Comparative study of post-transplant outcomes in hepatocellular carcinoma patients treated with chemoembolization or radioembolization |
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| Affiliation: | 1. Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago IL;2. Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL;3. Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL;4. Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago IL;5. Department of Radiology, Jules Bordet Institute, Brussels, Belgium;6. Department of Digestive Oncology and Gastroenterology, Jules Bordet Institute, Brussels, Belgium;7. Department of Nuclear Medicine, Jules Bordet Institute, Brussels, Belgium |
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| Abstract: | PurposeTo analyze long-term outcomes in patients bridged/downstaged to orthotopic liver transplantation (OLT) by transarterial chemoembolization (TACE) or yttrium-90 radioembolization (Y90) for hepatocellular carcinoma (HCC).Methods172 HCC patients who underwent OLT after being treated with transarterial liver-directed therapies (LDTs) (Y90: 93; TACE: 79) were identified. Pre-LDT and pre-OLT clinical/imaging/laboratory characteristics including United Network for Organ Sharing (UNOS) staging and alpha-fetoprotein values (AFP) were tabulated. Post-OLT HCC recurrence was assessed by imaging follow-up per standard of care. Recurrence-free (RFS) and overall survival (OS) were calculated. Uni/multivariate and sub-stratification analyses were performed.ResultsTime-to-OLT was longer in the Y90 group (Y90: 6.5 months; TACE: 4.8 months; p = 0.02). With a median post-OLT follow-up of 26.1 months (IQR: 11.1–49.7), tumor recurrence was found in 6/79 (8%) TACE and 8/93 (9%) Y90 patients. Time-to-recurrence was 26.6 (CI: 7.0–49.5) and 15.9 months (CI: 7.8–46.8) for TACE and Y90, respectively (p = 0.48). RFS (Y90: 79 months; TACE: 77 months; p = 0.84) and OS (Y90: 57% alive at 100 months; TACE: 84.2 months; p = 0.57) were similar. 54/155 patients (Y90: 29; TACE: 25) were downstaged to UNOS T2 or less. RFS hazard ratios for patients downstaged to ≤T2 versus those that were not were 0.6 (CI: 0.33–1.1) and 1.7 (CI: 0.9–3.1) respectively (p = 0.13). 17/155 patients (Y90: 8; TACE: 9) that were >T2 were downstaged to UNOS T2 or less (within transplant criteria). Distribution (unilobar/bilobar), AFP, and pre-transplant UNOS stage affected RFS on univariate analyses.ConclusionDespite longer time-to-OLT for Y90 patients, post-OLT outcomes were similar between patients bridged or downstaged by TACE or Y90. A trend towards improved RFS for downstaged patients was identified. |
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| Keywords: | Transarterial chemoembolization Radioembolization Liver transplantation Downstaging OLT" },{" #name" :" keyword" ," $" :{" id" :" kw0030" }," $$" :[{" #name" :" text" ," _" :" orthotopic liver transplantation TACE" },{" #name" :" keyword" ," $" :{" id" :" kw0040" }," $$" :[{" #name" :" text" ," _" :" transarterial chemoembolization Y90" },{" #name" :" keyword" ," $" :{" id" :" kw0050" }," $$" :[{" #name" :" text" ," _" :" yttrium-90 radioembolization HCC" },{" #name" :" keyword" ," $" :{" id" :" kw0060" }," $$" :[{" #name" :" text" ," _" :" hepatocellular carcinoma LDT" },{" #name" :" keyword" ," $" :{" id" :" kw0070" }," $$" :[{" #name" :" text" ," _" :" liver directed therapy UNOS" },{" #name" :" keyword" ," $" :{" id" :" kw0080" }," $$" :[{" #name" :" text" ," _" :" United Network for Organ Sharing classification AFP" },{" #name" :" keyword" ," $" :{" id" :" kw0090" }," $$" :[{" #name" :" text" ," _" :" alpha-fetoprotein BCLC" },{" #name" :" keyword" ," $" :{" id" :" kw0100" }," $$" :[{" #name" :" text" ," _" :" Barcelona Clinic for Liver Cancer CP" },{" #name" :" keyword" ," $" :{" id" :" kw0110" }," $$" :[{" #name" :" text" ," _" :" Child-Pugh score ECOG" },{" #name" :" keyword" ," $" :{" id" :" kw0120" }," $$" :[{" #name" :" text" ," _" :" Eastern Cooperative Oncology Group IQR" },{" #name" :" keyword" ," $" :{" id" :" kw0130" }," $$" :[{" #name" :" text" ," _" :" interquartile range MAA" },{" #name" :" keyword" ," $" :{" id" :" kw0140" }," $$" :[{" #name" :" text" ," _" :" macroaggregated albumin MELD" },{" #name" :" keyword" ," $" :{" id" :" kw0150" }," $$" :[{" #name" :" text" ," _" :" model for end stage liver disease scoring system MRI" },{" #name" :" keyword" ," $" :{" id" :" kw0160" }," $$" :[{" #name" :" text" ," _" :" magnetic resonance imaging PVT" },{" #name" :" keyword" ," $" :{" id" :" kw0170" }," $$" :[{" #name" :" text" ," _" :" portal vein thrombosis mRECIST" },{" #name" :" keyword" ," $" :{" id" :" kw0180" }," $$" :[{" #name" :" text" ," _" :" modified Response Evaluation Criteria in Solid Tumors RFS" },{" #name" :" keyword" ," $" :{" id" :" kw0190" }," $$" :[{" #name" :" text" ," _" :" recurrence-free survival RFA" },{" #name" :" keyword" ," $" :{" id" :" kw0200" }," $$" :[{" #name" :" text" ," _" :" radiofrequency ablation US" },{" #name" :" keyword" ," $" :{" id" :" kw0210" }," $$" :[{" #name" :" text" ," _" :" ultrasound |
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