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Impact of Pretransplant Bridging Locoregional Therapy for Patients With Hepatocellular Carcinoma Within Milan Criteria Undergoing Liver Transplantation: Analysis of 3601 Patients From the US Multicenter HCC Transplant Consortium.

Publication ,  Journal Article
Agopian, VG; Harlander-Locke, MP; Ruiz, RM; Klintmalm, GB; Senguttuvan, S; Florman, SS; Haydel, B; Hoteit, M; Levine, MH; Lee, DD; Taner, CB ...
Published in: Ann Surg
September 2017

OBJECTIVE: To evaluate the effect of pretransplant bridging locoregional therapy (LRT) on hepatocellular carcinoma (HCC) recurrence and survival after liver transplantation (LT) in patients meeting Milan criteria (MC). SUMMARY BACKGROUND DATA: Pre-LT LRT mitigates tumor progression and waitlist dropout in HCC patients within MC, but data on its impact on post-LT recurrence and survival remain limited. METHODS: Recurrence-free survival and post-LT recurrence were compared among 3601 MC patients with and without bridging LRT utilizing competing risk Cox regression in consecutive patients from 20 US centers (2002-2013). RESULTS: Compared with 747 LT recipients not receiving LRT, 2854 receiving LRT had similar 1, 3, and 5-year recurrence-free survival (89%, 77%, 68% vs 85%, 75%, 68%; P = 0.490) and 5-year post-LT recurrence (11.2% vs 10.1%; P = 0.474). Increasing LRT number [3 LRTs: hazard ratio (HR) 2.1, P < 0.001; 4+ LRTs: HR 2.5, P < 0.001), and unfavorable waitlist alphafetoprotein trend significantly predicted post-LT recurrence, whereas LRT modality did not. Treated patients achieving complete pathologic response (cPR) had superior 5-year RFS (72%) and lower post-LT recurrence (HR 0.52, P < 0.001) compared with both untreated patients (69%; P = 0.010; HR 1.0) and treated patients not achieving cPR (67%; P = 0.010; HR 1.31, P = 0.039), who demonstrated increased recurrence compared with untreated patients in multivariate analysis controlling for pretransplant and pathologic factors (HR 1.32, P = 0.044). CONCLUSIONS: Bridging LRT in HCC patients within MC does not improve post-LT survival or HCC recurrence in the majority of patients who fail to achieve cPR. The need for increasing LRT treatments and lack of alphafetoprotein response to LRT independently predict post-LT recurrence, serving as a surrogate for underlying tumor biology which can be utilized for prioritization of HCC LT candidates.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

September 2017

Volume

266

Issue

3

Start / End Page

525 / 535

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Survival Analysis
  • Surgery
  • Retrospective Studies
  • Proportional Hazards Models
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Male
  • Liver Transplantation
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Agopian, V. G., Harlander-Locke, M. P., Ruiz, R. M., Klintmalm, G. B., Senguttuvan, S., Florman, S. S., … Busuttil, R. W. (2017). Impact of Pretransplant Bridging Locoregional Therapy for Patients With Hepatocellular Carcinoma Within Milan Criteria Undergoing Liver Transplantation: Analysis of 3601 Patients From the US Multicenter HCC Transplant Consortium. Ann Surg, 266(3), 525–535. https://doi.org/10.1097/SLA.0000000000002381
Agopian, Vatche G., Michael P. Harlander-Locke, Richard M. Ruiz, Goran B. Klintmalm, Srinath Senguttuvan, Sander S. Florman, Brandy Haydel, et al. “Impact of Pretransplant Bridging Locoregional Therapy for Patients With Hepatocellular Carcinoma Within Milan Criteria Undergoing Liver Transplantation: Analysis of 3601 Patients From the US Multicenter HCC Transplant Consortium.Ann Surg 266, no. 3 (September 2017): 525–35. https://doi.org/10.1097/SLA.0000000000002381.
Agopian VG, Harlander-Locke MP, Ruiz RM, Klintmalm GB, Senguttuvan S, Florman SS, Haydel B, Hoteit M, Levine MH, Lee DD, Taner CB, Verna EC, Halazun KJ, Abdelmessih R, Tevar AD, Humar A, Aucejo F, Chapman WC, Vachharajani N, Nguyen MH, Melcher ML, Nydam TL, Mobley C, Ghobrial RM, Amundsen B, Markmann JF, Langnas AN, Carney CA, Berumen J, Hemming AW, Sudan DL, Hong JC, Kim J, Zimmerman MA, Rana A, Kueht ML, Jones CM, Fishbein TM, Busuttil RW. Impact of Pretransplant Bridging Locoregional Therapy for Patients With Hepatocellular Carcinoma Within Milan Criteria Undergoing Liver Transplantation: Analysis of 3601 Patients From the US Multicenter HCC Transplant Consortium. Ann Surg. 2017 Sep;266(3):525–535.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

September 2017

Volume

266

Issue

3

Start / End Page

525 / 535

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Survival Analysis
  • Surgery
  • Retrospective Studies
  • Proportional Hazards Models
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Male
  • Liver Transplantation