were included.


RESULTS
The patients after TACE without tumor progression underwent transplantation and had a median survival of 92.3 mo. Patients, who did not qualify for liver transplantation or had signs of tumor progression had a median survival of 8.4 mo. The patients without treatment had a median survival of 3.8 mo. Independent of International Union Against Cancer (UICC) stages, the patients without tumor progression and subsequent OLT had longer median survival. No significant difference was seen in the OLT treated patients if they did not fulfill the Milan criteria.


CONCLUSIONS
Selection of patients for OLT based on tumor progression results in good survival. The evaluation of HCC patients should not only be based on tumor size and number of foci but also on tumor progression and growth behavior under therapy.
Obed
Aiman
A
Department of Surgery, University of Regensburg, Regensburg 93053, Germany.
Beham
Alexander
A
Püllmann
Kerstin
K
Becker
Heinz
H
Schlitt
Hans J
HJ
Lorf
Thomas
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis