Comparative study of post-transplant outcomes in hepatocellular carcinoma patients treated with chemoembolization or radioembolization. Issue 93 (August 2017)

• Record Type: Journal Article
• Authors: Gabr, Ahmed; Abouchaleh, Nadine; Ali, Rehan; Vouche, Michael; Atassi, Rohi; Memon, Khairuddin; Asadi, Ali Al; Baker, Talia; Caicedo, Juan Carlos; Desai, Kush; Fryer, Jonathan; Hickey, Ryan; Abeccassis, Michael; Habib, Ali; Hohlastos, Elias; Ganger, Daniel; Kulik, Laura; Lewandowski, Robert J.; Riaz, Ahsun; Salem, Riad
• Is Part Of: European journal of radiology. Issue 93(2017)
• Page Start: 100
• Page End: 106
• Publication Date: 2017-08
• Subjects: Transarterial chemoembolization -- Radioembolization -- Liver transplantation -- Downstaging; OLT orthotopic liver transplantation -- TACE transarterial chemoembolization -- Y90 yttrium-90 radioembolization -- HCC hepatocellular carcinoma -- LDT liver directed therapy -- UNOS United Network for Organ Sharing classification -- AFP alpha-fetoprotein -- BCLC Barcelona Clinic for Liver Cancer -- CP Child-Pugh score -- ECOG Eastern Cooperative Oncology Group -- IQR interquartile range -- MAA macroaggregated albumin -- MELD model for end stage liver disease scoring system -- MRI magnetic resonance imaging -- PVT portal vein thrombosis -- mRECIST modified Response Evaluation Criteria in Solid Tumors -- RFS recurrence-free survival -- RFA radiofrequency ablation -- US ultrasound; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2017.05.022
• Languages: English
• ISSNs: 0720-048X

Abstract

Abstract: Purpose: To analyze long-term outcomes in patients bridged/downstaged to orthotopic liver transplantation (OLT) by transarterial chemoembolization (TACE) or yttrium-90 radioembolization (Y90) for hepatocellular carcinoma (HCC). Methods: 172 HCC patients who underwent OLT after being treated with transarterial liver-directed therapies (LDTs) (Y90: 93; TACE: 79) were identified. Pre-LDT and pre-OLT clinical/imaging/laboratory characteristics including United Network for Organ Sharing (UNOS) staging and alpha-fetoprotein values (AFP) were tabulated. Post-OLT HCC recurrence was assessed by imaging follow-up per standard of care. Recurrence-free (RFS) and overall survival (OS) were calculated. Uni/multivariate and sub-stratification analyses were performed. Results: Time-to-OLT was longer in the Y90 group (Y90: 6.5 months; TACE: 4.8 months; p = 0.02). With a median post-OLT follow-up of 26.1 months (IQR: 11.1–49.7), tumor recurrence was found in 6/79 (8%) TACE and 8/93 (9%) Y90 patients. Time-to-recurrence was 26.6 (CI: 7.0–49.5) and 15.9 months (CI: 7.8–46.8) for TACE and Y90, respectively ( p = 0.48). RFS (Y90: 79 months; TACE: 77 months; p = 0.84) and OS (Y90: 57% alive at 100 months; TACE: 84.2 months; p = 0.57) were similar. 54/155 patients (Y90: 29; TACE: 25) were downstaged to UNOS T2 or less. RFS hazard ratios for patients downstaged to ≤T2 versus those that were not were 0.6 (CI: 0.33–1.1) and 1.7 (CI: 0.9–3.1) respectively ( p = 0.13). 17/155 patients (Y90: 8; TACE: 9) that were >T2 were downstaged to UNOS T2 or less (within transplant criteria). Distribution (unilobar/bilobar), AFP, and pre-transplant UNOS stage affected RFS on univariate analyses. Conclusion: Despite longer time-to-OLT for Y90 patients, post-OLT outcomes were similar between patients bridged or downstaged by TACE or Y90. A trend towards improved RFS for downstaged patients was identified.