Transarterial chemotherapy is used to retard tumour progression for hepatocellular carcinoma patients awaiting orthotopic liver transplantation.
However, information regarding the acceptable waiting time and appropriate patient selection for the therapy is lacking.
Professor Jong Young Choi and colleagues from Korea examined dropout times and determined the best candidates for pre-transplant transarterial therapy in a cohort study.
In total, 180 consecutive hepatocellular carcinoma candidates receiving pre-transplant chemo-lipiodolization were included in the study.
Overall, 70 patients dropped off the waiting list during the median follow-up of 19 months.
|Child-Pugh classification was the strongest predictor of dropout |
|Alimentary Pharmacology & Therapeutics|
According to the Child-Pugh classification, the estimated dropout rates at 1 and 2 years were 17% and 45%, respectively, for the Child-Pugh A group.
The research team estimated that for Child-Pugh B and C groups, the dropout rates were 33% and 81% at 1 and 2 years, respectively.
The team observed that Child-Pugh B and C patients experienced more frequent dropouts than Child-Pugh A patients.
Risk factor analysis identified Child-Pugh classification to be the strongest predictor of dropout.
On multivariate analysis, alpha-fetoprotein over 100 ng/mL, tumor size over 3 cm, and multiple nodules remained predictive of dropout for Child-Pugh A group.
The team noted that candidates with none of these factors were found to be at the lowest risk of dropout, with only a 23% dropout rate up to 41 months.
Professor Choi's team commented, "This study suggests that Child-Pugh A patients with a nodule less than 3 cm, and alpha-fetoprotein less than 100 ng/mL may be the best candidates for pre-transplant chemo-lipiodolization, with the lowest dropout rate."
"However, comparative studies with other therapeutic options are needed to assess the definitive role of transarterial therapy in this setting."