Hepatic Artery Chemoembolization for Hepatocellular Carcinoma in Patients Listed for Liver Transplantation

Abstract

We retrospectively analyzed all listed patients having hepatic artery chemoembolization (HACE) for hepatocellular carcinoma (HCC) stage T2 or less. Outcomes were transplantation, waiting list removal, death, and HCC recurrence. Twenty patients (mean age 55.7 years; 15 males) were identified. Twelve (60%) were transplanted, seven (35%) were removed from the list and one (5%) remains listed. Fourteen (70%) are alive. All 12 transplanted patients are alive (mean 2.94 years); one of seven removed from the list is alive (mean 1.45 years). Survival was significantly higher for those transplanted or listed vs. removed from the list (100% vs. 14.3%, p = = 0.0002). No HCC's recurred. Three patients (15%) were removed from the list after prolonged waiting times before MELD. Hepatic artery chemoembolization induced deterioration and removal from the list of one (5%) patient. Survival for those transplanted was excellent(100%), but overall survival was significantly lower (61.3%) at a mean 5.48 years. Hepatic artery chemoembolization for listed patients with ≤ ≤ C = T2 stage HCC is beneficial, but must be weighed against decreased waiting times and risk of HACE-induced deterioration. This balance is influenced greatly by the MELD system's determination of waiting times for HCC patients.

Is the treatment of hepatocellular carcinoma on the waiting list necessary?

“…On the basis of the previously discussed definitions, these points can be addressed with a review of the literature; the main studies [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] are summarized in Table 1. Ideally, studies should include a large number of cases, clearly separate treated and untreated patients, and specify details (treatment, surveillance, dropout, recurrence, and causes of death).…”

Bridging and downstaging therapy in patients suffering from hepatocellular carcinoma waiting on the list of liver transplantation

“…Various reports had suggested some of patients could be bridged as well as downstaged, which resulted in favorable long-term outcome (43)(44)(45)(46). Unfortunately, not all patients responded to TACE.…”

Bridge Treatments for HCC in the Waiting List for Liver Transplantation

“…Authors concluded that there was no sufficient evidence to provide a response due to the absence of prospective comparative studies [14]. Hayashi et al reported a discouraging 35% of drop out rate in patients with stage 1 or 2 HCC and with a mean waiting time of 340 days treated with TACE [15]. However, an analysis of the most recent series including patients treated with TACE or transarterial chemoinfusion before LT, showed that the drop out rate due to tumor progression is low, ranging between 2.9% and 13% with a mean waiting time in the transplant list exceeding 6 months ( Table 1) [16][17][18][19].…”