Pre-Liver Transplantation Locoregional Adjuvant Therapy for Hepatocellular Carcinoma as a Strategy to Improve Longterm Survival

Ankit Bharat, Daniel B. Brown, Jeffrey S. Crippin, Jennifer E. Gould, Jeffrey A. Lowell, Surendra Shenoy, Niraj M. Desai, William C. Chapman*

*Corresponding author for this work

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Background: Preorthotopic liver transplantation locoregional therapy (LRT) for hepatocellular carcinoma (HCC) reduces drop-out rates in patients awaiting orthotopic liver transplantation (OLT). In this study, we investigated the efficacy of LRT as a strategy to improve longterm survival after transplantation. Study Design: A retrospective analysis of prospectively collected data identified 100 patients with HCC who underwent OLT between 1985 and 2005. Of these, 46 received LRT in the form of transarterial chemoembolization, radiofrequency ablation, percutaneous ethanol injection, or a combination of these. Results: The 1-, 3-, and 5-year survivals, regardless of LRT, were 81.3%, 66.1%, and 61.3%, respectively. Demographic data and waiting time for OLT were similar between LRT and untreated groups. Pre-OLT radiologic stage was comparable (LRT: 2.11 ± 0.74 versus Untreated: 2.39 ± 0.94; p = 0.16). At the time of transplantation, the LRT group had notable tumor downstaging (1.50 ± 1.34 versus 2.49 ± 1.17; p = 0.008). The LRT group had better 5-year survival (82.4% versus 51.8%; p = 0.01), but this improvement was observed in patients with HCC stages II, III, and IV (77.6% versus 37.4%; p = 0.016). Sixteen LRT patients, and none untreated, revealed complete tumor necrosis with no viable tumor cells on explant pathology (pT0). These patients did not experience any longterm recurrence, in contrast to those with similar pre-OLT tumors. Conclusions: OLT is a viable treatment option for primary HCC. LRT substantially downstages the primary tumor and improves longterm survival in patients with advanced disease. Complete tumor necrosis with LRT is associated with excellent longterm recurrence-free survival.

Original languageEnglish (US)
Pages (from-to)411-420
Number of pages10
JournalJournal of the American College of Surgeons
Volume203
Issue number4
DOIs
StatePublished - Oct 1 2006

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Liver Transplantation
Hepatocellular Carcinoma
Survival
Group Psychotherapy
Neoplasms
Therapeutics
Necrosis
Transplantation
Recurrence
Ethanol
Demography
Pathology
Injections

ASJC Scopus subject areas

  • Surgery

Cite this

Bharat, Ankit ; Brown, Daniel B. ; Crippin, Jeffrey S. ; Gould, Jennifer E. ; Lowell, Jeffrey A. ; Shenoy, Surendra ; Desai, Niraj M. ; Chapman, William C. / Pre-Liver Transplantation Locoregional Adjuvant Therapy for Hepatocellular Carcinoma as a Strategy to Improve Longterm Survival. In: Journal of the American College of Surgeons. 2006 ; Vol. 203, No. 4. pp. 411-420.
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title = "Pre-Liver Transplantation Locoregional Adjuvant Therapy for Hepatocellular Carcinoma as a Strategy to Improve Longterm Survival",
abstract = "Background: Preorthotopic liver transplantation locoregional therapy (LRT) for hepatocellular carcinoma (HCC) reduces drop-out rates in patients awaiting orthotopic liver transplantation (OLT). In this study, we investigated the efficacy of LRT as a strategy to improve longterm survival after transplantation. Study Design: A retrospective analysis of prospectively collected data identified 100 patients with HCC who underwent OLT between 1985 and 2005. Of these, 46 received LRT in the form of transarterial chemoembolization, radiofrequency ablation, percutaneous ethanol injection, or a combination of these. Results: The 1-, 3-, and 5-year survivals, regardless of LRT, were 81.3{\%}, 66.1{\%}, and 61.3{\%}, respectively. Demographic data and waiting time for OLT were similar between LRT and untreated groups. Pre-OLT radiologic stage was comparable (LRT: 2.11 ± 0.74 versus Untreated: 2.39 ± 0.94; p = 0.16). At the time of transplantation, the LRT group had notable tumor downstaging (1.50 ± 1.34 versus 2.49 ± 1.17; p = 0.008). The LRT group had better 5-year survival (82.4{\%} versus 51.8{\%}; p = 0.01), but this improvement was observed in patients with HCC stages II, III, and IV (77.6{\%} versus 37.4{\%}; p = 0.016). Sixteen LRT patients, and none untreated, revealed complete tumor necrosis with no viable tumor cells on explant pathology (pT0). These patients did not experience any longterm recurrence, in contrast to those with similar pre-OLT tumors. Conclusions: OLT is a viable treatment option for primary HCC. LRT substantially downstages the primary tumor and improves longterm survival in patients with advanced disease. Complete tumor necrosis with LRT is associated with excellent longterm recurrence-free survival.",
author = "Ankit Bharat and Brown, {Daniel B.} and Crippin, {Jeffrey S.} and Gould, {Jennifer E.} and Lowell, {Jeffrey A.} and Surendra Shenoy and Desai, {Niraj M.} and Chapman, {William C.}",
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Pre-Liver Transplantation Locoregional Adjuvant Therapy for Hepatocellular Carcinoma as a Strategy to Improve Longterm Survival. / Bharat, Ankit; Brown, Daniel B.; Crippin, Jeffrey S.; Gould, Jennifer E.; Lowell, Jeffrey A.; Shenoy, Surendra; Desai, Niraj M.; Chapman, William C.

In: Journal of the American College of Surgeons, Vol. 203, No. 4, 01.10.2006, p. 411-420.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pre-Liver Transplantation Locoregional Adjuvant Therapy for Hepatocellular Carcinoma as a Strategy to Improve Longterm Survival

AU - Bharat, Ankit

AU - Brown, Daniel B.

AU - Crippin, Jeffrey S.

AU - Gould, Jennifer E.

AU - Lowell, Jeffrey A.

AU - Shenoy, Surendra

AU - Desai, Niraj M.

AU - Chapman, William C.

PY - 2006/10/1

Y1 - 2006/10/1

N2 - Background: Preorthotopic liver transplantation locoregional therapy (LRT) for hepatocellular carcinoma (HCC) reduces drop-out rates in patients awaiting orthotopic liver transplantation (OLT). In this study, we investigated the efficacy of LRT as a strategy to improve longterm survival after transplantation. Study Design: A retrospective analysis of prospectively collected data identified 100 patients with HCC who underwent OLT between 1985 and 2005. Of these, 46 received LRT in the form of transarterial chemoembolization, radiofrequency ablation, percutaneous ethanol injection, or a combination of these. Results: The 1-, 3-, and 5-year survivals, regardless of LRT, were 81.3%, 66.1%, and 61.3%, respectively. Demographic data and waiting time for OLT were similar between LRT and untreated groups. Pre-OLT radiologic stage was comparable (LRT: 2.11 ± 0.74 versus Untreated: 2.39 ± 0.94; p = 0.16). At the time of transplantation, the LRT group had notable tumor downstaging (1.50 ± 1.34 versus 2.49 ± 1.17; p = 0.008). The LRT group had better 5-year survival (82.4% versus 51.8%; p = 0.01), but this improvement was observed in patients with HCC stages II, III, and IV (77.6% versus 37.4%; p = 0.016). Sixteen LRT patients, and none untreated, revealed complete tumor necrosis with no viable tumor cells on explant pathology (pT0). These patients did not experience any longterm recurrence, in contrast to those with similar pre-OLT tumors. Conclusions: OLT is a viable treatment option for primary HCC. LRT substantially downstages the primary tumor and improves longterm survival in patients with advanced disease. Complete tumor necrosis with LRT is associated with excellent longterm recurrence-free survival.

AB - Background: Preorthotopic liver transplantation locoregional therapy (LRT) for hepatocellular carcinoma (HCC) reduces drop-out rates in patients awaiting orthotopic liver transplantation (OLT). In this study, we investigated the efficacy of LRT as a strategy to improve longterm survival after transplantation. Study Design: A retrospective analysis of prospectively collected data identified 100 patients with HCC who underwent OLT between 1985 and 2005. Of these, 46 received LRT in the form of transarterial chemoembolization, radiofrequency ablation, percutaneous ethanol injection, or a combination of these. Results: The 1-, 3-, and 5-year survivals, regardless of LRT, were 81.3%, 66.1%, and 61.3%, respectively. Demographic data and waiting time for OLT were similar between LRT and untreated groups. Pre-OLT radiologic stage was comparable (LRT: 2.11 ± 0.74 versus Untreated: 2.39 ± 0.94; p = 0.16). At the time of transplantation, the LRT group had notable tumor downstaging (1.50 ± 1.34 versus 2.49 ± 1.17; p = 0.008). The LRT group had better 5-year survival (82.4% versus 51.8%; p = 0.01), but this improvement was observed in patients with HCC stages II, III, and IV (77.6% versus 37.4%; p = 0.016). Sixteen LRT patients, and none untreated, revealed complete tumor necrosis with no viable tumor cells on explant pathology (pT0). These patients did not experience any longterm recurrence, in contrast to those with similar pre-OLT tumors. Conclusions: OLT is a viable treatment option for primary HCC. LRT substantially downstages the primary tumor and improves longterm survival in patients with advanced disease. Complete tumor necrosis with LRT is associated with excellent longterm recurrence-free survival.

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