TY - JOUR
T1 - Recurrence of hepatocellular carcinoma
T2 - Importance of mRECIST response to chemoembolization and tumor size
AU - Kim, D. J.
AU - Clark, P. J.
AU - Heimbach, J.
AU - Rosen, C.
AU - Sanchez, W.
AU - Watt, K.
AU - Charlton, M. R.
PY - 2014/6
Y1 - 2014/6
N2 - Determining risk for recurrence of hepatocellular carcinoma (HCC) following liver transplantation (LT) is an important clinical need. We assessed consecutive patients who underwent LT for HCC following sequential transarterial chemoembolization (TACE). Treatment response was assessed using modified response evaluation criteria in solid tumors (mRECIST) categories: complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Cox proportional hazard models were used to predict HCC recurrence. One hundred seventy-three patients underwent TACE and imaging to assess response prior to LT. TACE responses were: CR = 23.7%, PR = 24.3%, SD = 27.7% and PD = 24.3%. Five-year HCC recurrence rate was 5.3% in patients responding to TACE (CR/PR), versus 17.6%, among patients who did not respond (SD/PD, p = 0.014). In multivariate analysis, independent pre-LT predictors of recurrence were response to TACE and largest radiologic size of tumor (>3 cm vs. ≤3 cm). HCC recurrence rate for patients with tumor size >3 cm and no response to TACE was 35.8%, compared with 1.9% for patients with tumor size ≤3 cm and response to TACE (p = 0.0007). We conclude that mRECIST criteria and tumor size differentiate patients with high or low likelihood of HCC recurrence after LT. These findings raise the possibility of incorporating response to TACE and largest tumor size to identify patients at highest risk for HCC recurrence. This study demonstrates the strong predictivity of two simple pretransplant parameters, maximal tumor diameter and mRECIST response to chemoembolization, for recurrence of hepatocellular carcinoma in liver transplant recipients.
AB - Determining risk for recurrence of hepatocellular carcinoma (HCC) following liver transplantation (LT) is an important clinical need. We assessed consecutive patients who underwent LT for HCC following sequential transarterial chemoembolization (TACE). Treatment response was assessed using modified response evaluation criteria in solid tumors (mRECIST) categories: complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Cox proportional hazard models were used to predict HCC recurrence. One hundred seventy-three patients underwent TACE and imaging to assess response prior to LT. TACE responses were: CR = 23.7%, PR = 24.3%, SD = 27.7% and PD = 24.3%. Five-year HCC recurrence rate was 5.3% in patients responding to TACE (CR/PR), versus 17.6%, among patients who did not respond (SD/PD, p = 0.014). In multivariate analysis, independent pre-LT predictors of recurrence were response to TACE and largest radiologic size of tumor (>3 cm vs. ≤3 cm). HCC recurrence rate for patients with tumor size >3 cm and no response to TACE was 35.8%, compared with 1.9% for patients with tumor size ≤3 cm and response to TACE (p = 0.0007). We conclude that mRECIST criteria and tumor size differentiate patients with high or low likelihood of HCC recurrence after LT. These findings raise the possibility of incorporating response to TACE and largest tumor size to identify patients at highest risk for HCC recurrence. This study demonstrates the strong predictivity of two simple pretransplant parameters, maximal tumor diameter and mRECIST response to chemoembolization, for recurrence of hepatocellular carcinoma in liver transplant recipients.
KW - Chemoembolization
KW - hepatocellular carcinoma
KW - liver transplantation
KW - recurrence
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U2 - 10.1111/ajt.12684
DO - 10.1111/ajt.12684
M3 - Article
C2 - 24801862
AN - SCOPUS:84901281242
SN - 1600-6135
VL - 14
SP - 1383
EP - 1390
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 6
ER -