Response to Therapy as a Criterion for Awarding Priority to Patients With Hepatocellular Carcinoma Awaiting Liver Transplantation

• Published in: Annals of surgical oncology Vol. 17; no. 9; pp. 2290 - 2302
• Main Authors: Vitale, Alessandro, D’Amico, Francesco, Frigo, Anna Chiara, Grigoletto, Francesco, Brolese, Alberto, Zanus, Giacomo, Neri, Daniele, Carraro, Amedeo, D’Amico, Francesco Enrico, Burra, Patrizia, Russo, Francesco, Angeli, Paolo, Cillo, Umberto
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.09.2010; Springer Nature B.V
• Subjects: Adult; Aged; Biopsy; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Female; Follow-Up Studies; Health Priorities; Hepatobiliary Tumors; Humans; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver Transplantation; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Patient Selection; Prospective Studies; Surgery; Surgical Oncology; Survival Rate; Treatment Outcome; Waiting Lists; Tace; Liver Transplantation; Wait List; Milan Criterion; Microscopic Vascular Invasion
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-010-0993-4

Background How to prioritize patients with hepatocellular carcinoma (HCC) for liver transplantation (LT) remains controversial. This study was designed to assess the effectiveness of a policy for prioritizing HCC patients according to their response to pre-LT therapy. Methods The study period was from 2000 to 2008. Dropout criteria included macroscopic vascular invasion, metastases, and poorly differentiated grade at pre-LT biopsy. A specific treatment algorithm was adopted to treat HCC before LT, and the effect of treatment was evaluated 3 months after listing or after the diagnosis of HCC for patients diagnosed while already on the waiting list. Patients were divided into two groups: group 1, patients with disease that completely or partially responded to therapy; and group 2, patients with stable, progressive, or untreatable disease. Group 2 patients were prioritized for LT unless full restaging and repeat biopsy identified dropout criteria. Results At the 3-month visit, 62 HCC patients (42%) were assigned to group 2 and 85 (58%) to group 1. Eleven of 12 dropouts due to tumor progression came from group 2 ( P  < 0.01). Response to therapy was the sole predictor of dropout probability, independent of tumor stage (competing risk analysis). The 42 patients in group 2 who were transplanted had much the same 3-year post-LT survival rate as the 57 transplanted patients in group 1 (with survival rates of 82% and 83%, respectively; P  > 0.05), but a slightly higher risk of post-LT HCC recurrence (13% and 2%, respectively; P  = 0.04). Conclusions Response to therapy is a potentially effective tool for prioritizing HCC patients for LT.