title: Does pathological response after transarterial chemoembolization for hepatocellular carcinoma in cirrhotic patients with cirrhosis predict outcome after liver resection or transplantation?
abstract: OBJECTIVE
  To investigate the prognostic significance of pathologic response (PR) after transarterial chemoembolization (TACE) in cirrhotic patients resected or transplanted for hepatocellular carcinoma (HCC), and to identify predictors of complete pathologic response (CPR).
  
  
  METHODS
  Between 1990 and 2010, 373 consecutive cirrhotic patients with HCC were treated by TACE followed by either liver resection (LR:184 patients) or liver transplantation (LT:189 patients). The PR was evaluated as the mean percentage of non-viable tumor area within each tumor. CPR was defined as the absence of any viable tumor area in all the present nodules.
  
  
  RESULTS
  A total of 59 (32%) and 37 (20%) patients had CPR after LR and LT, respectively. Five-year overall survival (OS) was higher in patients with CPR compared to those without, after LR (58% vs. 34%; p=0.0006) and tends to be higher after LT (84% vs. 65%; p=0.09). The 5-year recurrence-free survival (RFS) rates were significantly higher in both groups (24% vs. 13% after LR; p=0.008 and 94% vs. 73% after LT, p=0.007). A cut-off value of >90% necrosis emerged as an impacting factor on patient survival after LR or LT. On multivariate analysis stratified on the type of procedure (LR or LT), PR >90% remained an independent factor of better OS and RFS. Independent factors associated with CPR were: a maximal tumor size <30 mm (RR 2.17 [1.27-3.74]), a single tumor (RR 6.08 [3.29-12.07]), and an preoperative AFP<100 ng/ml (see results section) (RR 3.99 [1.63-11.98]). The probability to achieve a CPR ranged from 2% in the absence of any factors to 48% in the presence of all factors.
  
  
  CONCLUSIONS
  In cirrhotic patients with HCC, a complete or nearly complete PR improves long-term survival after LR and LT independently of other pathological factors. This underlines the importance of neoadjuvant treatment to obtain a significant decrease of active tumor load.
authors: Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; UMR-S776 Inserm, Villejuif, France.
authors: Marc-Antoine
authors: MA
authors: Allard
authors: Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; Departement of Pathology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France; UMR-S785 Inserm, Villejuif, France.
authors: Mylène
authors: M
authors: Sebagh
authors: University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Aldrick
authors: A
authors: Ruiz
authors: Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; Departement of Pathology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France; UMR-S785 Inserm, Villejuif, France.
authors: Catherine
authors: C
authors: Guettier
authors: Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France.
authors: Bernard
authors: B
authors: Paule
authors: Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; UMR-S785 Inserm, Villejuif, France.
authors: Eric
authors: E
authors: Vibert
authors: Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; UMR-S776 Inserm, Villejuif, France.
authors: Antonio Sa
authors: AS
authors: Cunha
authors: Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; UMR-S785 Inserm, Villejuif, France.
authors: Daniel
authors: D
authors: Cherqui
authors: Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; UMR-S785 Inserm, Villejuif, France.
authors: Didier
authors: D
authors: Samuel
authors: Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France.
authors: Henri
authors: H
authors: Bismuth
authors: Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; UMR-S785 Inserm, Villejuif, France.
authors: Denis
authors: D
authors: Castaing
authors: Centre Hépato-biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France; UMR-S776 Inserm, Villejuif, France. Electronic address: rene.adam@pbr.aphp.fr.
authors: René
authors: R
authors: Adam
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007269:Injections, Intra-Arterial; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Hepatocellular carcinoma; Liver resection; Liver transplantation; Pathologic response; Transarterial chemoembolization