Locoregional treatments before liver transplantation for hepatocellular carcinoma: a study from the European Liver Transplant Registry

• Published in: Transplant international Vol. 31; no. 5; p. 531
• Main Authors: Pommergaard, Hans-Christian, Rostved, Andreas Arendtsen, Adam, René, Thygesen, Lau Caspar, Salizzoni, Mauro, Gómez Bravo, Miguel Angel, Cherqui, Daniel, De Simone, Paolo, Boudjema, Karim, Mazzaferro, Vincenzo, Soubrane, Olivier, García-Valdecasas, Juan Carlos, Fabregat Prous, Joan, Pinna, Antonio D, O'Grady, John, Karam, Vincent, Duvoux, Christophe, Rasmussen, Allan
• Format: Journal Article
• Language: English
• Published: England 01-05-2018
• Subjects: Adolescent; Adult; Aged; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Catheter Ablation; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver Transplantation; Male; Middle Aged; Proportional Hazards Models; Registries; Waiting Lists; Young Adult; locoregional treatment; pretreatment; hepatocellular carcinoma; liver transplantation
• ISSN: 1432-2277
• DOI: 10.1111/tri.13123

Locoregional treatment while on the waiting list for liver transplantation (Ltx) for hepatocellular carcinoma (HCC) has been shown to improve survival. However, the effect of treatment type has not been investigated. We investigate the effect of locoregional treatment type on survival after Ltx for HCC. We investigated patients registered in the European Liver Transplant Registry database using multivariate Cox regression survival analysis. Information on locoregional therapy was registered for 4978 of 23 124 patients and was associated with improved overall survival [hazard ratio (HR) 0.84 (0.73-0.96)] and HCC-specific survival [HR 0.76 (0.59-0.98)]. Radiofrequency ablation (RFA) was the one monotherapy associated with improved overall survival [HR 0.51 (0.40-0.65)]. In addition, the combination of RFA and transarterial chemoembolization also improved survival [HR 0.74 (0.55-0.99)]. Adjusting for factors related to prognosis, disease severity, and tumor aggressiveness, RFA was highly beneficial for overall and HCC-specific survival. The effect may represent a selection of patients with favorable tumor biology; however, the treatment may be effective per se by halting tumor progression. Clinicaltrials.gov number: NCT02995096.