Transarterial chemoembolization before liver transplantation in 60 patients with hepatocellular carcinoma.
Tumor recurrence is a major problem after orthotopic liver transplantation (OLT) in patients with hepatocellular carcinoma (HCC). In 60 patients OLT was performed for HCC after pretreatment by repeated transarterial chemoembolization (TACE). Forty-four recipients exceeded the Milan criteria. Recurrence-free 5-year survival was 65.2% and 5-year freedom from recurrence was 73.2%. During the waiting time, 14 patients experienced minimal change, which did not fulfill the definition of tumor progression according to official oncological criteria. Five-year freedom from recurrence among patients with stable compared with progressive disease was 93.3% versus 28.1%, respectively (P = .0001). A strict TACE pretreatment protocol may select patients with obviously biologically less aggressive tumors, who are suitable for OLT even if the HCC exceeds the commonly accepted listing criteria.
Otto
G
G
Department of Transplantation and Hepatobiliary Surgery, Mainz, Germany. otto@transplantation.klinik.uni-mainz.de
Heise
M
M
Moench
C
C
Herber
S
S
Bittinger
F
F
Schuchmann
M
M
Hoppe-Lotichius
M
M
Pitton
M
M
D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D018572:Disease-Free Survival; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D018579:Patient Selection; D011300:Preoperative Care; D012008:Recurrence; D016019:Survival Analysis; D013997:Time Factors