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

8 Citations (Scopus)

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 1 2017

Fingerprint

Yttrium
Hepatocellular Carcinoma
Transplants
Liver Transplantation
Recurrence
alpha-Fetoproteins
Survival
Liver
Standard of Care

Keywords

  • Downstaging
  • Liver transplantation
  • Radioembolization
  • Transarterial chemoembolization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{f174037e53704f33b62d35e8c4c6aee1,
title = "Comparative study of post-transplant outcomes in hepatocellular carcinoma patients treated with chemoembolization or radioembolization",
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.",
keywords = "Downstaging, Liver transplantation, Radioembolization, Transarterial chemoembolization",
author = "Ahmed Gabr and Nadine Abouchaleh and Rehan Ali and Michael Vouche and Rohi Atassi and Khairuddin Memon and Asadi, {Ali Al} and Talia Baker and Caicedo, {Juan Carlos} and Kush Desai and Jonathan Fryer and Ryan Hickey and Abecassis, {Michael Messod} and Ali Habib and Elias Hohlastos and Daniel Ganger and Laura Kulik and Lewandowski, {Robert J.} and Ahsun Riaz and Riad Salem",
year = "2017",
month = "8",
day = "1",
doi = "10.1016/j.ejrad.2017.05.022",
language = "English (US)",
volume = "93",
pages = "100--106",
journal = "European Journal of Radiology",
issn = "0720-048X",
publisher = "Elsevier Ireland Ltd",

}

Comparative study of post-transplant outcomes in hepatocellular carcinoma patients treated with chemoembolization or radioembolization. / 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; Abecassis, Michael Messod; Habib, Ali; Hohlastos, Elias; Ganger, Daniel; Kulik, Laura; Lewandowski, Robert J.; Riaz, Ahsun; Salem, Riad.

In: European journal of radiology, Vol. 93, 01.08.2017, p. 100-106.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparative study of post-transplant outcomes in hepatocellular carcinoma patients treated with chemoembolization or radioembolization

AU - Gabr, Ahmed

AU - Abouchaleh, Nadine

AU - Ali, Rehan

AU - Vouche, Michael

AU - Atassi, Rohi

AU - Memon, Khairuddin

AU - Asadi, Ali Al

AU - Baker, Talia

AU - Caicedo, Juan Carlos

AU - Desai, Kush

AU - Fryer, Jonathan

AU - Hickey, Ryan

AU - Abecassis, Michael Messod

AU - Habib, Ali

AU - Hohlastos, Elias

AU - Ganger, Daniel

AU - Kulik, Laura

AU - Lewandowski, Robert J.

AU - Riaz, Ahsun

AU - Salem, Riad

PY - 2017/8/1

Y1 - 2017/8/1

N2 - 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.

AB - 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.

KW - Downstaging

KW - Liver transplantation

KW - Radioembolization

KW - Transarterial chemoembolization

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DO - 10.1016/j.ejrad.2017.05.022

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JO - European Journal of Radiology

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