Bridging Locoregional Therapy Prolongs Survival in Patients Listed for Liver Transplant with Hepatocellular Carcinoma
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Background and Aims
To evaluate the long-term survival benefit of bridging locoregional therapy (LRT) prior to orthotopic liver transplantation (OLT) in patients with hepatocellular carcinoma (HCC) within Milan criteria.
Our transplant center registry was studied for all HCC patients within the Milan criteria who were listed for OLT from 1998 to 2013. Baseline clinical characteristics and median overall survival (OS) were calculated and stratified by LRT, OLT status, and wait times. Survival analysis was conducted using Kaplan–Meier estimation and log-rank test.
Of 265 listed, 205 underwent OLT (mean follow-up 7.6 years). Of 205, 111 received bridging LRT (A), and 94 did not (B). Both were similar in demographics and tumor characteristics (p > 0.05). Median OS from HCC for A/B were 86.4 vs. 68.9 months (p = 0.01). Median OS from OLT for A/B were 74.6 vs. 63.6 months (p = 0.03). On multivariate analysis, independent predictors for survival from HCC were bridging LRT (p = 0.002) and high wait time (p = 0.008); independent predictors for survival from OLT were bridging LRT (p = 0.005) and high wait time (p = 0.005). Of 60 who were listed but did not undergo transplant, 44 received LRT (C) and 16 received best supportive care (D). Median OS from HCC for C/D were 37.1 vs. 24.8 months (p = 0.03).
Bridging LRT and high wait times were independent positive prognostic factors for survival from HCC diagnosis and OLT.
KeywordsHepatocellular carcinoma (HCC) Locoregional therapy (LRT) Liver transplantation Embolization Ablation Overall survival Milan criteria
Barcelona Clinic Liver Cancer Staging System
Conventional transarterial chemoembolization
Drug-eluting bead transarterial chemoembolization
Model for end-stage liver disease
Orthotopic liver transplantation
Portal vein thrombosis
The authors thank Dr. Jong-Hyeon Jeong in the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh for his assistance in statistical analysis for this manuscript.
MX conducted analysis and interpretation of the data, statistical analysis, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. SS was involved in acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and statistical analysis. RD was involved in acquisition of data, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. DZ was involved in the analysis and interpretation of data and statistical analysis. SP was involved in the study concept and design, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. JRS was involved in the study concept and design, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. SJK was involved in the study concept and design, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. HSK was involved in study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis, and study overall supervision. All authors were involved in critically revising the manuscript prior to final submission.
All authors have no financial or other disclosures or relationship with any commercial organization that may have a direct or indirect interest in this manuscript.
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The authors declare that there is no conflict of interest regarding the publication of this paper.
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