Loco-regional hepatocellular carcinoma treatment services as a bridge to liver transplantation.
Aged
Carcinoma, Hepatocellular
/ diagnostic imaging
Disease-Free Survival
Female
Humans
Liver Neoplasms
/ diagnostic imaging
Liver Transplantation
/ adverse effects
Male
Middle Aged
Neoadjuvant Therapy
/ adverse effects
Patient Dropouts
Retrospective Studies
Risk Factors
Time Factors
Time-to-Treatment
Tissue Donors
/ supply & distribution
Waiting Lists
/ mortality
Hepatocellular carcinoma
Liver neoplasms
Liver transplantation
Organ transplantation
Therapeutic embolization
Journal
Hepatobiliary & pancreatic diseases international : HBPD INT
ISSN: 1499-3872
Titre abrégé: Hepatobiliary Pancreat Dis Int
Pays: Singapore
ID NLM: 101151457
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
14
08
2018
accepted:
15
01
2019
pubmed:
6
2
2019
medline:
22
1
2020
entrez:
6
2
2019
Statut:
ppublish
Résumé
Liver transplantation remains the main curative treatment option for hepatocellular carcinoma (HCC) patients. In the Eurotransplant area Milan criteria are used to assign priority extra points (exceptional MELD, exMELD) for patients on the waiting list. To prevent patients from tumor progression, loco-regional (neoadjuvant) treatment (LRT) is used. For patients unlikely to timely receive an organ via primary allocation, "extended critera donor (ECD) organs" are used. The present study aimed to investigate the survival after LT with a strategy of minimizing waiting list dropouts by using LRT for bridging and transplanting ECD organs if possible and necessary. Between October 2010 and May 2015, 50 liver transplants for HCC were included in this retrospective study. Of those, 42 (84%) met the Milan criteria according to the preoperative radiological examination. Forty-one patients (82%) received LRT. The waiting time was analyzed according to LRT. Kaplan-Meier curves with log-rank statistics were used for survival analyses. One- and five-year overall survival within Milan criteria was 94.3% and 83.7% compared with 91.7% and 67.9% beyond Milan criteria, though statistical significance was not reached (P = 0.487). LRT had no impact on overall survival (P = 0.629). Median waiting time was shorter if no LRT was performed (4.6 months vs. 1.5 months, P = 0.006) and there were no cases of waiting list dropouts. Using ECD organs had no impact on overall survival (P = 0.663). Patients with an expected waiting time to transplantation of >6 months could be successfully treated with LRT as a bridge to transplant. Overall and disease-free survival for patients within and beyond Milan criteria was comparable and the use of ECD organs in this cohort of HCC patients proved to be a safe option.
Sections du résumé
BACKGROUND
BACKGROUND
Liver transplantation remains the main curative treatment option for hepatocellular carcinoma (HCC) patients. In the Eurotransplant area Milan criteria are used to assign priority extra points (exceptional MELD, exMELD) for patients on the waiting list. To prevent patients from tumor progression, loco-regional (neoadjuvant) treatment (LRT) is used. For patients unlikely to timely receive an organ via primary allocation, "extended critera donor (ECD) organs" are used. The present study aimed to investigate the survival after LT with a strategy of minimizing waiting list dropouts by using LRT for bridging and transplanting ECD organs if possible and necessary.
METHODS
METHODS
Between October 2010 and May 2015, 50 liver transplants for HCC were included in this retrospective study. Of those, 42 (84%) met the Milan criteria according to the preoperative radiological examination. Forty-one patients (82%) received LRT. The waiting time was analyzed according to LRT. Kaplan-Meier curves with log-rank statistics were used for survival analyses.
RESULTS
RESULTS
One- and five-year overall survival within Milan criteria was 94.3% and 83.7% compared with 91.7% and 67.9% beyond Milan criteria, though statistical significance was not reached (P = 0.487). LRT had no impact on overall survival (P = 0.629). Median waiting time was shorter if no LRT was performed (4.6 months vs. 1.5 months, P = 0.006) and there were no cases of waiting list dropouts. Using ECD organs had no impact on overall survival (P = 0.663).
CONCLUSIONS
CONCLUSIONS
Patients with an expected waiting time to transplantation of >6 months could be successfully treated with LRT as a bridge to transplant. Overall and disease-free survival for patients within and beyond Milan criteria was comparable and the use of ECD organs in this cohort of HCC patients proved to be a safe option.
Identifiants
pubmed: 30718181
pii: S1499-3872(19)30023-2
doi: 10.1016/j.hbpd.2019.01.004
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
228-236Informations de copyright
Copyright © 2019 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.