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Pathologic Response to Pretransplant Locoregional Therapy is Predictive of Patient Outcome After Liver Transplantation for Hepatocellular Carcinoma: Analysis From the US Multicenter HCC Transplant Consortium.

Publication ,  Journal Article
DiNorcia, J; Florman, SS; Haydel, B; Tabrizian, P; Ruiz, RM; Klintmalm, GB; Senguttuvan, S; Lee, DD; Taner, CB; Verna, EC; Halazun, KJ; Kim, J ...
Published in: Ann Surg
April 2020

OBJECTIVE: The aim of the study was to determine the rate, predictors, and impact of complete pathologic response (cPR) to pretransplant locoregional therapy (LRT) in a large, multicenter cohort of hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT). BACKGROUND: LRT is used to mitigate waitlist dropout for patients with HCC awaiting LT. Degree of tumor necrosis found on explant has been associated with recurrence and overall survival, but has not been evaluated in a large, multicenter study. METHODS: Comparisons were made among patients receiving pre-LT LRT with (n = 802) and without (n = 2637) cPR from the United States Multicenter HCC Transplant Consortium (UMHTC), and multivariable predictors of cPR were identified using logistic regression. RESULTS: Of 3439 patients, 802 (23%) had cPR on explant. Compared with patients without cPR, cPR patients were younger; had lower Model for End-stage Liver Disease (MELD) scores, AFP levels, and neutrophil-lymphocyte ratios (NLR); were more likely to have tumors within Milan criteria and fewer LRT treatments; and had significantly lower 1-, 3-, and 5-year incidence of post-LT recurrence (1.3%, 3.5%, and 5.2% vs 6.2%, 13.5%, and 16.4%; P < 0.001) and superior overall survival (92%, 84%, and 75% vs 90%, 78%, and 68%; P < 0.001). Multivariable predictors of cPR included age, sex, liver disease diagnosis, MELD, AFP, NLR, radiographic Milan status, and number of LRT treatments (C-statistic 0.67). CONCLUSIONS: For LT recipients with HCC receiving pretransplant LRT, achieving cPR portends significantly lower posttransplant recurrence and superior survival. Factors predicting cPR are identified, which may help prioritize patients and guide LRT strategies to optimize posttransplant cancer outcomes.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

April 2020

Volume

271

Issue

4

Start / End Page

616 / 624

Location

United States

Related Subject Headings

  • United States
  • Tumor Burden
  • Time Factors
  • Survival Analysis
  • Surgery
  • Risk Factors
  • Risk Assessment
  • Neoplasm Recurrence, Local
  • Neoadjuvant Therapy
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
MLA
NLM
DiNorcia, J., Florman, S. S., Haydel, B., Tabrizian, P., Ruiz, R. M., Klintmalm, G. B., … Agopian, V. G. (2020). Pathologic Response to Pretransplant Locoregional Therapy is Predictive of Patient Outcome After Liver Transplantation for Hepatocellular Carcinoma: Analysis From the US Multicenter HCC Transplant Consortium. Ann Surg, 271(4), 616–624. https://doi.org/10.1097/SLA.0000000000003253
DiNorcia, Joseph, Sander S. Florman, Brandy Haydel, Parissa Tabrizian, Richard M. Ruiz, Goran B. Klintmalm, Srinath Senguttuvan, et al. “Pathologic Response to Pretransplant Locoregional Therapy is Predictive of Patient Outcome After Liver Transplantation for Hepatocellular Carcinoma: Analysis From the US Multicenter HCC Transplant Consortium.Ann Surg 271, no. 4 (April 2020): 616–24. https://doi.org/10.1097/SLA.0000000000003253.
DiNorcia J, Florman SS, Haydel B, Tabrizian P, Ruiz RM, Klintmalm GB, Senguttuvan S, Lee DD, Taner CB, Verna EC, Halazun KJ, Hoteit M, Levine MH, Chapman WC, Vachharajani N, Aucejo F, Nguyen MH, Melcher ML, Tevar AD, Humar A, Mobley C, Ghobrial M, Nydam TL, Amundsen B, Markmann JF, Berumen J, Hemming AW, Langnas AN, Carney CA, Sudan DL, Hong JC, Kim J, Zimmerman MA, Rana A, Kueht ML, Jones CM, Fishbein TM, Markovic D, Busuttil RW, Agopian VG. Pathologic Response to Pretransplant Locoregional Therapy is Predictive of Patient Outcome After Liver Transplantation for Hepatocellular Carcinoma: Analysis From the US Multicenter HCC Transplant Consortium. Ann Surg. 2020 Apr;271(4):616–624.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

April 2020

Volume

271

Issue

4

Start / End Page

616 / 624

Location

United States

Related Subject Headings

  • United States
  • Tumor Burden
  • Time Factors
  • Survival Analysis
  • Surgery
  • Risk Factors
  • Risk Assessment
  • Neoplasm Recurrence, Local
  • Neoadjuvant Therapy
  • Middle Aged