Metabolic tumor volume predicts long-term survival after transplantation for unresectable colorectal liver metastases: 15 years of experience from the SECA study

Abstract

Objective To report 15 years of experience with metabolic tumor volume (MTV) of liver metastases from the preoperative 18F-FDG PET/CT to predict long-term survival after liver transplantation (LT) for unresectable colorectal liver metastases (CRLM). Methods The preoperative 18F-FDG PET/CT from all SECA 1 and 2 patients was evaluated. MTV was obtained from all liver metastases. The patients were divided into one group with low MTV (< 70 cm3) and one group with high MTV (> 70 cm3) based on a receiver operating characteristic analysis. Overall survival (OS), disease-free survival (DFS) and post recurrence survival (PRS) for patients with low versus high MTV were compared using the Kaplan–Meier method and log rank test. Clinopathological features between the two groups were compared by a nonparametric Mann–Whitney U test for continuous and Fishers exact test for categorical data. Results At total of 40 patients were included. Patients with low MTV had significantly longer OS (p < 0.001), DFS (p < 0.001) and PRS (p = 0.006) compared to patients with high values. The patients with high MTV had higher CEA levels, number of liver metastases, size of the largest liver metastasis, N-stage, number of chemotherapy lines and more frequently progression of disease at LT compared to the patients with low MTV. Conclusion MTV of liver metastases is highly predictive of long-term OS, DFS and PRS after LT for unresectable CRLM and should be implemented in risk stratification prior to LT.

Rescue Liver Transplantation for Posthepatectomy Liver Failure: A Systematic Review and Survey of an International Experience

“…The shortage of deceased-donor grafts and the need to respect the principles of equity, urgency, and benefit should caution the liberal use of deceased-donor organs for rescue LT post-PHLF in patients with tumors outside conventional transplant criteria. Similarly, the triple equipoise concept in LDLT needs to be respected, and although criteria can be expanded in patients with HCC 54,55 and CRLM 52 to some extent, current evidence may not justify rescue LDLT in patients with IHCC or PHC. The emotional and psychological stress on a living donor to donate in an emergency cannot be underestimated.…”

“…50,51 For CRLM, the reported results of rescue LT were good and concordant with those reported by specialized centers in the elective setting. 52 Most patients transplanted for PHLF following resection for cholangiocarcinoma died either early during the postoperative period or in the medium term due to tumor recurrence ( Table S1, SDC , http://links.lww.com/TP/C888). Knowing the results of elective LT for IHCC without pretransplant treatment, this result is not surprising.…”

“…a conventional transplant criteria. Similarly, the triple equipoise concept in LDLT needs to be respected, and although criteria can be expanded in patients with HCC 54,55 and CRLM 52 to some extent, current evidence may not justify rescue LDLT in patients with IHCC or PHC. The emotional and psychological stress on a living donor to donate in an emergency cannot be underestimated.…”

Proceedings of the 28th Annual Congress of the International Liver Transplantation Society

“…Current prediction tools for assessing eligibility include the Oslo score, Fong Clinical Risk Score, and Metabolic Tumor Volume, pending further study validation. [26][27][28]…”

Liver transplantation for non-resectable colorectal liver metastases: the thin red line

“…Currently, the understanding of these is limited at best and we are only able to treat but a minority of the features involved. The dynamic, altered, and disruptive biological behaviour of CRLMs is essential to understand at a cellular level, such as the image-based metabolic response that appears essential also for selection from the SECA cohort [15].…”