Effects of Locoregional Treatment and “Downstaging” on Long-Term Post-Liver Transplant Outcomes for Patients with Hepatocellular Carcinoma
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
Research, UNOS, Richmond, VA
Meeting: 2013 American Transplant Congress
Abstract number: 48
Introduction
Locoregional therapy (LRT) has been used to stabilize tumor growth for patients with hepatocellular carcinoma (HCC) waiting for liver transplantation (LT). However, the long-term effects after LT have not been characterized in a national data set with detailed clinical and pathological data.
Methods
A novel NCI-funded database linking clinical (pre-LT) and pathological (post-LT) explant reports with OPTN registry for 2980 LT recipients transplanted with standard HCC exceptions between 2002 and 2006 was analyzed to assess impact of LRT on overall and HCC-recurrence free survival. Recurrence was defined from OPTN follow-up or malignancy forms. “Downstaging” was defined as a patient with explant pathologic staging less advanced than listed clinical stage. Stratified Kaplan-Meier and adjusted Cox and logistic regression models were used to predict outcomes.
Results
Five-year post-LT survival was highest among LRT patients who were downstaged (72%). Patients receiving LRT without downstaging or no LRT had 62% and 66% 5-year survival, respectively (Figure 1). In multivariable analysis, LRT with downstaging was strongly associated with reduced risk of death. Compared to no LRT group, the LRT with downstaging had 22% reduced risk of post-LT death (HR 0.78, 95% CI 0.62-0.98) and LRT with no downstaging resulted in 7% increased risk of death (HR 1.07, 95% CI 0.91-1.25).
Patients receiving LRT without downstaging had the highest risk of HCC recurrence. The odds of HCC recurrence were half the odds for LRT with downstaging group compared to no LRT group (OR 0.49, 95% CI 0.27-0.90). Odds of recurrence for LRT without downstaging were 1.63 times the odds of HCC recurrence in no LRT group (OR 1.63, 95% CI 1.17-2.26).
Conclusion
Consistent with other smaller studies, LRT resulting in downstaging is associated with improved 5-year survival and lower odds of recurrence. Response to LRT treatment appears to be a marker for more favorable tumor biology and appears effective for improving HCC outcomes post LT.
To cite this abstract in AMA style:
Dzebisashvili N, Stark C, Mezochow G, Harper A, Edwards E, Axelrod D, Freeman R. Effects of Locoregional Treatment and “Downstaging” on Long-Term Post-Liver Transplant Outcomes for Patients with Hepatocellular Carcinoma [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/effects-of-locoregional-treatment-and-downstaging-on-long-term-post-liver-transplant-outcomes-for-patients-with-hepatocellular-carcinoma/. Accessed May 14, 2025.« Back to 2013 American Transplant Congress