Liver Transplantation is a Preferable Alternative to Palliative Therapy for Selected Patients with Advanced Hepatocellular Carcinoma

  • Aloysious D. Aravinthan
  • Silvio G. Bruni
  • Adam C. Doyle
  • Hla-Hla Thein
  • Nicolas Goldaracena
  • Assaf Issachar
  • Leslie B. Lilly
  • Nazia Selzner
  • Mamatha Bhat
  • Boraiah Sreeharsha
  • Markus Selzner
  • Anand Ghanekar
  • Mark S. Cattral
  • Ian D. McGilvray
  • Paul D. Greig
  • Eberhard L. Renner
  • David R. Grant
  • Gonzalo Sapisochin
Hepatobiliary Tumors

DOI: 10.1245/s10434-017-5789-3

Cite this article as:
Aravinthan, A.D., Bruni, S.G., Doyle, A.C. et al. Ann Surg Oncol (2017). doi:10.1245/s10434-017-5789-3

Abstract

Background

Patients with hepatocellular carcinoma (HCC) beyond the traditional criteria (advanced HCC) are typically offered palliation, which is associated with a 3-year survival rate lower than 30%. This study aimed to describe the outcomes for a subset of patients with advanced HCC who satisfied the Extended Toronto Criteria (ETC) and were listed for liver transplantation (LT).

Methods

All patients listed in the Toronto liver transplantation program with HCC beyond both the Milan and University of California, San Francisco criteria were included in this study. Data were extracted from the prospectively collected electronic database. All radiologic images were reviewed by two independent radiologists. The primary end point was patient survival.

Results

Between January 1999 and August 2014, 96 patients with advanced HCC were listed for LT, and 62 (65%) of these patients received bridging therapy while on the waiting list. Bridging therapy led to a significant reduction in tumor progression (p = 0.02) and tumor burden (p < 0.001). The majority of those listed underwent LT (n = 69, 72%). Both tumor progression on waiting list (hazard ratio [HR] 4.973; range1.599–15.464; p = 0.006) and peak alpha-fetoprotein (AFP) at 400 ng/ml or higher (HR, 4.604; range 1.660–12.768; p = 0.003) were independently associated with waiting list dropout. Post-LT HCC recurrence occurred in 35% of the patients (n = 24). Among those with HCC recurrence, survival was significantly better for those who received curative treatment (p = 0.004). The overall actuarial survival rates from the listing were 76% at 1 year, 56% at 3 years, and 47% at 5 years, and the corresponding rates from LT were 93, 71, and 66%.

Conclusion

Liver transplantation provides significantly better survival rates than palliation for patients with selected advanced HCC.

Supplementary material

10434_2017_5789_MOESM1_ESM.docx (34 kb)
Supplementary material 1 (DOCX 34 kb)

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Aloysious D. Aravinthan
    • 1
    • 2
  • Silvio G. Bruni
    • 3
  • Adam C. Doyle
    • 1
  • Hla-Hla Thein
    • 4
  • Nicolas Goldaracena
    • 1
  • Assaf Issachar
    • 1
  • Leslie B. Lilly
    • 1
  • Nazia Selzner
    • 1
  • Mamatha Bhat
    • 1
  • Boraiah Sreeharsha
    • 1
  • Markus Selzner
    • 1
  • Anand Ghanekar
    • 1
  • Mark S. Cattral
    • 1
  • Ian D. McGilvray
    • 1
  • Paul D. Greig
    • 1
  • Eberhard L. Renner
    • 1
    • 5
  • David R. Grant
    • 1
  • Gonzalo Sapisochin
    • 1
    • 6
  1. 1.Multiorgan Transplant Program, Toronto General HospitalUniversity of TorontoTorontoCanada
  2. 2.National Institute for Health Research (NIHR) Biomedical Research Centre, Nottingham Digestive Diseases CentreUniversity of NottinghamNottinghamUK
  3. 3.Department of Medical ImagingUniversity of TorontoTorontoCanada
  4. 4.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  5. 5.Department of Medicine, Max Rady College of Medicine/Rady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
  6. 6.Abdominal Transplant & HPB Surgical Oncology, Toronto General HospitalUniversity of TorontoTorontoCanada

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