Comparative study of post-transplant outcomes in hepatocellular carcinoma patients treated with chemoembolization or radioembolization

Ahmed Gabr, Nadine Abouchaleh, Rehan Ali, Michael Vouche, Rohi Atassi, Khairuddin Memon, Ali Al Asadi, Talia Baker, Juan Carlos Caicedo, Kush Desai, Jonathan Fryer, Ryan Hickey, Michael Messod Abecassis, Ali Habib, Elias Hohlastos, Daniel Ganger, Laura Kulik, Robert J. Lewandowski, Ahsun Riaz, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

9 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)100-106
Number of pages7
JournalEuropean journal of radiology
Volume93
DOIs
StatePublished - Aug 2017

Keywords

  • Downstaging
  • Liver transplantation
  • Radioembolization
  • Transarterial chemoembolization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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