Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

• Published in: Diagnostic and interventional radiology (Ankara, Turkey) Vol. 23; no. 6; pp. 441 - 447
• Main Authors: Dorcaratto, Dimitri, Udupa, Venkatesha, Hogan, Niamh M, Brophy, David P, McCann, Jeffrey W, Maguire, Donal, Geoghegan, Justin, Cantwell, Colin P, Hoti, Emir
• Format: Journal Article
• Language: English
• Published: Turkey Galenos Yayinevi Tic. Ltd 01.11.2017; Aves Yayincilik Ltd. STI; Turkish Society of Radiology; Galenos Publishing House
• Subjects: Anthracyclines; Chemoembolization; Doxorubicin; Glycoproteins; Hepatoma; Interventional Radiology; Liver; Liver cancer; Liver transplants; Medical research; Medicine, Experimental; Patient outcomes; Patients; Stent (Surgery); Survival; Transplantation; Transplants & implants
• ISSN: 1305-3825; 1305-3612
• DOI: 10.5152/dir.2017.17106

We aimed to compare the overall (OS) and disease-free survival (DFS) of patients undergoing orthotopic liver transplant (OLT) for hepatocellular carcinoma who did and did not have neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization (DEB-TACE). This is a retrospective study of 94 patients with HCC transplanted between 2000 and 2014 in a single tertiary center. Pre- and postoperative features, DFS and OS were compared between patients who received pre-OLT DEB-TACE (n=34, DEB-TACE group) and those who did not (n=60, non-TACE group). Radiologic and histologic response to neoadjuvant treatment as well as its complications were also studied. There were no significant differences in post-transplantation DFS and OS rates between groups (5-year DFS: 70% in DEB-TACE group vs. 63% in non-TACE group, P = 0.454; 5-year OS: 70% in DEB-TACE group vs. 65% in non-TACE group, P = 0.532). The DEB-TACE group had longer OLT waiting time compared with the non-TACE group (110 vs. 72 days; P = 0.01). On univariate and multivariate analyses, alpha-fetoprotein (AFP) levels >500 ng/mL prior to OLT were associated with decreased OS and DFS regardless of neoadjuvant approach (hazard ratio of 6, P = 0.001 and 5.5, P = 0.002, respectively). Patients who underwent neoadjuvant DEB-TACE and OLT for hepatocellular carcinoma had no statistically different OS or DFS at 3 and 5 years from patients undergoing OLT alone.