Recurrence of hepatocellular carcinoma: Importance of mRECIST response to chemoembolization and tumor size

D. J. Kim, P. J. Clark, J. Heimbach, C. Rosen, W. Sanchez, K. Watt, M. R. Charlton

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1383-1390
Number of pages8
JournalAmerican Journal of Transplantation
Volume14
Issue number6
DOIs
StatePublished - 2014

Fingerprint

Hepatocellular Carcinoma
Recurrence
Liver Transplantation
Neoplasms
Response Evaluation Criteria in Solid Tumors
Proportional Hazards Models
Multivariate Analysis
Liver

Keywords

  • Chemoembolization
  • hepatocellular carcinoma
  • liver transplantation
  • recurrence

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Transplantation
  • Immunology and Allergy
  • Medicine(all)

Cite this

Kim, D. J., Clark, P. J., Heimbach, J., Rosen, C., Sanchez, W., Watt, K., & Charlton, M. R. (2014). Recurrence of hepatocellular carcinoma: Importance of mRECIST response to chemoembolization and tumor size. American Journal of Transplantation, 14(6), 1383-1390. https://doi.org/10.1111/ajt.12684

Recurrence of hepatocellular carcinoma : Importance of mRECIST response to chemoembolization and tumor size. / Kim, D. J.; Clark, P. J.; Heimbach, J.; Rosen, C.; Sanchez, W.; Watt, K.; Charlton, M. R.

In: American Journal of Transplantation, Vol. 14, No. 6, 2014, p. 1383-1390.

Research output: Contribution to journalArticle

Kim, DJ, Clark, PJ, Heimbach, J, Rosen, C, Sanchez, W, Watt, K & Charlton, MR 2014, 'Recurrence of hepatocellular carcinoma: Importance of mRECIST response to chemoembolization and tumor size', American Journal of Transplantation, vol. 14, no. 6, pp. 1383-1390. https://doi.org/10.1111/ajt.12684
Kim, D. J. ; Clark, P. J. ; Heimbach, J. ; Rosen, C. ; Sanchez, W. ; Watt, K. ; Charlton, M. R. / Recurrence of hepatocellular carcinoma : Importance of mRECIST response to chemoembolization and tumor size. In: American Journal of Transplantation. 2014 ; Vol. 14, No. 6. pp. 1383-1390.
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