Patients without hepatocellular carcinoma progression after transarterial chemoembolization benefit from liver transplantation

Obed, Aiman; Beham, A.; Püllmann, Kerstin; Becker, Heinz; Lorf, Thomas

doi:10.3748/wjg.v13.i5.761

Cited by 17 publications

(10 citation statements)

References 33 publications

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“…13,27,31,44,[60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] Four studies treated the tumor size as a continuous variable, and they all assessed overall survival (HR ¼ 1.14, 95% CI ¼ 1-1.30; Table 1). 67,69,71,74 Sixteen studies treated the tumor size as a cutoff.…”

Section: Tumor Size Without Specificationsmentioning

confidence: 99%

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Which matters most: Number of tumors, size of the largest tumor, or total tumor volume?

et al. 2011

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Section: Tumor Size Without Specificationsmentioning

confidence: 99%

“…,27,31,44,[60][61][62][63][64][65][66][67][68]70,72,73 The HR for overall survival was reduced by 1.92 (95% CI ¼ 1.48-2.50) in patients with a tumor size ! 5 cm versus patients with a tumor size < 5 cm.…”

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confidence: 99%

Which matters most: Number of tumors, size of the largest tumor, or total tumor volume?

et al. 2011

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“…34 Listing criteria worldwide vs. UK -a comparison The first criterion of a single tumour ≤5 cm is essentially within Milan criteria and patients within this group have been shown to have a 5-year disease free survival of 75%. 13 Studies that used tumour size of 5 cm as a cut-off reported a significantly decreased overall survival, [35][36][37][38][39][40][41][42][43] disease free survival 36,41,[44][45][46] and increased recurrence rates [47][48][49][50] for tumour size >5 cm. Therefore, data on diameter of the largest nodule and outcomes would therefore suggest that a single tumour size of up to 5 cm as proposed in the Milan and the current UK criteria would be associated with the a disease free survival of >70%.…”

Section: -33mentioning

confidence: 99%

Review article: liver transplantation for hepatocellular carcinoma – a critical appraisal of the current worldwide listing criteria

Menon

Hakeem²,

Heaton

2014

Aliment Pharmacol Ther

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SUMMARY BackgroundLiver transplantation (LT) plays an important role in the management of patients with hepatocellular carcinoma (HCC). Although early results following LT for HCC were poor, since the introduction of the Milan criteria in 1996 morphological criteria have since been well established. Thereafter, various expansions of the Milan criteria were introduced worldwide. Listing criteria for LT for HCC in the United Kingdom (UK) initially conformed to the Milan criteria but were re-defined in 2009 by expansion of the Milan criteria. AimsTo look at the evidence in literature on listing criteria and management of HCC worldwide in comparison with the UK. Secondly, we aim to review worldwide vs. UK literature on prioritisation models, loco-regional therapy protocols and role of alpha-fetoprotein (AFP) in LT for HCC. MethodsAn electronic literature search with Medline was carried out to identify articles related to LT for HCC. ResultsAlthough various expansions of the Milan criteria have been described, they remain the gold standard against which other criteria are measured. The UK criteria are an expansion of the Milan criteria that go beyond Milan and University of California, San Francisco (UCSF) criteria. The current UK listing criteria for LT for HCC when compared to the worldwide criteria have a worse survival benefit (projected 5-year survival between 35-50%) when plotted on the metroticket calculator. ConclusionsIn keeping with most transplant centres worldwide, the UK have adopted expansions to Milan to allow more patients to benefit from LT. However, currently, as it stands the UK criteria when plotted in the modification of the Metroticket model project worse survival that would seem unjustified.

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“…Currently, the post-OLT 5-year survival rate is approximately 70% to 80% [2, 5–7], with a disease-recurrence rate of 15% [3–5]. Because of these excellent long-term results, the percent of OLTs performed for cirrhosis complicated by HCC has increased from 7% to 22% and is bound to increase further as the incidence of HCC continues to climb [5, 7–11]. Another breakthrough occurred with the introduction of the Model for End-Stage Liver Disease (MELD) allocation system in 2002, which decreased the mean liver transplant wait list period from 27.7 months to 8.3 months [7].…”

Section: Introductionmentioning

confidence: 99%

“…Chemoembolization has been shown to provide a survival benefit to patients with unresectable HCC [13–15] and to result in significant tumor responses according to both European Association for the Study of the Liver (EASL) and Response Evaluation Criteria In Solid Tumors (RECIST), [8, 10, 16]. It has occasionally been employed as a bridging treatment for patients on the liver transplantation waiting list, hoping either to decrease the drop-off risk or to improve post-OLT survival, but has had mixed results [4, 5, 8, 10, 11, 16–23]. Our objective was to establish whether treating patients who are on the liver transplantation waiting list for HCC with chemoembolization decreases their drop-off risk.…”

Section: Introductionmentioning

confidence: 99%

Chemoembolization Decreases Drop-Off Risk of Hepatocellular Carcinoma Patients on the Liver Transplant List

Frangakis

Geschwind

Kim

et al. 2010

Cardiovasc Intervent Radiol

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Introduction The drop-off risk for patients awaiting liver transplantation for hepatocellular carcinoma (HCC) is 22%. Transplant liver availability is expected to worsen, resulting in longer waiting times and increased drop-off rates. Our aim was to determine whether chemoembolization can decrease this risk. Patients and Methods Eighty-seven consecutive HCC patients listed for liver transplant (Milan criteria) underwent statistical comparability adjustments using the propensity score (Wilcoxon, Fisher’s, and chi-square tests). Forty-three nonchemoembolization patients and 22 chemoembolization patients were comparable for Child-Pugh and Model for End-Stage Liver Disease scores, tumor size and number, alpha fetoprotein (AFP) levels, and cause of cirrhosis. We calculated the risk of dropping off the transplant list by assigning a transplant time to those who dropped off (equal probability with patients who were on the list longer than the patient in question). The significance level was obtained by calculating the simulation distribution of the difference compared with the permutations of chemoembolization versus nonchemoembolization assignment of the patients. Kaplan–Meier estimators (log-rank test) were used to determine survival rates. Results Median follow-up was 187 ± 110 weeks (range 38 to 435, date of diagnosis). The chemoembolization group had an 80% drop-off risk decrease (15% nonchemoembolization versus 3% chemoembolization, p = 0.04). Although survival was better for the chemoembolization group, it did not reach statistical significance. Two-year survival for the nonchemoembolization and chemoembolization group was 57.3% ± 7.1% and 76.0% ± 7.9%, respectively (p = 0.078). Conclusions Chemoembolization appears to result in a significant decrease in the risk of dropping off liver transplant list for patients with HCC and results in a tendency toward longer survival.

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Patients without hepatocellular carcinoma progression after transarterial chemoembolization benefit from liver transplantation

Cited by 17 publications

References 33 publications

Which matters most: Number of tumors, size of the largest tumor, or total tumor volume?

Which matters most: Number of tumors, size of the largest tumor, or total tumor volume?

Review article: liver transplantation for hepatocellular carcinoma – a critical appraisal of the current worldwide listing criteria

Chemoembolization Decreases Drop-Off Risk of Hepatocellular Carcinoma Patients on the Liver Transplant List

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