title: Pathologic response to non-surgical locoregional therapies as potential selection criteria for liver transplantation for hepatocellular carcinoma.
abstract: BACKGROUND
  Preoperative locoregional treatments (PLT) are performed to avoid progression before liver transplantation for hepatocellular carcinoma (HCC). The objective of this study was to analyze the prognostic factors affecting the outcome in patients who received PLT.
  
  
  METHODS
  A retrospective analysis of patients who underwent liver transplantation (LT) was performed. All patients who underwent PLT with confirmed pathological diagnosis of HCC were included. The rate of tumor necrosis (TN) was assessed by microscopic histological examination.
  
  
  RESULTS
  From January 1997 to December 2010, PLT was performed in 154 patients ROC analysis individuated a TN cut-off value at 40%. Ninety-one patients (59.1%) of the patients presented TN>40%. At multivariate analysis, TN<40% (HR=1.76; p=0.04) and vascular invasion (VI) (HR=2.16; p<0.01) were associated with lower Overall Survival (OS). At multivariate analysis, TN<40% (HR=1.59; p=0.001) and VI (HR=2.51; p=0.001) were significant associated with lower Disease Free Survival (DFS). One, 3 and 5 years OS was 87.9%, 82.0% and 69.1% for patients with TN>40% and 82.5%, 64.2% and 53.2% for those with TN<40% (p=0.02). Tumour size <5 cm (p=0.02); age <55 years (p=0.02); absence of VI (p=0.02) and multiple procedures (p=0.04) were predictive factors for TN>40%.
  
  
  CONCLUSIONS
  Response to preoperative locoregional treatment can be used as potential selection criteria for LT.
authors.affiliation: Department of Visceral Surgery and Multi-Organ Transplantation, University of Strasbourg, Strasbourg, France.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Cantu
authors.forename: Tullio
authors.initials: T
authors.lastname: Piardi
authors.forename: Daniele
authors.initials: D
authors.lastname: Sommacale
authors.forename: Bernard
authors.initials: B
authors.lastname: Ellero
authors.forename: Marie Lorraine
authors.initials: ML
authors.lastname: Woehl-Jaegle
authors.forename: Maxime
authors.initials: M
authors.lastname: Audet
authors.forename: Dimitri
authors.initials: D
authors.lastname: Ntourakis
authors.forename: Philippe
authors.initials: P
authors.lastname: Wolf
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies