Extended postinterventional tumor necrosis-implication for outcome in liver transplant patients with advanced HCC
Locoregional interventional bridging therapy (IBT) is an accepted neoadjuvant approach in liver transplant candidates with hepatocellular carcinoma (HCC). However, the prognostic value of IBT in patients with advanced HCC is still undefined. The aim of this trial was to evaluate the impact of postin...
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| description | Locoregional interventional bridging therapy (IBT) is an accepted neoadjuvant approach in liver transplant candidates with hepatocellular carcinoma (HCC). However, the prognostic value of IBT in patients with advanced HCC is still undefined.
The aim of this trial was to evaluate the impact of postinterventional tumor necrosis on recurrence-free long-term survival after liver transplantation (LT) in patients with HCC, especially focusing on those exceeding the Milan criteria on pretransplant radiographic imaging.
A total of 93 consecutive liver transplant candidates with HCC were included in this trial. In 36 patients, tumors were clinically staged beyond Milan criteria prior LT. Fifty-nine patients underwent IBT by transarterial chemoembolization or radiofrequency ablation pretransplantation. Postinterventional tumor necrosis rate as assessed at liver explant pathology was correlated with outcome post-LT.
There was no significant difference in 5-year tumor-free survival rate between the IBT- and the non-IBT subpopulation (78% versus 68%, P=0.25). However, tumor response following IBT (≥ 50% tumor necrosis rate at explant pathology) resulted in a significantly better outcome 5 years post-LT (96%) than tumor non-response to IBT ( |
| doi_str_mv | 10.1371/journal.pone.0053960 |
| format | Article |
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The aim of this trial was to evaluate the impact of postinterventional tumor necrosis on recurrence-free long-term survival after liver transplantation (LT) in patients with HCC, especially focusing on those exceeding the Milan criteria on pretransplant radiographic imaging.
A total of 93 consecutive liver transplant candidates with HCC were included in this trial. In 36 patients, tumors were clinically staged beyond Milan criteria prior LT. Fifty-nine patients underwent IBT by transarterial chemoembolization or radiofrequency ablation pretransplantation. Postinterventional tumor necrosis rate as assessed at liver explant pathology was correlated with outcome post-LT.
There was no significant difference in 5-year tumor-free survival rate between the IBT- and the non-IBT subpopulation (78% versus 68%, P=0.25). However, tumor response following IBT (≥ 50% tumor necrosis rate at explant pathology) resulted in a significantly better outcome 5 years post-LT (96%) than tumor non-response to IBT (<50% tumor necrosis rate at explant pathology; 21%; P<0.001). Five-year recurrence-free survival rate was 80% in Milan Out patients with extended post-IBT tumor necrosis versus 0% in Milan Out patients without tumor response to IBT (P<0.001). None of macromorphological HCC features, but only the absence of increased (18)F-fluoro-deoxy-glucose ((18)FDG) uptake on pretransplant positron emission tomography (PET) was identified as independent predictor of postinterventional tumor response (P<0.001).
Our results implicate that extended postinterventional tumor necrosis promotes recurrence-free long-term survival in patients with HCC beyond standard criteria. Pretransplant PET assessment may identify those patients with advanced HCC that will benefit from post-IBT tumor response and may, thereby, achieve excellent posttransplant outcome.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0053960</identifier><identifier>PMID: 23349774</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Ablation (Surgery) ; Adult ; Aged ; Cancer ; Carcinoma, Hepatocellular - pathology ; Carcinoma, Hepatocellular - surgery ; Carcinoma, Hepatocellular - therapy ; Catheter Ablation ; Chemoembolization ; Combined Modality Therapy ; Criteria ; Disease-Free Survival ; Embolization, Therapeutic ; Female ; Gangrene ; Hepatocellular carcinoma ; Humans ; Liver ; Liver - diagnostic imaging ; Liver - surgery ; Liver cancer ; Liver cirrhosis ; Liver diseases ; Liver Neoplasms - pathology ; Liver Neoplasms - surgery ; Liver Neoplasms - therapy ; Liver Transplantation ; Liver transplants ; Logistic Models ; Male ; Medical imaging ; Medicine ; Middle Aged ; Multimodal Imaging ; Multivariate Analysis ; Necrosis ; Neoplasm Recurrence, Local ; Pathology ; Patient outcomes ; Patients ; Positron emission ; Positron emission tomography ; Prognosis ; Radio frequency ; Surgery ; Survival ; Time Factors ; Tomography ; Tomography, X-Ray Computed ; Transplantation ; Treatment Outcome ; Tumors</subject><ispartof>PloS one, 2013-01, Vol.8 (1), p.e53960-e53960</ispartof><rights>COPYRIGHT 2013 Public Library of Science</rights><rights>2013 Kornberg et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2013 Kornberg et al 2013 Kornberg et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-e686e7b966c53b9c14f80ebc8724b61a16b62008004f11d063eb37b7d5ac16f23</citedby><cites>FETCH-LOGICAL-c692t-e686e7b966c53b9c14f80ebc8724b61a16b62008004f11d063eb37b7d5ac16f23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551930/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551930/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2100,2926,23865,27923,27924,53790,53792,79371,79372</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23349774$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Man, Kwan</contributor><creatorcontrib>Kornberg, Arno</creatorcontrib><creatorcontrib>Witt, Ulrike</creatorcontrib><creatorcontrib>Matevossian, Edouard</creatorcontrib><creatorcontrib>Küpper, Bernadett</creatorcontrib><creatorcontrib>Assfalg, Volker</creatorcontrib><creatorcontrib>Drzezga, Alexander</creatorcontrib><creatorcontrib>Hüser, Norbert</creatorcontrib><creatorcontrib>Wildgruber, Moritz</creatorcontrib><creatorcontrib>Friess, Helmut</creatorcontrib><title>Extended postinterventional tumor necrosis-implication for outcome in liver transplant patients with advanced HCC</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Locoregional interventional bridging therapy (IBT) is an accepted neoadjuvant approach in liver transplant candidates with hepatocellular carcinoma (HCC). However, the prognostic value of IBT in patients with advanced HCC is still undefined.
The aim of this trial was to evaluate the impact of postinterventional tumor necrosis on recurrence-free long-term survival after liver transplantation (LT) in patients with HCC, especially focusing on those exceeding the Milan criteria on pretransplant radiographic imaging.
A total of 93 consecutive liver transplant candidates with HCC were included in this trial. In 36 patients, tumors were clinically staged beyond Milan criteria prior LT. Fifty-nine patients underwent IBT by transarterial chemoembolization or radiofrequency ablation pretransplantation. Postinterventional tumor necrosis rate as assessed at liver explant pathology was correlated with outcome post-LT.
There was no significant difference in 5-year tumor-free survival rate between the IBT- and the non-IBT subpopulation (78% versus 68%, P=0.25). However, tumor response following IBT (≥ 50% tumor necrosis rate at explant pathology) resulted in a significantly better outcome 5 years post-LT (96%) than tumor non-response to IBT (<50% tumor necrosis rate at explant pathology; 21%; P<0.001). Five-year recurrence-free survival rate was 80% in Milan Out patients with extended post-IBT tumor necrosis versus 0% in Milan Out patients without tumor response to IBT (P<0.001). None of macromorphological HCC features, but only the absence of increased (18)F-fluoro-deoxy-glucose ((18)FDG) uptake on pretransplant positron emission tomography (PET) was identified as independent predictor of postinterventional tumor response (P<0.001).
Our results implicate that extended postinterventional tumor necrosis promotes recurrence-free long-term survival in patients with HCC beyond standard criteria. Pretransplant PET assessment may identify those patients with advanced HCC that will benefit from post-IBT tumor response and may, thereby, achieve excellent posttransplant outcome.</description><subject>Ablation (Surgery)</subject><subject>Adult</subject><subject>Aged</subject><subject>Cancer</subject><subject>Carcinoma, Hepatocellular - pathology</subject><subject>Carcinoma, Hepatocellular - surgery</subject><subject>Carcinoma, Hepatocellular - therapy</subject><subject>Catheter Ablation</subject><subject>Chemoembolization</subject><subject>Combined Modality Therapy</subject><subject>Criteria</subject><subject>Disease-Free Survival</subject><subject>Embolization, Therapeutic</subject><subject>Female</subject><subject>Gangrene</subject><subject>Hepatocellular carcinoma</subject><subject>Humans</subject><subject>Liver</subject><subject>Liver - diagnostic imaging</subject><subject>Liver - surgery</subject><subject>Liver cancer</subject><subject>Liver cirrhosis</subject><subject>Liver diseases</subject><subject>Liver Neoplasms - pathology</subject><subject>Liver Neoplasms - surgery</subject><subject>Liver Neoplasms - therapy</subject><subject>Liver Transplantation</subject><subject>Liver transplants</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Multimodal Imaging</subject><subject>Multivariate Analysis</subject><subject>Necrosis</subject><subject>Neoplasm Recurrence, Local</subject><subject>Pathology</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Positron emission</subject><subject>Positron emission tomography</subject><subject>Prognosis</subject><subject>Radio frequency</subject><subject>Surgery</subject><subject>Survival</subject><subject>Time Factors</subject><subject>Tomography</subject><subject>Tomography, X-Ray Computed</subject><subject>Transplantation</subject><subject>Treatment 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postinterventional tumor necrosis-implication for outcome in liver transplant patients with advanced HCC</title><author>Kornberg, Arno ; Witt, Ulrike ; Matevossian, Edouard ; Küpper, Bernadett ; Assfalg, Volker ; Drzezga, Alexander ; Hüser, Norbert ; Wildgruber, Moritz ; Friess, Helmut</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-e686e7b966c53b9c14f80ebc8724b61a16b62008004f11d063eb37b7d5ac16f23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Ablation (Surgery)</topic><topic>Adult</topic><topic>Aged</topic><topic>Cancer</topic><topic>Carcinoma, Hepatocellular - pathology</topic><topic>Carcinoma, Hepatocellular - surgery</topic><topic>Carcinoma, Hepatocellular - therapy</topic><topic>Catheter Ablation</topic><topic>Chemoembolization</topic><topic>Combined Modality Therapy</topic><topic>Criteria</topic><topic>Disease-Free Survival</topic><topic>Embolization, 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One</addtitle><date>2013-01-22</date><risdate>2013</risdate><volume>8</volume><issue>1</issue><spage>e53960</spage><epage>e53960</epage><pages>e53960-e53960</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Locoregional interventional bridging therapy (IBT) is an accepted neoadjuvant approach in liver transplant candidates with hepatocellular carcinoma (HCC). However, the prognostic value of IBT in patients with advanced HCC is still undefined.
The aim of this trial was to evaluate the impact of postinterventional tumor necrosis on recurrence-free long-term survival after liver transplantation (LT) in patients with HCC, especially focusing on those exceeding the Milan criteria on pretransplant radiographic imaging.
A total of 93 consecutive liver transplant candidates with HCC were included in this trial. In 36 patients, tumors were clinically staged beyond Milan criteria prior LT. Fifty-nine patients underwent IBT by transarterial chemoembolization or radiofrequency ablation pretransplantation. Postinterventional tumor necrosis rate as assessed at liver explant pathology was correlated with outcome post-LT.
There was no significant difference in 5-year tumor-free survival rate between the IBT- and the non-IBT subpopulation (78% versus 68%, P=0.25). However, tumor response following IBT (≥ 50% tumor necrosis rate at explant pathology) resulted in a significantly better outcome 5 years post-LT (96%) than tumor non-response to IBT (<50% tumor necrosis rate at explant pathology; 21%; P<0.001). Five-year recurrence-free survival rate was 80% in Milan Out patients with extended post-IBT tumor necrosis versus 0% in Milan Out patients without tumor response to IBT (P<0.001). None of macromorphological HCC features, but only the absence of increased (18)F-fluoro-deoxy-glucose ((18)FDG) uptake on pretransplant positron emission tomography (PET) was identified as independent predictor of postinterventional tumor response (P<0.001).
Our results implicate that extended postinterventional tumor necrosis promotes recurrence-free long-term survival in patients with HCC beyond standard criteria. Pretransplant PET assessment may identify those patients with advanced HCC that will benefit from post-IBT tumor response and may, thereby, achieve excellent posttransplant outcome.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23349774</pmid><doi>10.1371/journal.pone.0053960</doi><tpages>e53960</tpages><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_1327799132 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Ablation (Surgery) Adult Aged Cancer Carcinoma, Hepatocellular - pathology Carcinoma, Hepatocellular - surgery Carcinoma, Hepatocellular - therapy Catheter Ablation Chemoembolization Combined Modality Therapy Criteria Disease-Free Survival Embolization, Therapeutic Female Gangrene Hepatocellular carcinoma Humans Liver Liver - diagnostic imaging Liver - surgery Liver cancer Liver cirrhosis Liver diseases Liver Neoplasms - pathology Liver Neoplasms - surgery Liver Neoplasms - therapy Liver Transplantation Liver transplants Logistic Models Male Medical imaging Medicine Middle Aged Multimodal Imaging Multivariate Analysis Necrosis Neoplasm Recurrence, Local Pathology Patient outcomes Patients Positron emission Positron emission tomography Prognosis Radio frequency Surgery Survival Time Factors Tomography Tomography, X-Ray Computed Transplantation Treatment Outcome Tumors |
| title | Extended postinterventional tumor necrosis-implication for outcome in liver transplant patients with advanced HCC |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-13T01%3A00%3A14IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Extended%20postinterventional%20tumor%20necrosis-implication%20for%20outcome%20in%20liver%20transplant%20patients%20with%20advanced%20HCC&rft.jtitle=PloS%20one&rft.au=Kornberg,%20Arno&rft.date=2013-01-22&rft.volume=8&rft.issue=1&rft.spage=e53960&rft.epage=e53960&rft.pages=e53960-e53960&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0053960&rft_dat=%3Cgale_plos_%3EA478167043%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1327799132&rft_id=info:pmid/23349774&rft_galeid=A478167043&rft_doaj_id=oai_doaj_org_article_a21aee6c5c5740feb2373b9bad20fb08&rfr_iscdi=true |