title: Hepatocellular carcinoma downstaging in liver transplantation.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is the leading malignant tumor in Taiwan. The majority of HCC patients are diagnosed in late stages and therefore in eligible for potentially curative treatments. Locoregional therapy has been advocated as an effective treatment for patients with advanced HCCs.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the outcomes of HCC downstaged patients after locoregional therapy to allow eligibility for liver transplantation.
  
  
  METHODS
  From January 2004 to June 2010, 161 patients with HCCs underwent liver transplantation including 51 (31.6%) who exceeded the University of California-San Francisco (UCSF) who had undergone successful locoregional therapy to be downstaged within these criteria. Among the downstaged patients, 48 (94.1%) underwent transarterial embolization; 7 (13.8%), percutaneous ethanol injection; 24 (47.1%), radiofrequency ablation; 15 (29.4%), surgical resection, and 34 (66.7%), combined treatment.
  
  
  RESULTS
  The overall 1- and 5-year survival rates of all HCC patients (n=161) were 93.2% and 80.5%. The overall 1- and 5-year survival rates of downstaged (n=51) versus non-downstaged (n=110) subjects were 94.1% versus 83.7% and 92.7% versus 78.9%, respectively (P=.727). There are 15 (9.2%) HCC recurrences. The overall 1- and 5-year tumor-free rates of all HCC patients were 94.8% and 87.2%. The overall 1- and 5-year tumor-free rates between downstaged versus non-downstaged patients were 93.9% and 90.1% versus 95.2% and 86.0%, respectively (P=.812).
  
  
  CONCLUSIONS
  Patients with advanced HCC exceeding the UCSF/Milan criteria can be downstaged to fit the criteria using locoregional therapy. Importantly, successfully downstaged patients who are transplanted show excellent tumor-free and overall survival rates, similar to fit-criteria group.
authors.affiliation: Liver Transplantation Program and Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: C-Y
authors.initials: CY
authors.lastname: Yu
authors.forename: H-Y
authors.initials: HY
authors.lastname: Ou
authors.forename: T-L
authors.initials: TL
authors.lastname: Huang
authors.forename: T-Y
authors.initials: TY
authors.lastname: Chen
authors.forename: L L-C
authors.initials: LL
authors.lastname: Tsang
authors.forename: C-L
authors.initials: CL
authors.lastname: Chen
authors.forename: Y-F
authors.initials: YF
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D000431:Ethanol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007267:Injections; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000431:Ethanol