The best candidates for transarterial chemotherapy in patients with hepatocellular carcinoma awaiting liver transplantation: a cohort-based characterization of dropout times.
BACKGROUND
Although transarterial chemotherapy is used to retard tumour progression for hepatocellular carcinoma (HCC) patients awaiting orthotopic liver transplantation (OLT), information regarding the acceptable waiting time and appropriate patient selection for the therapy is lacking.


OBJECTIVE
To examine dropout times and determine the best candidates for pre-transplant transarterial therapy in a cohort study.


METHODS
In total, 180 consecutive HCC candidates receiving pre-transplant chemo-lipiodolization were included in the study.


RESULTS
Overall, 70 (38.9%) patients dropped off the waiting list during the median follow-up of 19 months. According to the Child-Pugh (C-P) classification, the estimated dropout rates at 1 and 2 years were 17.2% and 44.8% for the C-P A group and 33.4% and 81.3% for the C-P B/C group, respectively. C-P B/C patients experienced more frequent dropouts than C-P A patients (P < 0.001). Risk factor analysis identified C-P classification to be the strongest predictor of dropout (P < 0.001). On multivariate analysis, alpha-fetoprotein (AFP) >100 ng/mL, tumour size >3 cm and multiple nodules remained independently predictive of dropout for C-P A group (all P < 0.05). Candidates with none of these factors were found to be at the lowest risk of dropout, with only a 22.5% dropout rate up to 41 months.


CONCLUSIONS
This study suggests that Child-Pugh A patients with one nodule <3 cm and AFP < 100 ng/mL may be the best candidates for pre-transplant chemo-lipiodolization, with the lowest dropout rate. However, comparative studies with other therapeutic options are needed to assess the definitive role of transarterial therapy in this setting.
Jang
J W
JW
Department of Internal Medicine, College of Medicine, WHO collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea.
Choi
J Y
JY
Bae
S H
SH
Kim
C W
CW
Cho
S H
SH
Yoon
S K
SK
Yang
J M
JM
Han
J Y
JY
Lee
Y S
YS
Kim
D G
DG
D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D018450:Disease Progression; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data; D018579:Patient Selection; D012307:Risk Factors; D014850:Waiting Lists
D000903:Antibiotics, Antineoplastic; D015251:Epirubicin; D002945:Cisplatin