Efficacy and nontarget effects of transarterial chemoembolization in bridging of hepatocellular carcinoma patients to liver transplantation: a histopathologic study.
OBJECTIVE
To histologically evaluate the efficacy and nontarget effects induced by transarterial chemoembolization as a "bridge" treatment of hepatocellular carcinoma (HCC) before liver transplantation (LT) and its relation to patient survival.


METHODS
Between October 2003 and January 2011, 51 patients with HCC underwent LT after chemoembolization with iodized oil, small spherical particles, and carboplatin. The decision for LT was made according to national guidelines. The efficacy and nontarget effects of chemoembolization were determined histologically in explanted livers, and their impact on patients' survival after LT was analyzed.


RESULTS
A total of 126 chemoembolization procedures were performed in 51 patients; the median number of procedures per patient was three (range, one to six). The extent of HCC necrosis was less than or equal to 50% in 32% of treated HCCs, more than 50% and less than or equal to 90% in 17%, and more than 90%-99% in 14%; 38% showed complete necrosis of the lesion. The most common nontarget effects were focal necrosis of the liver parenchyma adjacent to the embolized HCC nodule (28%), intralesional (micro)abscess (26%), intralesional hemorrhage (22%), and peritumoral bile duct necrosis (12%). Based on histopathologic examination, 35% of patients had HCC that did not meet Milan criteria. None of these findings was significantly associated with patient survival after LT.


CONCLUSIONS
Transarterial chemoembolization induces histopathologically confirmed HCC necrosis with a high degree of efficacy, but histologically proven complete HCC necrosis was not predictive of survival in this cohort of patients. Although histopathologic examination revealed (clinically relevant) nontarget effects in a subset of patients, they did not impair survival.
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. Electronic address: ulrike.stampfl@med.uni-heidelberg.de.
Ulrike
U
Stampfl
Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Justo Lorenzo
JL
Bermejo
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, Katharinenhospital Stuttgart, Stuttgart, Germany.
Christof M
CM
Sommer
Department of General and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Katrin
K
Hoffmann
Department of Gastroenterology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Liver Cancer Center Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Karl Heinz
KH
Weiss
Liver Cancer Center Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Peter
P
Schirmacher
Department of General and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Liver Cancer Center Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Peter
P
Schemmer
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Hans-Ulrich
HU
Kauczor
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, Katharinenhospital Stuttgart, Stuttgart, Germany.
Götz M
GM
Richter
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Boris A
BA
Radeleff
Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Thomas
T
Longerich
D000368:Aged; D016190:Carboplatin / Q000008:administration & dosage* / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005858:Germany; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D007459:Iodized Oil; D016190:Carboplatin