Bridging Locoregional Therapy Prolongs Survival in Patients Listed for Liver Transplant with Hepatocellular Carcinoma.

Published

Journal Article

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. METHODS: 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. RESULTS: 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). CONCLUSIONS: Bridging LRT and high wait times were independent positive prognostic factors for survival from HCC diagnosis and OLT.

Full Text

Duke Authors

Cited Authors

  • Xing, M; Sakaria, S; Dhanasekaran, R; Parekh, S; Spivey, J; Knechtle, SJ; Zhang, D; Kim, HS

Published Date

  • March 2017

Published In

Volume / Issue

  • 40 / 3

Start / End Page

  • 410 - 420

PubMed ID

  • 27900445

Pubmed Central ID

  • 27900445

Electronic International Standard Serial Number (EISSN)

  • 1432-086X

Digital Object Identifier (DOI)

  • 10.1007/s00270-016-1505-0

Language

  • eng

Conference Location

  • United States