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Association of Complete Radiologic and Pathologic Response following Locoregional Therapy before Liver Transplantation with Long-Term Outcomes of Hepatocellular Carcinoma: A Retrospective Study
Authors:Peiman Habibollahi  Sara Pourhassan Shamchi  John M. Choi  Terence P. Gade  S. William Stavropoulos  Stephen J. Hunt  Mandeep Dagli  Deepak Sudheendra  Jeffery I. Mondschein  Michael C. Soulen  Gregory J. Nadolski
Affiliation:1. Penn Image Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;2. Division of Vascular and Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;3. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;4. Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;5. Division of Vascular and Interventional Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
Abstract:

Purpose

To evaluate long-term outcomes of patients with hepatocellular carcinoma (HCC) who show a complete response (CR) vs non-CR on pretransplantation imaging studies or pathologic evaluation of liver explants after locoregional therapy (LRT) before liver transplantation.

Materials and Methods

Patients listed for liver transplantation for HCC (March 1998 to December 2010) undergoing LRT with available multiphase MR/CT imaging before transplantation were included. Pathologic response was evaluated based on liver explant pathology. A total of 108 patients (17 women; 16%) met the inclusion criteria.

Results

Radiologic CR was achieved in 65 patients (60%) vs non-CR in 43 (40%), and pathologic CR was achieved in 36 patients (33%) vs non-CR in 72 (67%). Mean 5-year overall survival (OS) from the time of listing and recurrence-free survival (RFS) after liver transplantation were significantly better for patients with pathologic CR vs non-CR on explant pathology (OS, 83.3% vs 65.2% [28% difference; P = .046]; RFS, 80.6% vs 62.5% [29% difference; P = .045]). Mean 5-y OS and RFS were not significantly different between patients with radiologic CR or non-CR on pretransplantation imaging (OS, 75.4% vs 65.1% [P = .12]; RFS, 74% vs 62.8% [P = .17]).

Conclusions

Achievement of a pathologic CR vs non-CR in response to LRT before liver transplantation for HCC is associated with improved OS from time of listing and improved RFS after liver transplantation. However, current imaging paradigms fall short of accurate delineation of response to LRT, resulting in poor correlation of outcomes between pathologic and radiologic CR.
Keywords:CR  complete response  HCC  hepatocellular carcinoma  LRT  locoregional therapy  MELD  Model for End-stage Liver Disease  OS  overall survival  RF  radiofrequency  RFS  recurrence-free survival
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