title: Impact of multiple transarterial chemoembolization treatments on hepatocellular carcinoma for patients awaiting liver transplantation.
abstract: Transarterial chemoembolization (TACE) is a common treatment for patients with hepatocellular carcinoma (HCC) who are awaiting liver transplantation (LT). The aim of this study was to assess the impact of multiple TACE treatments on tumor necrosis, tumor recurrence, and survival in these patients. A retrospective analysis was performed for 104 consecutive patients undergoing LT for HCC from January 2002 to December 2009 who were treated with TACE before LT. The number of TACE treatments was not associated with tumor necrosis in the explant. After a median follow-up of 69 months (range = 0-123 months), 14 of the 104 patients (13%) developed recurrent HCC after LT. Recurrence had a significant relationship with a short interval between the diagnosis of HCC and LT (≤6 months) in univariate and multivariate analyses [P = 0.029, odds ratio (OR) = 19.2]. Patients subjected to a single TACE treatment were more likely to experience recurrence, although this finding was not confirmed in the multivariate analysis. No significant relationship was observed between tumor necrosis in the explant and recurrence. The mean overall survival was 102.8 months (95% confidence interval = 94.9-110.8 months) with 1-, 3-, and 5-year survival rates of 91%, 89%, and 84% respectively. In the univariate survival analysis, the presence of ascites before TACE, a waiting time ≤ 9 months, and tumor characteristics at the pathological examination were statistically associated with shorter survival. In the multivariate analysis, only vascular invasion (P < 0.001, OR = 7.99) remained independently associated with shorter survival. The number of TACE treatments was not associated with survival. In conclusion, multiple TACE treatments were not associated with a higher risk of recurrence or shorter survival. Continued use of TACE should be considered as indicated if the patient and lesions are suitable for retreatment. A shorter waiting time before LT is related to an increased risk of recurrence and decreased survival after LT for HCC. These data could reflect the presence of more aggressive tumor biology and may be useful for guiding organ allocation policy to consider a minimum observation period before LT for regions with shorter wait times.
authors.affiliation: Department of Internal Medicine and Gastroenterology, University of Bologna, Sant'Orsola-Malpighi Polyclinic, Bologna, Italy; Division of Transplant Surgery, William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Terzi
authors.forename: W
authors.initials: W
authors.lastname: Ray Kim
authors.forename: William
authors.initials: W
authors.lastname: Sanchez
authors.forename: Michael R
authors.initials: MR
authors.lastname: Charlton
authors.forename: Paul
authors.initials: P
authors.lastname: Schmeltzer
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Gores
authors.forename: James C
authors.initials: JC
authors.lastname: Andrews
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Smyrk
authors.forename: Julie K
authors.initials: JK
authors.lastname: Heimbach
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000473:pathology*; D006528:Carcinoma, Hepatocellular / Q000601:surgery* / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000601:surgery* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis / Q000473:pathology; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult