Multimodality therapy and liver transplantation for hepatocellular carcinoma: A 14-year prospective analysis of outcomes

Rajesh Ramanathan, Amit Sharma, David D. Lee, Martha Behnke, Karen Bornstein, R. Todd Stravitz, Malcolm Sydnor, Ann Fulcher, Adrian Cotterell, Marc P. Posner, Robert A. Fisher

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Hepatocellular carcinoma is a major cause of death among patients with cirrhosis. A standardized approach of multimodality therapy with intent-to-treat by transplantation for all patients with hepatocellular carcinoma was instituted at our transplant center in 1997. Data were prospectively collected to evaluate the impact of multimodality therapy on posttransplant patient survival, tumor recurrence, and patient survival without transplantation. METHODS: All patients with hepatocellular carcinoma were eligible for multimodality therapy. Multimodality therapy consisted of hepatic resection, radiofrequency ablation, transarterial chemoembolization, transarterial chemoinfusion, yttrium-90 microsphere radioembolization, and sorafenib. RESULTS: Approximately 715 patients underwent multimodality therapy; 231 patients were included in the intent-to-treat with transplantation arm, and 484 patients were treated with multimodality therapy or palliative therapy because of contraindications for transplantation. A 60.2% transplantation rate was achieved in the intent-to-treat with transplantation arm. Posttransplant survivals at 1 and 5 years were 97.1% and 72.5%, respectively. Tumor recurrence rates at 1, 3, and 5 years were 2.4%, 6.2%, and 11.6%, respectively. Patients with contraindications to transplant had increased 1- and 5-year survival from diagnosis with multimodality therapy compared with those not treated (73.1% and 46.5% versus 15.5% and 4.4%, P<0.0001). CONCLUSIONS: Using multimodality therapy before liver transplantation for hepatocellular carcinoma achieved low recurrence rates and posttransplant survival equivalent to patients with primary liver disease without hepatocellular carcinoma. Multimodality therapy may help identify patients with less active tumor biology and result in improved disease-free survival and organ utilization.

Original languageEnglish (US)
Pages (from-to)100-106
Number of pages7
JournalTransplantation
Volume98
Issue number1
DOIs
StatePublished - Jul 15 2014
Externally publishedYes

Fingerprint

Liver Transplantation
Hepatocellular Carcinoma
Transplantation
Therapeutics
Survival
Recurrence
Arm
Transplants
Yttrium
Neoplasms
Microspheres
Palliative Care
Disease-Free Survival
Liver Diseases
Cause of Death
Fibrosis
Survival Rate
Liver

Keywords

  • Hepatocellular carcinoma
  • Hepatocellular carcinoma recurrence
  • Liver resection
  • Liver transplantation
  • Radiofrequency ablation
  • Transarterial chemoembolization

ASJC Scopus subject areas

  • Transplantation

Cite this

Ramanathan, R., Sharma, A., Lee, D. D., Behnke, M., Bornstein, K., Stravitz, R. T., ... Fisher, R. A. (2014). Multimodality therapy and liver transplantation for hepatocellular carcinoma: A 14-year prospective analysis of outcomes. Transplantation, 98(1), 100-106. https://doi.org/10.1097/01.TP.0000441090.39840.b0

Multimodality therapy and liver transplantation for hepatocellular carcinoma : A 14-year prospective analysis of outcomes. / Ramanathan, Rajesh; Sharma, Amit; Lee, David D.; Behnke, Martha; Bornstein, Karen; Stravitz, R. Todd; Sydnor, Malcolm; Fulcher, Ann; Cotterell, Adrian; Posner, Marc P.; Fisher, Robert A.

In: Transplantation, Vol. 98, No. 1, 15.07.2014, p. 100-106.

Research output: Contribution to journalArticle

Ramanathan, R, Sharma, A, Lee, DD, Behnke, M, Bornstein, K, Stravitz, RT, Sydnor, M, Fulcher, A, Cotterell, A, Posner, MP & Fisher, RA 2014, 'Multimodality therapy and liver transplantation for hepatocellular carcinoma: A 14-year prospective analysis of outcomes', Transplantation, vol. 98, no. 1, pp. 100-106. https://doi.org/10.1097/01.TP.0000441090.39840.b0
Ramanathan, Rajesh ; Sharma, Amit ; Lee, David D. ; Behnke, Martha ; Bornstein, Karen ; Stravitz, R. Todd ; Sydnor, Malcolm ; Fulcher, Ann ; Cotterell, Adrian ; Posner, Marc P. ; Fisher, Robert A. / Multimodality therapy and liver transplantation for hepatocellular carcinoma : A 14-year prospective analysis of outcomes. In: Transplantation. 2014 ; Vol. 98, No. 1. pp. 100-106.
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title = "Multimodality therapy and liver transplantation for hepatocellular carcinoma: A 14-year prospective analysis of outcomes",
abstract = "BACKGROUND: Hepatocellular carcinoma is a major cause of death among patients with cirrhosis. A standardized approach of multimodality therapy with intent-to-treat by transplantation for all patients with hepatocellular carcinoma was instituted at our transplant center in 1997. Data were prospectively collected to evaluate the impact of multimodality therapy on posttransplant patient survival, tumor recurrence, and patient survival without transplantation. METHODS: All patients with hepatocellular carcinoma were eligible for multimodality therapy. Multimodality therapy consisted of hepatic resection, radiofrequency ablation, transarterial chemoembolization, transarterial chemoinfusion, yttrium-90 microsphere radioembolization, and sorafenib. RESULTS: Approximately 715 patients underwent multimodality therapy; 231 patients were included in the intent-to-treat with transplantation arm, and 484 patients were treated with multimodality therapy or palliative therapy because of contraindications for transplantation. A 60.2{\%} transplantation rate was achieved in the intent-to-treat with transplantation arm. Posttransplant survivals at 1 and 5 years were 97.1{\%} and 72.5{\%}, respectively. Tumor recurrence rates at 1, 3, and 5 years were 2.4{\%}, 6.2{\%}, and 11.6{\%}, respectively. Patients with contraindications to transplant had increased 1- and 5-year survival from diagnosis with multimodality therapy compared with those not treated (73.1{\%} and 46.5{\%} versus 15.5{\%} and 4.4{\%}, P<0.0001). CONCLUSIONS: Using multimodality therapy before liver transplantation for hepatocellular carcinoma achieved low recurrence rates and posttransplant survival equivalent to patients with primary liver disease without hepatocellular carcinoma. Multimodality therapy may help identify patients with less active tumor biology and result in improved disease-free survival and organ utilization.",
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T2 - A 14-year prospective analysis of outcomes

AU - Ramanathan, Rajesh

AU - Sharma, Amit

AU - Lee, David D.

AU - Behnke, Martha

AU - Bornstein, Karen

AU - Stravitz, R. Todd

AU - Sydnor, Malcolm

AU - Fulcher, Ann

AU - Cotterell, Adrian

AU - Posner, Marc P.

AU - Fisher, Robert A.

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N2 - BACKGROUND: Hepatocellular carcinoma is a major cause of death among patients with cirrhosis. A standardized approach of multimodality therapy with intent-to-treat by transplantation for all patients with hepatocellular carcinoma was instituted at our transplant center in 1997. Data were prospectively collected to evaluate the impact of multimodality therapy on posttransplant patient survival, tumor recurrence, and patient survival without transplantation. METHODS: All patients with hepatocellular carcinoma were eligible for multimodality therapy. Multimodality therapy consisted of hepatic resection, radiofrequency ablation, transarterial chemoembolization, transarterial chemoinfusion, yttrium-90 microsphere radioembolization, and sorafenib. RESULTS: Approximately 715 patients underwent multimodality therapy; 231 patients were included in the intent-to-treat with transplantation arm, and 484 patients were treated with multimodality therapy or palliative therapy because of contraindications for transplantation. A 60.2% transplantation rate was achieved in the intent-to-treat with transplantation arm. Posttransplant survivals at 1 and 5 years were 97.1% and 72.5%, respectively. Tumor recurrence rates at 1, 3, and 5 years were 2.4%, 6.2%, and 11.6%, respectively. Patients with contraindications to transplant had increased 1- and 5-year survival from diagnosis with multimodality therapy compared with those not treated (73.1% and 46.5% versus 15.5% and 4.4%, P<0.0001). CONCLUSIONS: Using multimodality therapy before liver transplantation for hepatocellular carcinoma achieved low recurrence rates and posttransplant survival equivalent to patients with primary liver disease without hepatocellular carcinoma. Multimodality therapy may help identify patients with less active tumor biology and result in improved disease-free survival and organ utilization.

AB - BACKGROUND: Hepatocellular carcinoma is a major cause of death among patients with cirrhosis. A standardized approach of multimodality therapy with intent-to-treat by transplantation for all patients with hepatocellular carcinoma was instituted at our transplant center in 1997. Data were prospectively collected to evaluate the impact of multimodality therapy on posttransplant patient survival, tumor recurrence, and patient survival without transplantation. METHODS: All patients with hepatocellular carcinoma were eligible for multimodality therapy. Multimodality therapy consisted of hepatic resection, radiofrequency ablation, transarterial chemoembolization, transarterial chemoinfusion, yttrium-90 microsphere radioembolization, and sorafenib. RESULTS: Approximately 715 patients underwent multimodality therapy; 231 patients were included in the intent-to-treat with transplantation arm, and 484 patients were treated with multimodality therapy or palliative therapy because of contraindications for transplantation. A 60.2% transplantation rate was achieved in the intent-to-treat with transplantation arm. Posttransplant survivals at 1 and 5 years were 97.1% and 72.5%, respectively. Tumor recurrence rates at 1, 3, and 5 years were 2.4%, 6.2%, and 11.6%, respectively. Patients with contraindications to transplant had increased 1- and 5-year survival from diagnosis with multimodality therapy compared with those not treated (73.1% and 46.5% versus 15.5% and 4.4%, P<0.0001). CONCLUSIONS: Using multimodality therapy before liver transplantation for hepatocellular carcinoma achieved low recurrence rates and posttransplant survival equivalent to patients with primary liver disease without hepatocellular carcinoma. Multimodality therapy may help identify patients with less active tumor biology and result in improved disease-free survival and organ utilization.

KW - Hepatocellular carcinoma

KW - Hepatocellular carcinoma recurrence

KW - Liver resection

KW - Liver transplantation

KW - Radiofrequency ablation

KW - Transarterial chemoembolization

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