title: Impact of neoadjuvant transarterial chemoembolization on tumor recurrence and patient survival after liver transplantation for hepatocellular carcinoma: a retrospective analysis.
abstract: Transarterial chemoembolization (TACE) has gained wide acceptance as a bridge to liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Aim of this analysis was to compare long-term results with and without neoadjuvant TACE and to identify subgroups, which particularly benefit from TACE. Patients with HCC transplanted at our center were retrospectively analyzed. The following were excluded to increase consistency: incidental-HCC, Child-C, living-related-LT, other HCC-specific-treatment. Of 336 patients, 177 were subject of this analysis, 71 received TACE and 106 no HCC therapy. Patients with and without TACE showed similar five-yr survival (73/67%) and recurrence rates (23/29%). Progression on the waiting list was associated with a higher recurrence rate in the TACE (50 vs.12%) and the non-TACE group (40 vs. 22%). HCC recurrence was reduced in patients inside Milan (0.053) and UCSF (0.037) criteria by neoadjuvant TACE but not outside UCSF (0.99). Also a trend towards an improved survival was seen within these criteria. Our large single center experience suggests that TACE lowers the HCC recurrence rate in patients inside the Milan and UCSF criteria. Moreover, the response to TACE is a good indicator of low recurrence rates. The effect of TACE might be more pronounced in patients with longer waiting time than in this cohort (mean, 4.6 months).
authors.affiliation: Department of General-, Visceral and Transplantation Surgery, Charité Campus Virchow, Berlin, Germany. daniel.seehofer@charite.de
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
authors.forename: Maxim
authors.initials: M
authors.lastname: Nebrig
authors.forename: Timm
authors.initials: T
authors.lastname: Denecke
authors.forename: Thomas
authors.initials: T
authors.lastname: Kroencke
authors.forename: Wilko
authors.initials: W
authors.lastname: Weichert
authors.forename: Martin
authors.initials: M
authors.lastname: Stockmann
authors.forename: Rajan
authors.initials: R
authors.lastname: Somasundaram
authors.forename: Eckart
authors.initials: E
authors.lastname: Schott
authors.forename: Gero
authors.initials: G
authors.lastname: Puhl
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate