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Locoregional treatments before liver transplantation for hepatocellular carcinoma: a study from the European Liver Transplant Registry |
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| Authors: | Hans‐Christian Pommergaard Andreas Arendtsen Rostved René Adam Lau Caspar Thygesen Mauro Salizzoni Miguel Angel Gómez Bravo Daniel Cherqui Paolo De Simone Karim Boudjema Vincenzo Mazzaferro Olivier Soubrane Juan Carlos García‐Valdecasas Joan Fabregat Prous Antonio D. Pinna John O'Grady Vincent Karam Christophe Duvoux Allan Rasmussen European Liver Intestine Transplant Association |
| Affiliation: | 1. Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;2. Department of Hepatobiliary Surgery, Cancer and Transplantation, AP‐HP, H?pital Universitaire Paul Brousse, Inserm U 935, University Paris‐Sud, Villejuif, France;3. National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark;4. Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy;5. Liver Transplant Unit, Department of Surgery, Hospital Virgen del Rocio, Sevilla, Spain;6. Liver Transplantation Unit, Hepatobiliary Surgery, University of Pisa Medical School Hospital, Pisa, Italy;7. Service de Chirurgie Hépatobiliaire et Digestive, H?pital Pontchaillou, Centre Hospitalier Université de Rennes 1, Rennes, France;8. INSERM, UMR991, Foie, Métabolisme et Cancer, Université de Rennes 1, Rennes, France;9. Division of Gastrointestinal Surgery and Liver Transplantation, Istituto Nazionale Tumori, Fondazione IRCCS, University of Milan, Milan, Italy;10. Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, University Denis Diderot, Paris, France;11. Hepatobiliopancreatic & Transplant Surgery, ICMDiM, Hospital Clínic, Barcelona, Spain;12. Unitat de Cirurgia Hepato‐Bilio‐Pancreàtica, Hospital Universitari de Bellvitge, Barcelona, Spain;13. General Surgery and Transplant Division, S. Orsola Hospital, University of Bologna, Bologna, Italy;14. Institute of Liver Studies, King's College Hospital, London, UK;15. Liver Transplant Unit, Department of Hepatology, Henri Mondor Hospital, Paris Est University (UPEC), Créteil, France |
| Abstract: | Locoregional treatment while on the waiting list for liver transplantation (Ltx) for hepatocellular carcinoma (HCC) has been shown to improve survival. However, the effect of treatment type has not been investigated. We investigate the effect of locoregional treatment type on survival after Ltx for HCC. We investigated patients registered in the European Liver Transplant Registry database using multivariate Cox regression survival analysis. Information on locoregional therapy was registered for 4978 of 23 124 patients and was associated with improved overall survival [hazard ratio (HR) 0.84 (0.73–0.96)] and HCC‐specific survival [HR 0.76 (0.59–0.98)]. Radiofrequency ablation (RFA) was the one monotherapy associated with improved overall survival [HR 0.51 (0.40–0.65)]. In addition, the combination of RFA and transarterial chemoembolization also improved survival [HR 0.74 (0.55–0.99)]. Adjusting for factors related to prognosis, disease severity, and tumor aggressiveness, RFA was highly beneficial for overall and HCC‐specific survival. The effect may represent a selection of patients with favorable tumor biology; however, the treatment may be effective per se by halting tumor progression. Clinicaltrials.gov number: NCT02995096. |
| Keywords: | hepatocellular carcinoma liver transplantation locoregional treatment pretreatment |