The Timing of Liver Transplantation Following Downstaging: Wait of Not to Wait?

• Published in: Journal of gastrointestinal cancer Vol. 51; no. 4; pp. 1152 - 1156
• Main Authors: Ersan, Veysel, Barut, Bora, Yilmaz, Sezai
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2020
• Subjects: Ablation Techniques - methods; Cancer Research; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - immunology; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic - methods; Clinical Decision-Making; Consensus; Disease-Free Survival; Gastroenterology; Hepatectomy - standards; Humans; Internal Medicine; Liver - immunology; Liver - pathology; Liver Neoplasms - diagnosis; Liver Neoplasms - immunology; Liver Neoplasms - mortality; Liver Neoplasms - therapy; Liver Transplantation - standards; Medicine; Medicine & Public Health; Neoadjuvant Therapy - methods; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - immunology; Neoplasm Recurrence, Local - prevention & control; Neoplasm Staging; Oncology; Patient Selection; Practice Guidelines as Topic; Radiosurgery - methods; Radiotherapy; Review Article; Survival Rate; Time-to-Treatment - standards; Treatment Outcome; Tumor Microenvironment - drug effects; Tumor Microenvironment - immunology; Tumor Microenvironment - radiation effects; Hepatocellular carcinoma; Antitumor immune response; Tumor microenvironment; Locoregional therapy; Down-staging
• ISSN: 1941-6628; 1941-6636
• DOI: 10.1007/s12029-020-00491-z

Purpose HCC is a complex disease that is diagnosed in advanced stage and on the background of cirrhosis. Locoregional therapies provide sufficient downstaging to enable patients suitable for radical procedures such liver transplantation. However, the interval between locoregional therapies and definitive therapy is still controversial. We performed a review of literature to evaluate the role of waiting period between locoregional therapies and liver transplantation or resection from the perspective of cure and recurrence rates. Methods Thorough literature search was performed to evaluate the role of locoregional therapy and the interval to definitive therapies for the treatment of hepatocellular cancer. Results Usually, small tumors with lower tumor burden, in other words, tumors within Milan criteria, can be transplanted with an acceptable overall and disease-free survival. However, treating patients with locally advanced tumors is currently a matter of extensive research. Currently, locoregional therapies are applied to downstage the patients. However, the duration of waiting is a crucial point that needs further research. There is a consensus that the waiting interval between down-staging and transplantation should be no less than 3 months. This is important for selection of favorable tumor biology as well as from the point of antitumor immune response. Conclusion Currently, there are no surrogate markers for surveillance of response to locoregional therapies as well as the antitumor immune response that develops as a result of down-staging.