title: Bridging Locoregional Therapy Prolongs Survival in Patients Listed for Liver Transplant with Hepatocellular Carcinoma.
abstract: OBJECTIVE
  To evaluate the long-term survival benefit of bridging locoregional therapy (LRT) prior to orthotopic liver transplantation (OLT) in patients with hepatocellular carcinoma (HCC) within Milan criteria.
  
  
  METHODS
  Our transplant center registry was studied for all HCC patients within the Milan criteria who were listed for OLT from 1998 to 2013. Baseline clinical characteristics and median overall survival (OS) were calculated and stratified by LRT, OLT status, and wait times. Survival analysis was conducted using Kaplan-Meier estimation and log-rank test.
  
  
  RESULTS
  Of 265 listed, 205 underwent OLT (mean follow-up 7.6 years). Of 205, 111 received bridging LRT (A), and 94 did not (B). Both were similar in demographics and tumor characteristics (p > 0.05). Median OS from HCC for A/B were 86.4 vs. 68.9 months (p = 0.01). Median OS from OLT for A/B were 74.6 vs. 63.6 months (p = 0.03). On multivariate analysis, independent predictors for survival from HCC were bridging LRT (p = 0.002) and high wait time (p = 0.008); independent predictors for survival from OLT were bridging LRT (p = 0.005) and high wait time (p = 0.005). Of 60 who were listed but did not undergo transplant, 44 received LRT (C) and 16 received best supportive care (D). Median OS from HCC for C/D were 37.1 vs. 24.8 months (p = 0.03).
  
  
  CONCLUSIONS
  Bridging LRT and high wait times were independent positive prognostic factors for survival from HCC diagnosis and OLT.
authors.affiliation: Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, P.O. Box 208042, New Haven, CT, 06510, USA.
authors.forename: Minzhi
authors.initials: M
authors.lastname: Xing
authors.affiliation: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Sonali
authors.initials: S
authors.lastname: Sakaria
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Renumathy
authors.initials: R
authors.lastname: Dhanasekaran
authors.affiliation: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Parekh
authors.affiliation: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Spivey
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Knechtle
authors.affiliation: Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Di
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, P.O. Box 208042, New Haven, CT, 06510, USA. kevin.kim@yale.edu.|Yale Cancer Center, New Haven, CT, USA. kevin.kim@yale.edu.
authors.forename: Hyun S
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D018450:Disease Progression; D005500:Follow-Up Studies; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods; D009367:Neoplasm Staging; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement; D014850:Waiting Lists; D015021:Yttrium Radioisotopes / Q000627:therapeutic use; D017410:Practice Guidelines as Topic
chemical_list: D015021:Yttrium Radioisotopes
keywords: Ablation; Embolization; Hepatocellular carcinoma (HCC); Liver transplantation; Locoregional therapy (LRT); Milan criteria; Overall survival