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Locoregional Therapy-Induced Tumor Necrosis as a Predictor of Recurrence after Liver Transplant in Patients with Hepatocellular Carcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients with hepatocellular carcinoma (HCC) often undergo locoregional therapy before liver transplant either to downstage the tumor or as bridge therapy. Our goal was to assess the risk factors for posttransplant tumor recurrence, specifically the extent of necrosis induced by locoregional therapy.

Methods

We conducted a hospital-based retrospective analysis of 100 patients with HCC who received a liver transplant, 86 of whom had received pretransplant locoregional therapy. We evaluated various patient- and tumor-related parameters to determine the risk factors for recurrence. Furthermore, we grouped patients by the degree of tumor necrosis after locoregional therapy and identified the factors that were associated with a favorable tumor response.

Results

Initial tumor extent beyond the University of San Francisco (UCSF) criteria, microvascular invasion, and attainment of less than 90% tumor necrosis after locoregional therapy were independent risk factors for tumor recurrence. In addition, there was a significant correlation between the tumor necrosis percentage and disease-specific survival rate. Among patients whose tumors initially exceeded the UCSF criteria, those with extensive locoregional therapy-induced tumor necrosis had lower recurrence rates. All recurrences after transplant occurred within 3 years, and recurrence rates in patients with extensive tumor necrosis at 1, 2, and 3 years were 3%, 6%, and 10%, respectively. Female gender and a solitary tumor were independently associated with extensive tumor necrosis.

Conclusions

In HCC patients who are transplant candidates and undergo pretransplant locoregional therapy, the degree of induced tumor necrosis affects both tumor recurrence and survival rate.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Meng-Hsing Ho MD, Teng-Wei Chen MD & Chung-Bao Hsieh MD

  2. Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Chih-Yung Yu MD

  3. Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan

    Kuo-Piao Chung PhD & Chung-Bao Hsieh MD

  4. Division of Gastroenterology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Heng-Cheng Chu MD, PhD

  5. Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Chih-Kung Lin MD

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Correspondence to Chung-Bao Hsieh MD.

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Ho, MH., Yu, CY., Chung, KP. et al. Locoregional Therapy-Induced Tumor Necrosis as a Predictor of Recurrence after Liver Transplant in Patients with Hepatocellular Carcinoma. Ann Surg Oncol 18, 3632–3639 (2011). https://doi.org/10.1245/s10434-011-1803-3

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  • DOI: https://doi.org/10.1245/s10434-011-1803-3

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