Ann Surg Treat Res.  2018 Aug;95(2):111-120. 10.4174/astr.2018.95.2.111.

Clinical usefulness of transarterial chemoembolization response prior to liver transplantation as predictor of optimal timing for living donor liver transplantation

• Cho CW
• Choi GS
• Kim JM
• Kwon CH
• Kim DJ
• Joh JW

• KMID: 2417777
• DOI: http://doi.org/10.4174/astr.2018.95.2.111

Abstract

PURPOSE
Response to preoperative transarterial chemoembolization (TACE) has been recommended as a biological selection criterion for liver transplantation (LT). The aim of our study was to identify optimal timing of living donor liver transplantation (LDLT) after TACE based on the TACE response.
METHODS
We performed a retrospective study to assess recurrence in 128 hepatocellular carcinoma (HCC) patients who underwent LDLT following sequential TACE from January 2002 to March 2015 at a single institute. Cox proportional hazard models and Kaplan-Meier analysis were utilized to estimate HCC recurrence and find optimal timing for LDLT.
RESULTS
Seventy-three and 61 patients were divided as the responder and nonresponder, respectively. Multivariate analysis showed independent pre-liver transplantation (pre-LT) predictors of recurrence were larger sized tumor (>3 cm, P = 0.024), nonresponse to TACE (P = 0.031), vascular invasion (P = 0.002), and extrahepatic nodal involvement (P = 0.001). In the 3-month time difference between last pre-LT TACE and LDLT subgroup, TACE responders showed significantly higher adjusted hazard ratio (aHR) of recurrence free survival (aHR, 6.284; P = 0.007), cancer specific survival (aHR, 7.033; P = 0.016), and overall survival (aHR, 7.055; P = 0.005). Moreover, for overall patients and responder groups, the significant time difference between last pre-LT TACE and LDLT was 2 months in the minimum P-value approach.
CONCLUSION
In selected patients who showed good response to pre-LT TACE, a shorter time interval between TACE and LDLT may be associated with higher recurrence free survival, cancer specific survival, and overall survival.

Keyword

Chemoembolization; Liver transplantation; Hepatocellular carcinoma

MeSH Terms

Carcinoma, Hepatocellular
Humans
Kaplan-Meier Estimate
Liver Transplantation*
Liver*
Living Donors*
Multivariate Analysis
Proportional Hazards Models
Recurrence
Retrospective Studies

Figure

• 

  Fig. 1 Study design and population. LDLT, living donor liver transplantation; HCC, hepatocellular carcinoma; LT, liver transplantation; Tx, treatment; TACE, transarterial chemoembolization; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease; RFA, radiofrequency ablation.

• 

  Fig. 2 Disease-free survival (A) and overall survival (B) according to modified response evaluation criteria in solid tumors-defined transarterial chemoembolization (TACE) responses. HR, hazard ratio; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease.

• 

  Fig. 3 Kaplan-Meier analysis of the interval between the last pre-LT TACE and LDLT in all (A), RP (B), and NR (C) patients. The minimum P-value approach indicated the significant cutoff value for interval between last pre-LT TACE and LDLT was 2 months in all patients and the RP group. LT, liver transplantation; TACE, transarterial chemoembolization; LDLT, living donor liver transplantation; RP, responder; NR, nonresponder; DFS, disease-free survival.

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