Predicting Recurrence Prior to Transplant: The Response of HCC to Chemoembolization.
1Radiology, Ochsner Clinic Foundation, New Orleans, LA
2Transplant Surgery, Ochsner Clinic Foundation, New Orleans, LA
3Institute of Translational Research, Ochsner Clinic Foundation, New Orleans, LA
4Pathology, Ochsner Clinic Foundation, New Orleans, LA
Meeting: 2017 American Transplant Congress
Abstract number: A79
Keywords: Hepatocellular carcinoma, Liver transplantation, Prediction models, Recurrence
Session Information
Date: Saturday, April 29, 2017
Session Name: Poster Session A: Clinical Science: Liver - Hepatocellular Carcinoma and Cholangiocarcinoma Malignancies
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Purpose:
This study assesses imaging response characteristics of patients with hepatocellular carcinoma (HCC) to chemoembolization (TACE) as a bridge to transplant and the risk of post-transplant recurrence.
Materials:
Retrospective analysis was performed on all HCC patients who were treated with TACE (100-300[micro] LC Beads™ mixed with doxorubicin) from 2011 to 2016 and later transplanted. Treatment response was based on modified RECIST imaging criteria. Multiple treatment cycles were performed in cases of partial response (PR), stable disease (SD), and disease progression (DP) at follow-up. Patients with complete response (CR) were monitored with routine imaging. The most immediate post-treatment imaging response prior to transplantation was compared with tumor biology and recurrence.
Results:
Eighty-two patients were followed after transplant (mean time of follow-up, 659 days). Recurrence occurred in 7 (8.5%) patients (mean time from transplant, 635 days). Poor response to TACE (SD/DP) was present in 86% of patients with recurrence and accounted for 35% of all patients with SD/DP (p=0.0002). Lesion size (4.5 cm with vs 3.5 cm without, p=0.09), lymphovascular invasion (57% with vs 16% without, p=0.02), and satellite nodules (57% with vs 20% without, p=0.05) demonstrated significance for recurrence. Post-transplant RETREAT (Risk Estimation of Tumor Recurrence After Transplant) score showed recurrence in 13% of score 4 and 33% of score >5 (p=0.06).
| Multivariate Analysis with recurrence as the outcome model | ||
| Variable | OR | p-value |
| Lesion size | 1.76 | 0.08 |
| Poor response to TACE (SD/DP) prior to transplant | 56.5 | 0.0045 |
| Lymphovascular invasion at explant | 1.64 | 0.69 |
| Satellite nodules at explant | 3.15 | 0.36 |
Conclusions:
Poor TACE treatment response demonstrates similar efficacy in predicting post-transplant recurrence at similar follow-up intervals compared with RETREAT. Given its pre-transplant predictive value, it allows for improved selection criterion and better strategy in the treatment of HCC.
CITATION INFORMATION: Sandow T, Bohorquez H, Kirsch D, Thevenot P, Nunez K, Albar A, DeVun D, Gimenez J, Galliano G, Cohen A, Loss G, Kay D, Gulotta P. Predicting Recurrence Prior to Transplant: The Response of HCC to Chemoembolization. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Sandow T, Bohorquez H, Kirsch D, Thevenot P, Nunez K, Albar A, DeVun D, Gimenez J, Galliano G, Cohen A, Loss G, Kay D, Gulotta P. Predicting Recurrence Prior to Transplant: The Response of HCC to Chemoembolization. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/predicting-recurrence-prior-to-transplant-the-response-of-hcc-to-chemoembolization/. Accessed October 19, 2019.« Back to 2017 American Transplant Congress