title: Hepatocellular carcinomas within the Milan criteria: predictors of histologic necrosis after drug-eluting beads transarterial chemoembolization.
abstract: OBJECTIVE
  To evaluate pathologic, imaging, and technical predictors of therapy response in patients with hepatocellular carcinoma (HCC) within the Milan criteria undergoing doxorubicin drug-eluting beads transarterial chemoembolization (DEB-TACE) before orthotopic liver transplantation (OLT).
  
  
  METHODS
  This prospective study included consecutive patients with HCC who underwent DEB-TACE before OLT. Tumor histologic necrosis on liver explants was utilized as the standard of reference to categorize treated HCCs as group 1 (>50 % necrosis) or group 2 (≤50 % necrosis). DEB-TACE technique, histological factors, and imaging evaluation utilizing the modified Response Evaluation Criteria in Solid Tumors (mRECIST) were compared between groups 1 and 2.
  
  
  RESULTS
  Twenty-seven HCCs were identified in 23 patients. Group 1 comprised 18 HCCs (mean necrosis 86.2 %). Group 2 comprised 9 HCCs (mean necrosis 31.1 %). The mean time between the last DEB-TACE session and the OLT was 112 days. Lesion size was significantly larger in group 1 (mean 3.2 cm; 95 % confidence interval 2.55-3.85) than in group 2 (mean 2.1 cm; 95 % confidence interval 1.79-2.48) (p = 0.030). Group 1 also demonstrated a higher frequency of encapsulated lesions when compared to group 2 (78 % vs. 22 %; p = 0.0027). A significant linear correlation was found between the quantification of necrosis by imaging and pathology (p = 0.0011) using the mRECIST, with a poorer correlation index in group 2.
  
  
  CONCLUSIONS
  Larger and encapsulated HCCS are associated with a higher percentage of necrosis. A significant linear correlation between the amount of necrosis by imaging and pathology was encountered when mRECIST was utilized.
authors.affiliation: Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1471, Houston, TX, 77030-3722, USA, bcodisio@mdanderson.org.
authors.forename: Bruno C
authors.initials: BC
authors.lastname: Odisio
authors.forename: Francisco
authors.initials: F
authors.lastname: Galastri
authors.forename: Rony
authors.initials: R
authors.lastname: Avritscher
authors.forename: Breno B
authors.initials: BB
authors.lastname: Afonso
authors.forename: Vanderlei
authors.initials: V
authors.lastname: Segatelli
authors.forename: Guilherme E G
authors.initials: GE
authors.lastname: Felga
authors.forename: Paolo R O
authors.initials: PR
authors.lastname: Salvalaggio
authors.forename: Joe
authors.initials: J
authors.lastname: Ensor
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wallace
authors.forename: Felipe
authors.initials: F
authors.lastname: Nasser
mesh_terms: D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003952:Diagnostic Imaging; D004317:Doxorubicin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin