Orthotopic liver transplantation (OLT) is the best treatment option for patients with hepatocellular carcinoma (HCC).
However, due to increased waiting times, a proportion of patients are excluded from OLT because of tumor progression. A greater than 20% dropout rate from the waiting list has recently been reported.
In this study, researchers evaluated the effect of preoperative transarterial chemoembolization (TACE) on preventing tumor progression while on a waiting list.
Their results are published in the June issue of Liver Transplantation.
|1-, 2-, and 5-year survival rates of 98%, 98%, and 93%, respectively.|
Included patients met the selection criteria; solitary lesions ≤ 5 cm, or 3 lesions ≤ 3 cm).
In addition, the team analyzed a separate group of patients with advanced-stage HCC outside the selection criteria, but with at least 50% tumor reduction after TACE.
The researchers identified 48 patients who met the selection criteria
Of these, 7 patients remain on the waiting list, while 41 have undergone OLT.
The team found that the 1-, 2-, and 5-year intention-to-treat survival was 98%, 98%, and 94%, respectively.
In addition, outcome after OLT was also excellent with 1-, 2-, and 5-year survival rates of 98%, 98%, and 93%, respectively.
Furthermore, they found that tumor recurrence occurred in only 1 patient.
The team had also included 15 patients with advanced-stage HCC in this study. However, 3 developed a tumor progression and had to be removed from the list.
They determined that, despite tumor reduction before OLT, these patients had a less favorable outcome in the intention-to-treat analysis and posttransplantation survival.
The researchers found that tumors recurred in 30% of patients after OLT.
Dr Ivo Graziadei's team concluded, "TACE followed by OLT is associated with an excellent outcome in selected patients".
"Furthermore, TACE is highly efficacious in preventing tumor progression while waiting for OLT".
"Although TACE reduced tumor preoperatively, it failed to show a beneficial effect on patient survival in advanced-stage HCCs".