Effectiveness of preliver transplantation transarterial chemoembolization therapy in treatment of hepatocellular carcinoma beyond UCSF criteria

doi:10.16139/j.1007-9610.2018.03.012

Abstract

Abstract: Objective: To assess the safety and effectiveness of preliver transplantation transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) beyond UCSF criteria. Methods: We retrospectively analyzed the clinical data of 83 patients with HCC beyond UCSF criteria, who were divided into TACE group and control group. The postoperative acute rejection, biliary complications, vascular complications, tumor free survival rate and overall survival rate between two groups were compared. Results: There were (2.0±1.3) preliver transplantation TACE procedures with the period of (15.7±8.4) d between final TACE treatment and liver transplantation. There was no significant difference in postoperative acute rejection, biliary complications and hepatic artery embolism between TACE group and control group(P>0.05). The tumor free survival rate and overall survival rate in TACE group were significantly higher than those in control group (P<0.05). Stratification analysis revealed that the 1-, 3-, 5-year tumor free survival rate and overall survival rate of the patients with complete response or partial response were much higher than those of the patients without response(P<0.05). The 1-, 3-, 5-year tumor free survival rate and overall survival rate were significantly higher in the patients with HCC which satisfied UCSF criteria after TACE than those in the patients with HCC still beyond UCSF criteria(P<0.05). Conclusions: Preliver transplantation TACE can prolong tumor free survival time and overall survival time, and is safe with only one case of hepatic artery embolism.

Key words: Liver transplantation, Hepatocellular carcinoma, Tansarterial chemoembolization, Down-staging treatment

CLC Number:

R735.7

TONG Hui, ZHANG Jiaqiang, ZHU Zhecheng, PENG Chenghong, LI Tao. Effectiveness of preliver transplantation transarterial chemoembolization therapy in treatment of hepatocellular carcinoma beyond UCSF criteria[J]. Journal of Surgery Concepts & Practice, 2018, 23(03): 241-246.

References

[1] Chen W, Zheng R, Baade PD, et al.Cancer statistics in China, 2015[J]. CA Cancer J Clin,2016,66(2):115-132.
[2] Piñero F, Costa P, Boteon YL, et al.Results of liver transplantation for hepatocellular carcinoma in a multicenter Latin American cohort study[J]. Ann Hepatol,2018,17(2):256-267.
[3] Mehta N, Guy J, Frenette CT, et al. Excellent outcomes of liver transplantation following down-staging of hepatocellular carcinoma to within Milan Criteria: A multicenter study[J]. Clin Gastroenterol Hepatol,2017,pii:S1542-3565(17)31410-31416.
[4] Kim Y, Stahl CC, Makramalla A, et al.Downstaging the-rapy followed by liver transplantation for hepatocellular carcinoma beyond Milan criteria[J]. Surgery,2017,162(6):1250-1258.
[5] Kang WH, Hwang S, Song GW, et al.Prognostic effect of transarterial chemoembolization-induced complete pathological response in patients undergoing liver resection and transplantation for hepatocellular carcinoma[J]. Liver Transpl,2017,23(6):781-790.
[6] Lei JY, Zhong JJ, Luo YF, et al.Response to transarterial chemoembolization may serve as selection criteria for hepatocellular carcinoma liver transplantation[J]. Oncotarget,2017,8(53):91328-91342.
[7] Mazzaferro V, Regalia E, Doci R, et al.Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis[J]. N Engl J Med,1996,334(11):693-699.
[8] Yao FY, Ferrell L, Bass NM, et al.Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival[J]. Hepatology,2001,33(6):1394-1403.
[9] 樊嘉, 周俭, 徐泱, 等. 肝癌肝移植适应证的选择:上海复旦标准[J]. 中华医学杂志,2006,86(18):1227-1231.
[10] 徐骁, 杨家印, 钟林, 等. 肝癌肝移植“杭州标准”的多中心应用研究——1163例报道[J]. 中华器官移植杂志,2013,34(9):524-527.
[11] Hodavance MS, Vikingstad EM, Griffin AS, et al.Effectiveness of transarterial emolization of hepatocellular carcinoma as a bridge to transplantation[J]. J Vasc Interv Radiol,2016,27(1):39-45.
[12] Thuluvath PJ, Guidinger MK, Fung JJ, et al.Liver transplantation in the United States[J]. Am J Transplant,2010,10(4 Pt 2):1003-1019.
[13] Graziadei IW, Sandmueller H, Waldenberger P, et al.Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome[J]. Liver Transpl,2003,9(6):557-563.
[14] Decaens T, Roudot-Thoraval F, Bresson-Hadni S, et al.Impact of pretransplantation transarterial chemoembolization on survival and recurrence after liver transplantation for hepatocellular carcinoma[J]. Liver Transpl,2005,11(7):767-775.
[15] Eswaran SL, Pierce K, Weaver F, et al.Transarterial chemoembolization for HCC in patients with extensive liver transplantation waiting times[J]. Angiology,2012,63(3):206-212.
[16] Seehofer D, Nebrig M, Denecke T, et al.Impact of neoadjuvant transarterial chemoembolization on tumor recurrence and patient survival after liver transplantation for hepatocellular carcinoma: a retrospective analysis[J]. Clinical Transplantation,2012,26(5):764-774.
[17] Schaudt A, Kriener S, Schwarz W, et al.Role of transarterial chemoembolization for hepatocellular carcinoma before liver transplantation with special consideration of tumor necrosis[J]. Clinical Transplantation,2009,23(Suppl 21):61-67.
[18] Jianyong L, Jinjing Z, Lunan Y, et al.Preoperative adjuvant transarterial chemoembolization cannot improve the long term outcome of radical therapies for hepatocellular carcinoma[J]. Sci Rep,2017,7:41624.
[19] Si T, Chen Y, Ma D, et al.Transarterial chemoembolization prior to liver transplantation for patients with hepatocellular carcinoma: a meta-analysis[J]. J Gastroenterol Hepatol,2017,32(7):1286-1294.
[20] Kulik L, Heimbach JK, Zaiem F, et al.Therapies for patients with hepatocellular carcinoma awaiting liver transplantation: a systematic review and meta-analysis[J]. Hepatology,2018,67(1):381-400.
[21] Al Sebayel MI, Elsiesy H, Al-Hamoudi WA, et al.Effect of downstaging and bridging of hepatocellular carcinoma on survival following liver transplant: a single center experience[J]. Exp Clin Transplant,2017,15(suppl 2):7-11.
[22] Ince V, Ersan V, Karakas S, et al.Does preoperative transarterial chemoembolization for hepatocellular carcinoma increase the incidence of hepatic artery thrombosis after living-donor liver transplant?[J]. Exp Clin Transplant,2017,15(supp1 2):21-24.
[23] Sneiders D, Houwen T, Pengel LHM, et al.Systematic review and meta-analysis of posttransplant hepatic artery and biliary complications in patients treated with transarterial chemoembolization before liver transplantation[J]. Transplantation,2018,102(1):88-96.
[24] Kallini JR, Gabr A, Ali R, et al.Pretransplant intra-arterial liver-directed therapy does not increase the risk of hepatic arterial complications in liver transplantation: a single-center 10-year experience[J]. Cardiovasc Intervent Radiol,2018,41(2):231-238.