Response to Transarterial Chemoembolization in Candidates With Hepatocellular Carcinoma Within Milan Criteria Does not Predict Post-Transplant Disease-Free Survival

Salvalaggio, Paolo R.; Felga, Guilherme Eduardo Gonçalves; Alves, Juliano; Meirelles, Roberto Ferreira; Almeida, Márcio Dias de; Rezende, Marcelo Bruno de

doi:10.1016/j.transproceed.2014.05.039

Cited by 4 publications

(5 citation statements)

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“…TTP and OS were not significantly influenced by age, sex, AFP concentration, or accompanying cirrhosis. These results are consistent with findings from previous studies ( 32 33 34 35 ).…”

Section: Discussionsupporting

confidence: 94%

Comparison of the Efficacy and Prognostic Factors of Transarterial Chemoembolization Plus Microwave Ablation versus Transarterial Chemoembolization Alone in Patients with a Large Solitary or Multinodular Hepatocellular Carcinomas

Lin

Guo

et al. 2018

Korean J Radiol

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ObjectiveTo evaluate the efficacy and prognostic factors associated with transcatheter arterial chemoembolization (TACE) combined with microwave ablation (MWA) versus TACE alone for a large solitary or multinodular hepatocellular carcinomas (HCCs).Materials and MethodsThis retrospective study involved 258 patients with a large solitary or multinodular HCCs (not more than 10 tumors) who underwent TACE + MWA (n = 92) or TACE alone (n = 166) between July 2011 and April 2015. Local tumor control, survival outcomes, and complications were compared between the two groups. Prognostic factors for time to progression (TTP) and overall survival (OS) were evaluated by univariate and multivariate analyses.ResultsThe median duration of follow-up was 21.2 months (range, 4–45 months). The median TTP and OS were 12.5 months and 26.6 months, respectively, for the TACE + MWA group and 6.7 months and 17.1 months, respectively, for the TACE group (p < 0.001). The 1-, 2-, and 3-year OS rates were 85.9, 59.8, and 32.6%, respectively, for the TACE + MWA group and 59.0, 40.4, and 11.4%, respectively, for the TACE group (p < 0.001). The corresponding recurrence rates were 47.8, 78.3, and 94.6% for the TACE + MWA group, respectively, and 74.7, 96.4, and 97.6%, respectively, for the TACE group (p < 0.001). Logistic regression analyses showed that the treatment method, tumor size, and tumor number were significant prognostic factors for TTP and OS.ConclusionTACE + MWA appears to have more advantages compared to TACE in prolonging OS, with a satisfactory TTP, for inpatients with solitary large or multinodular HCCs. Treatment method, tumor size, and tumor number are significant prognostic factors for TTP and OS. Further randomized, multi-center, prospective trials are required to confirm the findings of this study.

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“…TTP and OS were not significantly influenced by age, sex, AFP concentration, or accompanying cirrhosis. These results are consistent with findings from previous studies ( 32 33 34 35 ).…”

Section: Discussionsupporting

confidence: 94%

Comparison of the Efficacy and Prognostic Factors of Transarterial Chemoembolization Plus Microwave Ablation versus Transarterial Chemoembolization Alone in Patients with a Large Solitary or Multinodular Hepatocellular Carcinomas

Lin

Guo

et al. 2018

Korean J Radiol

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“…These findings agree with several previous nonrandomized studies evaluating the use of neoadjuvant cTACE (14, 17-19, 21, 22). However, comprehensive review of the literature reveals no overall consensus on the survival benefit of neoadjuvant cTACE, with many studies equivocal and conflicting (2,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). In the current study, the effectiveness of DEB-TACE to down-stage patients to fulfill OLT criteria and to prevent dropouts from the waiting list was not under evaluation.…”

Section: Discussionmentioning

confidence: 85%

“…The usefulness of pre-OLT TACE to avoid disease progression while waiting for organ allocation and to down-stage selected patients to fulfill transplant criteria is well known. However, the effect of neoadjuvant TACE treatment prior to OLT for HCC on overall survival (OS) and disease-free survival (DFS) is contentious (2,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).Doxorubicin drug-eluting bead TACE (DEB-TACE) is a drug delivery embolization system that can achieve higher tumor and lower systemic concentrations of doxorubicin compared with cTACE and demonstrated equal efficacy with low toxicity in previous clinical studies (23-27). However, the evidence to support the use of this relatively novel technique as a neoadjuvant treatment before OLT and its impact on OS and DFS is scarce.…”

mentioning

confidence: 99%

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

Dorcaratto

Udupa²,

Hogan³

et al. 2017

Diagn Interv Radiol

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O rthotopic liver transplant is the gold standard treatment for patients with hepatocellular carcinoma (HCC) within Milan criteria (1, 2). Conventional transarterial chemoembolization (cTACE) is widely accepted as a palliative treatment for patients who do not fulfill the criteria for OLT, HCC resection, or local therapies such as ethanol injection, radiofrequency ablation, microwave ablation, cryotherapy, or electroporation (3-11). The usefulness of pre-OLT TACE to avoid disease progression while waiting for organ allocation and to down-stage selected patients to fulfill transplant criteria is well known. However, the effect of neoadjuvant TACE treatment prior to OLT for HCC on overall survival (OS) and disease-free survival (DFS) is contentious (2,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).Doxorubicin drug-eluting bead TACE (DEB-TACE) is a drug delivery embolization system that can achieve higher tumor and lower systemic concentrations of doxorubicin compared with cTACE and demonstrated equal efficacy with low toxicity in previous clinical studies (23-27). However, the evidence to support the use of this relatively novel technique as a neoadjuvant treatment before OLT and its impact on OS and DFS is scarce.The aim of this study was to compare OS and DFS of patient undergoing OLT for HCC who did and did not receive neoadjuvant DEB-TACE. Methods Study design and populationData was investigated from a prospectively maintained database and the need to ob- I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to compare the overall (OS) and disease-free survival (DFS) of patients undergoing orthotopic liver transplant (OLT) for hepatocellular carcinoma who did and did not have neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization (DEB-TACE). METHODSThis is a retrospective study of 94 patients with HCC transplanted between 2000 and 2014 in a single tertiary center. Pre-and postoperative features, DFS and OS were compared between patients who received pre-OLT DEB-TACE (n=34, DEB-TACE group) and those who did not (n=60, non-TACE group). Radiologic and histologic response to neoadjuvant treatment as well as its complications were also studied. RESULTSThere were no significant differences in post-transplantation DFS and OS rates between groups (5-year DFS: 70% in DEB-TACE group vs. 63% in non-TACE group, P = 0.454; 5-year OS: 70% in DEB-TACE group vs. 65% in non-TACE group, P = 0.532). The DEB-TACE group had longer OLT waiting time compared with the non-TACE group (110 vs. 72 days; P = 0.01). On univariate and multivariate analyses, alpha-fetoprotein (AFP) levels >500 ng/mL prior to OLT were associated with decreased OS and DFS regardless of neoadjuvant approach (hazard ratio of 6, P = 0.001 and 5.5, P = 0.002, respectively). CONCLUSIONPatients who underwent neoadjuvant DEB-TACE and OLT for hepatocellular carcinoma had no statistically different OS or DFS at 3 and 5 years from patients undergoing OLT alone.You may cite this article as: Dorcaratto D, Udupa V, Ho...

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“…Eighteen comparative studies reported outcomes of interest. Baseline characteristics of included studies are described in http://onlinelibrary.wiley.com/doi/10.1002/hep.29485/suppinfo.…”

Section: Resultsmentioning

confidence: 99%

Therapies for patients with hepatocellular carcinoma awaiting liver transplantation: A systematic review and meta‐analysis

et al. 2017

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Patients with hepatocellular carcinoma (HCC) who are listed for liver transplantation (LT) are often treated while on the waiting list with locoregional therapy (LRT), which is aimed at either preventing progression of HCC or reducing the measurable disease burden of HCC in order to receive increased allocation priority. We aimed to synthesize evidence regarding the effectiveness of LRT in the management of patients with HCC who were on the LT waitlist. We conducted a comprehensive search of multiple databases from 1996 to April 25, 2016, for studies that enrolled adults with cirrhosis awaiting LT and treated with bridging or down-staging therapies before LT. Therapies included transcatheter arterial chemoembolization, transarterial radioembolization, ablation, and radiotherapy. We included both comparative and noncomparative studies. There were no randomized controlled trials identified. For adults with T1 HCC and waiting for LT, there were only two nonrandomized comparative studies, both with a high risk of bias, which reported the outcome of interest. In one series, the rate of dropout from all causes at 6 months in T1 HCC patients who underwent LRT was 5.3%, while in the other series of T1 HCC patients who did not receive LRT, the dropout rate at median follow-up of 2.4 years and the progression rate to T2 HCC were 30% and 88%, respectively. For adults with T2 HCC awaiting LT, transplant with any bridging therapy showed a nonsignificant reduction in the risk of waitlist dropout due to progression (relative risk [RR], 0.32; 95% confidence interval [CI], 0.06-1.85; I 2 5 0%) and of waitlist dropout from all causes (RR, 0.38; 95% CI, 0.060-2.370; I 2 5 85.7%) compared to no therapy based on three comparative studies. The quality of evidence is very low due to high risk of bias, imprecision, and inconsistency. There were five comparative studies which reported on posttransplant survival rates and 10 comparative studies which reported on posttransplant recurrence, and there was no significant difference seen in either of these endpoints. For adults initially with stage T3 HCC who received LRT, there were three studies reporting on transplant with any downstaging therapy versus no downstaging, and this showed a significant increase in 1-year (two studies, RR, 1.11; 95% CI, 1.01-1.23) and 5-year (1 study, RR, 1.17; 95% CI, 1.03-1.32) post-LT survival rates for patients who received LRT. The quality of evidence is very low due to serious risk of bias and imprecision. Conclusion: In patients with HCC listed for LT, the use of LRT is associated with a nonsignificant trend toward improved waitlist and posttransplant outcomes, though there is a high risk of selection bias in the available evidence. (HEPATOLOGY 2018;67:381-400).H epatocellular carcinoma (HCC) is a growing indication for liver transplantation (LT) due to the rising incidence of HCC and recognition that transplantation offers the best chance for long-term survival for patients with unresectable HCC. Transplant offers the benefit of removal of the cancer as...

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Response to Transarterial Chemoembolization in Candidates With Hepatocellular Carcinoma Within Milan Criteria Does not Predict Post-Transplant Disease-Free Survival

Cited by 4 publications

References 15 publications

Comparison of the Efficacy and Prognostic Factors of Transarterial Chemoembolization Plus Microwave Ablation versus Transarterial Chemoembolization Alone in Patients with a Large Solitary or Multinodular Hepatocellular Carcinomas

Comparison of the Efficacy and Prognostic Factors of Transarterial Chemoembolization Plus Microwave Ablation versus Transarterial Chemoembolization Alone in Patients with a Large Solitary or Multinodular Hepatocellular Carcinomas

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

Therapies for patients with hepatocellular carcinoma awaiting liver transplantation: A systematic review and meta‐analysis

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