The impact of pre-operative loco-regional therapy on outcome after liver transplantation for hepatocellular carcinoma

Francis Y. Yao, Milan Kinkhabwala, Jeanne M. LaBerge, Nathan M. Bass, Robert Brown, Robert Kerlan, Alan Venook, Nancy L. Ascher, Jean C. Emond, John P. Roberts

Research output: Contribution to journalArticle

150 Citations (Scopus)

Abstract

No prior studies have shown that pre-operative loco-regional therapy for hepatocellular carcinoma (HCC) improves survival following orthotopic liver transplantation (OLT). We performed subgroup analyses according to pathologic HCC stage among 168 patients who underwent OLT to test the hypothesis that pre-operative loco-regional therapy confers a survival advantage in a subgroup at intermediate risk for HCC recurrence. Patients with pathologic T3 HCC meeting the proposed UCSF expanded criteria (single lesion not exceeding 6.5 cm or two to three lesions none > 4.5 cm with total tumor diameter within 8 cm) had a similar 5-year recurrence-free survival as patients with pathologic T2 HCC (88.5% vs. 93.8%; p = 0.56). In the subgroup with pathologic T2 or T3 HCC, the 5-year recurrence-free survival was 93.8% for the 85 patients who received pre-operative loco-regional therapy, versus 80.6% for the other 41 patients without treatment (p = 0.049). The treatment benefit, according to 5-year recurrence-free survival, appeared greater for pathologic T3 (85.9% vs. 51.4%; p = 0.05) than T2 HCC (96.4% versus 87.1%; p = 0.12). In conclusion, although the lack of a randomized controlled design precludes drawing firm conclusions, our results suggest that pre-operative loco-regional therapy may confer a survival benefit after OLT in the subgroup with pathologic T2 and T3 HCC.

Original languageEnglish (US)
Pages (from-to)795-804
Number of pages10
JournalAmerican Journal of Transplantation
Volume5
Issue number4 I
DOIs
StatePublished - Apr 2005
Externally publishedYes

Fingerprint

Liver Transplantation
Hepatocellular Carcinoma
Survival
Recurrence
Therapeutics
Neoplasms

Keywords

  • Hepatocellular carinoma
  • Loco-regional therapy
  • Orthotopic liver transplantation

ASJC Scopus subject areas

  • Immunology

Cite this

The impact of pre-operative loco-regional therapy on outcome after liver transplantation for hepatocellular carcinoma. / Yao, Francis Y.; Kinkhabwala, Milan; LaBerge, Jeanne M.; Bass, Nathan M.; Brown, Robert; Kerlan, Robert; Venook, Alan; Ascher, Nancy L.; Emond, Jean C.; Roberts, John P.

In: American Journal of Transplantation, Vol. 5, No. 4 I, 04.2005, p. 795-804.

Research output: Contribution to journalArticle

Yao, Francis Y. ; Kinkhabwala, Milan ; LaBerge, Jeanne M. ; Bass, Nathan M. ; Brown, Robert ; Kerlan, Robert ; Venook, Alan ; Ascher, Nancy L. ; Emond, Jean C. ; Roberts, John P. / The impact of pre-operative loco-regional therapy on outcome after liver transplantation for hepatocellular carcinoma. In: American Journal of Transplantation. 2005 ; Vol. 5, No. 4 I. pp. 795-804.
@article{fd67c7c1f0e4403dafce7b2e80199a73,
title = "The impact of pre-operative loco-regional therapy on outcome after liver transplantation for hepatocellular carcinoma",
abstract = "No prior studies have shown that pre-operative loco-regional therapy for hepatocellular carcinoma (HCC) improves survival following orthotopic liver transplantation (OLT). We performed subgroup analyses according to pathologic HCC stage among 168 patients who underwent OLT to test the hypothesis that pre-operative loco-regional therapy confers a survival advantage in a subgroup at intermediate risk for HCC recurrence. Patients with pathologic T3 HCC meeting the proposed UCSF expanded criteria (single lesion not exceeding 6.5 cm or two to three lesions none > 4.5 cm with total tumor diameter within 8 cm) had a similar 5-year recurrence-free survival as patients with pathologic T2 HCC (88.5{\%} vs. 93.8{\%}; p = 0.56). In the subgroup with pathologic T2 or T3 HCC, the 5-year recurrence-free survival was 93.8{\%} for the 85 patients who received pre-operative loco-regional therapy, versus 80.6{\%} for the other 41 patients without treatment (p = 0.049). The treatment benefit, according to 5-year recurrence-free survival, appeared greater for pathologic T3 (85.9{\%} vs. 51.4{\%}; p = 0.05) than T2 HCC (96.4{\%} versus 87.1{\%}; p = 0.12). In conclusion, although the lack of a randomized controlled design precludes drawing firm conclusions, our results suggest that pre-operative loco-regional therapy may confer a survival benefit after OLT in the subgroup with pathologic T2 and T3 HCC.",
keywords = "Hepatocellular carinoma, Loco-regional therapy, Orthotopic liver transplantation",
author = "Yao, {Francis Y.} and Milan Kinkhabwala and LaBerge, {Jeanne M.} and Bass, {Nathan M.} and Robert Brown and Robert Kerlan and Alan Venook and Ascher, {Nancy L.} and Emond, {Jean C.} and Roberts, {John P.}",
year = "2005",
month = "4",
doi = "10.1111/j.1600-6143.2005.00750.x",
language = "English (US)",
volume = "5",
pages = "795--804",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "4 I",

}

TY - JOUR

T1 - The impact of pre-operative loco-regional therapy on outcome after liver transplantation for hepatocellular carcinoma

AU - Yao, Francis Y.

AU - Kinkhabwala, Milan

AU - LaBerge, Jeanne M.

AU - Bass, Nathan M.

AU - Brown, Robert

AU - Kerlan, Robert

AU - Venook, Alan

AU - Ascher, Nancy L.

AU - Emond, Jean C.

AU - Roberts, John P.

PY - 2005/4

Y1 - 2005/4

N2 - No prior studies have shown that pre-operative loco-regional therapy for hepatocellular carcinoma (HCC) improves survival following orthotopic liver transplantation (OLT). We performed subgroup analyses according to pathologic HCC stage among 168 patients who underwent OLT to test the hypothesis that pre-operative loco-regional therapy confers a survival advantage in a subgroup at intermediate risk for HCC recurrence. Patients with pathologic T3 HCC meeting the proposed UCSF expanded criteria (single lesion not exceeding 6.5 cm or two to three lesions none > 4.5 cm with total tumor diameter within 8 cm) had a similar 5-year recurrence-free survival as patients with pathologic T2 HCC (88.5% vs. 93.8%; p = 0.56). In the subgroup with pathologic T2 or T3 HCC, the 5-year recurrence-free survival was 93.8% for the 85 patients who received pre-operative loco-regional therapy, versus 80.6% for the other 41 patients without treatment (p = 0.049). The treatment benefit, according to 5-year recurrence-free survival, appeared greater for pathologic T3 (85.9% vs. 51.4%; p = 0.05) than T2 HCC (96.4% versus 87.1%; p = 0.12). In conclusion, although the lack of a randomized controlled design precludes drawing firm conclusions, our results suggest that pre-operative loco-regional therapy may confer a survival benefit after OLT in the subgroup with pathologic T2 and T3 HCC.

AB - No prior studies have shown that pre-operative loco-regional therapy for hepatocellular carcinoma (HCC) improves survival following orthotopic liver transplantation (OLT). We performed subgroup analyses according to pathologic HCC stage among 168 patients who underwent OLT to test the hypothesis that pre-operative loco-regional therapy confers a survival advantage in a subgroup at intermediate risk for HCC recurrence. Patients with pathologic T3 HCC meeting the proposed UCSF expanded criteria (single lesion not exceeding 6.5 cm or two to three lesions none > 4.5 cm with total tumor diameter within 8 cm) had a similar 5-year recurrence-free survival as patients with pathologic T2 HCC (88.5% vs. 93.8%; p = 0.56). In the subgroup with pathologic T2 or T3 HCC, the 5-year recurrence-free survival was 93.8% for the 85 patients who received pre-operative loco-regional therapy, versus 80.6% for the other 41 patients without treatment (p = 0.049). The treatment benefit, according to 5-year recurrence-free survival, appeared greater for pathologic T3 (85.9% vs. 51.4%; p = 0.05) than T2 HCC (96.4% versus 87.1%; p = 0.12). In conclusion, although the lack of a randomized controlled design precludes drawing firm conclusions, our results suggest that pre-operative loco-regional therapy may confer a survival benefit after OLT in the subgroup with pathologic T2 and T3 HCC.

KW - Hepatocellular carinoma

KW - Loco-regional therapy

KW - Orthotopic liver transplantation

UR - http://www.scopus.com/inward/record.url?scp=20144389000&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=20144389000&partnerID=8YFLogxK

U2 - 10.1111/j.1600-6143.2005.00750.x

DO - 10.1111/j.1600-6143.2005.00750.x

M3 - Article

VL - 5

SP - 795

EP - 804

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 4 I

ER -