title: Role of Transarterial Chemoembolization to Downstage Hepatocellular Carcinoma Within the Milan Criteria.
abstract: The practice of treating candidates for liver transplantation (LT) for hepatocellular carcinoma (HCC), with locoregional therapies, is common in most transplantation centers. We present our results using transarterial chemoembolization (TACE) as a neo-adjuvant treatment in our center between 2002 and 2013 to determine its effectiveness in downstaging (DS) HCC within the Milan criteria (MC). Clinical variables were recorded of both donors and recipients, such as diagnosis and treatment, variables related to its etiology, the use of TACE as a neo-adjuvant treatment, immunosuppressive therapy, toxicity, recurrence of disease, exitus, and others. Sixty-four patients were analyzed. Median age was 57 (range, 51-64) years. In this study, 84% (54) were male and 16% (10) were women. Etiology of HCC was viral in 47% (30), alcoholic in 25% (16), and other in 28% (18). TACE was conducted in 45 patients (70%). Every patient included in our study presented a T2 stage (of tumor-nodes-metastasis [TNM]) before surgery, thus within the MC. However, DS protocol was performed in 5 patients (7.8%). We performed a bivariate analysis, having assessed that the use of TACE decreases T2 stage into T1-T0 stage (P < .05). We have also calculated the recurrence-free survival, which reaches up to 80% to 125 months. Furthermore, even though the statistical differences are not consistent due to the simple size presented, we conclude that TACE is a safe and effective therapy to control HCC progression during the waiting list time.
authors.affiliation: General, Digestive Surgery and Liver Transplantation Department, Virgen de las Nieves University Hospital (University Hospital Centre of Granada), Granada, Spain. Electronic address: sanmiguel.carlos@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: San Miguel
authors.affiliation: General, Digestive Surgery and Liver Transplantation Department, Virgen de las Nieves University Hospital (University Hospital Centre of Granada), Granada, Spain.
authors.forename: K
authors.initials: K
authors.lastname: Muffak
authors.affiliation: General, Digestive Surgery and Liver Transplantation Department, Virgen de las Nieves University Hospital (University Hospital Centre of Granada), Granada, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Triguero
authors.affiliation: General, Digestive Surgery and Liver Transplantation Department, Virgen de las Nieves University Hospital (University Hospital Centre of Granada), Granada, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Becerra
authors.affiliation: General, Digestive Surgery and Liver Transplantation Department, Virgen de las Nieves University Hospital (University Hospital Centre of Granada), Granada, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Villegas
authors.affiliation: Hepatology Department, Virgen de las Nieves University Hospital (University Hospital Centre of Granada), Granada, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Nogueras
authors.affiliation: Department of Research, Virgen de las Nieves University Hospital (University Hospital Centre of Granada), Granada, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Expósito
authors.affiliation: General, Digestive Surgery and Liver Transplantation Department, Virgen de las Nieves University Hospital (University Hospital Centre of Granada), Granada, Spain.
authors.forename: Y
authors.initials: Y
authors.lastname: Fundora
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014850:Waiting Lists