Locoregional therapy-induced tumor necrosis as a predictor of recurrence after liver transplant in patients with hepatocellular carcinoma

Meng-Hsing Ho, Chih-Yung Yu, Kuo-Piao Chung, Teng-Wei Chen, Heng-Cheng Chu, Chih-Kung Lin, Chung-Bao Hsieh

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Patients with hepatocellular carcinoma (HCC) often undergo locoregional therapy before liver transplant either to downstage the tumor or as bridge therapy. Our goal was to assess the risk factors for posttransplant tumor recurrence, specifically the extent of necrosis induced by locoregional therapy. Methods: We conducted a hospital-based retrospective analysis of 100 patients with HCC who received a liver transplant, 86 of whom had received pretransplant locoregional therapy. We evaluated various patient- and tumor-related parameters to determine the risk factors for recurrence. Furthermore, we grouped patients by the degree of tumor necrosis after locoregional therapy and identified the factors that were associated with a favorable tumor response. Results: Initial tumor extent beyond the University of San Francisco (UCSF) criteria, microvascular invasion, and attainment of less than 90% tumor necrosis after locoregional therapy were independent risk factors for tumor recurrence. In addition, there was a significant correlation between the tumor necrosis percentage and disease-specific survival rate. Among patients whose tumors initially exceeded the UCSF criteria, those with extensive locoregional therapy-induced tumor necrosis had lower recurrence rates. All recurrences after transplant occurred within 3 years, and recurrence rates in patients with extensive tumor necrosis at 1, 2, and 3 years were 3%, 6%, and 10%, respectively. Female gender and a solitary tumor were independently associated with extensive tumor necrosis. Conclusions: In HCC patients who are transplant candidates and undergo pretransplant locoregional therapy, the degree of induced tumor necrosis affects both tumor recurrence and survival rate. © 2011 Society of Surgical Oncology.
Original languageEnglish
Pages (from-to)3632-3639
Number of pages8
JournalAnnals of Surgical Oncology
Volume18
Issue number13
DOIs
Publication statusPublished - 2011
Externally publishedYes

Fingerprint

Hepatocellular Carcinoma
Necrosis
Transplants
Recurrence
Liver
Neoplasms
Therapeutics
Survival Rate
San Francisco

Keywords

  • adult
  • article
  • cancer invasion
  • cancer patient
  • cancer recurrence
  • female
  • gender
  • human
  • liver cell carcinoma
  • liver graft
  • local therapy
  • major clinical study
  • male
  • postoperative period
  • preoperative period
  • retrospective study
  • survival rate
  • tumor necrosis
  • Carcinoma, Hepatocellular
  • Female
  • Follow-Up Studies
  • Humans
  • Liver Neoplasms
  • Liver Transplantation
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Prognosis
  • Retrospective Studies
  • Survival Rate

Cite this

Locoregional therapy-induced tumor necrosis as a predictor of recurrence after liver transplant in patients with hepatocellular carcinoma. / Ho, Meng-Hsing; Yu, Chih-Yung; Chung, Kuo-Piao; Chen, Teng-Wei; Chu, Heng-Cheng; Lin, Chih-Kung; Hsieh, Chung-Bao.

In: Annals of Surgical Oncology, Vol. 18, No. 13, 2011, p. 3632-3639.

Research output: Contribution to journalArticle

Ho, Meng-Hsing ; Yu, Chih-Yung ; Chung, Kuo-Piao ; Chen, Teng-Wei ; Chu, Heng-Cheng ; Lin, Chih-Kung ; Hsieh, Chung-Bao. / Locoregional therapy-induced tumor necrosis as a predictor of recurrence after liver transplant in patients with hepatocellular carcinoma. In: Annals of Surgical Oncology. 2011 ; Vol. 18, No. 13. pp. 3632-3639.
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title = "Locoregional therapy-induced tumor necrosis as a predictor of recurrence after liver transplant in patients with hepatocellular carcinoma",
abstract = "Background: Patients with hepatocellular carcinoma (HCC) often undergo locoregional therapy before liver transplant either to downstage the tumor or as bridge therapy. Our goal was to assess the risk factors for posttransplant tumor recurrence, specifically the extent of necrosis induced by locoregional therapy. Methods: We conducted a hospital-based retrospective analysis of 100 patients with HCC who received a liver transplant, 86 of whom had received pretransplant locoregional therapy. We evaluated various patient- and tumor-related parameters to determine the risk factors for recurrence. Furthermore, we grouped patients by the degree of tumor necrosis after locoregional therapy and identified the factors that were associated with a favorable tumor response. Results: Initial tumor extent beyond the University of San Francisco (UCSF) criteria, microvascular invasion, and attainment of less than 90{\%} tumor necrosis after locoregional therapy were independent risk factors for tumor recurrence. In addition, there was a significant correlation between the tumor necrosis percentage and disease-specific survival rate. Among patients whose tumors initially exceeded the UCSF criteria, those with extensive locoregional therapy-induced tumor necrosis had lower recurrence rates. All recurrences after transplant occurred within 3 years, and recurrence rates in patients with extensive tumor necrosis at 1, 2, and 3 years were 3{\%}, 6{\%}, and 10{\%}, respectively. Female gender and a solitary tumor were independently associated with extensive tumor necrosis. Conclusions: In HCC patients who are transplant candidates and undergo pretransplant locoregional therapy, the degree of induced tumor necrosis affects both tumor recurrence and survival rate. {\circledC} 2011 Society of Surgical Oncology.",
keywords = "adult, article, cancer invasion, cancer patient, cancer recurrence, female, gender, human, liver cell carcinoma, liver graft, local therapy, major clinical study, male, postoperative period, preoperative period, retrospective study, survival rate, tumor necrosis, Carcinoma, Hepatocellular, Female, Follow-Up Studies, Humans, Liver Neoplasms, Liver Transplantation, Male, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Prognosis, Retrospective Studies, Survival Rate",
author = "Meng-Hsing Ho and Chih-Yung Yu and Kuo-Piao Chung and Teng-Wei Chen and Heng-Cheng Chu and Chih-Kung Lin and Chung-Bao Hsieh",
note = "被引用次數:5 Export Date: 22 March 2016 CODEN: ASONF 通訊地址: Ho, M.-H.; Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 參考文獻: Maxwell Parkin, D., Bray, F., Ferlay, J., Pisani, P., Estimating the world cancer burden: Globocan 2000 (2001) International Journal of Cancer, 94 (2), pp. 153-156. , DOI 10.1002/ijc.1440; El-Serag, H.B., Mason, A.C., Rising incidence of hepatocellular carcinoma in the United States (1999) New England Journal of Medicine, 340 (10), pp. 745-750. , DOI 10.1056/NEJM199903113401001; Wakabayashi, H., Ushiyama, T., Ishimura, K., Izuishi, K., Karasawa, Y., Masaki, T., Watanabe, S., Maeta, H., Significance of reduction surgery in multidisciplinary treatment of advanced hepatocellular carcinoma with multiple intrahepatic lesions (2003) Journal of Surgical Oncology, 82 (2), pp. 98-103. , DOI 10.1002/jso.10203; Kim W.Ray, Brown Jr., R.S., Terrault, N.A., El-Serag, H., Burden of liver disease in the United States: Summary of a workshop (2002) Hepatology, 36 (1), pp. 227-242. , DOI 10.1053/jhep.2002.34734; Mazzaferro, V., Regalia, E., Doci, R., Andreola, S., Pulvirenti, A., Bozzetti, F., Montalto, F., Gennari, L., Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis (1996) New England Journal of Medicine, 334 (11), pp. 693-699. , DOI 10.1056/NEJM199603143341104; Jonas, S., Bechstein, W.O., Steinmuller, T., Herrmann, M., Radke, C., Berg, T., Settmacher, U., Neuhaus, P., Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis (2001) Hepatology, 33 (5), pp. 1080-1086. , DOI 10.1053/jhep.2001.23561; Yao, F.Y., Ferrell, L., Bass, N.M., Watson, J.J., Bacchetti, P., Venook, A., Ascher, N.L., Roberts, J.P., Liver transplantation for hepatocellular carcinoma: Expansion of the tumor size limits does not adversely impact survival (2001) Hepatology, 33 (6), pp. 1394-1403. , DOI 10.1053/jhep.2001.24563; Mor, E., Kaspa, R.T., Sheiner, P., Schwartz, M., Treatment of hepatocellular carcinoma associated with cirrhosis in the era of liver transplantation (1998) Annals of Internal Medicine, 129 (8), pp. 643-653; Ota, K., Teraoka, S., Kawai, T., Donor difficulties in Japan and Asian countries (1995) Transpl Proc, 27, pp. 83-86. , 1:STN:280:DyaK2M7osVymtQ{\%}3D{\%}3D; Mazziotti, A., Surgical treatment of hepatocellular carcinoma on cirrhosis: A Western experience (1998) Hepato-Gastroenterology, 45 (SUPPL. 3), pp. 1281-1287; Toso, C., Mentha, G., Kneteman, N.M., Majno, P., The place of downstaging for hepatocellular carcinoma (2010) J Hepatol, 52, pp. 930-936. , 20385428 10.1016/j.jhep.2009.12.032; Oldhafer, K.J., Chavan, A., Fruhauf, N.R., Flemming, P., Schlitt, H.J., Kubicka, S., Nashan, B., Galanski, M., Arterial chemoembolization before liver transplantation in patients with hepatocellular carcinoma: Marked tumor necrosis, but no survival benefit? (1998) Journal of Hepatology, 29 (6), pp. 953-959. , DOI 10.1016/S0168-8278(98)80123-2; Decaens, T., Roudot-Thoraval, F., Bresson-Hadni, S., Meyer, C., Gugenheim, J., Durand, F., Bernard, P.-H., Duvoux, C., Impact of pretransplantation transarterial chemoembolization on survival and recurrence after liver transplantation for hepatocellular carcinoma (2005) Liver Transplantation, 11 (7), pp. 767-775. , DOI 10.1002/lt.20418; Porrett, P.M., Peterman, H., Rosen, M., Lack of benefit of pre-transplant locoregional hapatic therapy for hepatocellular cancer in the current MELD era (2006) Liver Transpl, 12, pp. 665-673. , 16482577 10.1002/lt.20636; Lesurtel, M., Mullhaupt, B., Pestalozzi, B.C., Pfammatter, T., Clavien, P.-A., Transarterial chemoembolization as a bridge to liver transplantation for hepatocellular carcinoma: An evidence-based analysis (2006) American Journal of Transplantation, 6 (11), pp. 2644-2650. , DOI 10.1111/j.1600-6143.2006.01509.x; Poon, R.T.-P., Ngan, H., Lo, C.-M., Liu, C.-L., Fan, S.-T., Wong, J., Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence (2000) Journal of Surgical Oncology, 73 (2), pp. 109-114. , DOI 10.1002/(SICI)1096-9098(200002)73:2<109::AID-JSO10>3.0.CO;2-J; Yao, F.Y., Kerlan Jr., R.K., Hirose, R., Excellent outcome following down-staging of hepatocellular carcinoma prior to liver transplantation: An intention-to-treat analysis (2008) Hepatology, 48, pp. 819-827. , 18688876 10.1002/hep.22412; Harnois, D.M., Steers, J., Andrews, J.C., Rubin, J.C., Pitot, H.C., Burgart, L., Wiesner, R.H., Gores, G.J., Preoperative hepatic artery chemoembolization followed by orthotopic liver transplantation for hepatocellular carcinoma (1999) Liver Transplantation and Surgery, 5 (3), pp. 192-199; Roayaie, S., Frischer, J.S., Emre, S.H., Fishbein, T.M., Sheiner, P.A., Sung, M., Miller, C.M., Schwartz, M.E., Long-term results with multimodal adjuvant therapy and liver transplantation for the treatment of hepatocellular carcinomas larger than 5 centimeters (2002) Annals of Surgery, 235 (4), pp. 533-539. , DOI 10.1097/00000658-200204000-00012; Graziadei, I.W., Sandmueller, H., Waldenberger, P., Koenigsrainer, A., Nachbaur, K., Jaschke, W., Margreiter, R., Vogel, W., Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome (2003) Liver Transplantation, 9 (6), pp. 557-563. , DOI 10.1053/jlts.2003.50106; Bharat, A., Brown, D.B., Crippin, J.S., Gould, J.E., Lowell, J.A., Shenoy, S., Desai, N.M., Chapman, W.C., Pre-Liver Transplantation Locoregional Adjuvant Therapy for Hepatocellular Carcinoma as a Strategy to Improve Longterm Survival (2006) Journal of the American College of Surgeons, 203 (4), pp. 411-420. , DOI 10.1016/j.jamcollsurg.2006.06.016, PII S1072751506009409; Wong, L.L., Tanaka, K., Lau, L., Komura, S., Pre-transplant treatment of hepatocellular carcinoma: Assessment of tumor necrosis in explanted livers (2004) Clinical Transplantation, 18 (3), pp. 227-234. , DOI 10.1111/j.1399-0012.2004.00164.x; Ravaioli, M., Grazi, G.L., Piscaglia, F., Liver transplantation for hepatocellular carcinoma: Results of down-staging in patients initially outside the Milan selection criteria (2008) Am J Transplant, 8, pp. 2547-2557. , 19032223 10.1111/j.1600-6143.2008.02409.x 1:STN:280: DC{\%}2BD1cjmsV2jsA{\%}3D{\%}3D; Toso, C., Asthana, S., Bigam, D.L., Shapiro, A.M., Kneteman, N.M., Reassessing selection criteria prior to liver transplantation for hepatocellular carcinoma utilizing the Scientific Registry of transplant recipients database (2009) Hepatology, 49, pp. 832-838. , 19152426 10.1002/hep.22693; 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year = "2011",
doi = "10.1245/s10434-011-1803-3",
language = "English",
volume = "18",
pages = "3632--3639",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
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}

TY - JOUR

T1 - Locoregional therapy-induced tumor necrosis as a predictor of recurrence after liver transplant in patients with hepatocellular carcinoma

AU - Ho, Meng-Hsing

AU - Yu, Chih-Yung

AU - Chung, Kuo-Piao

AU - Chen, Teng-Wei

AU - Chu, Heng-Cheng

AU - Lin, Chih-Kung

AU - Hsieh, Chung-Bao

N1 - 被引用次數:5 Export Date: 22 March 2016 CODEN: ASONF 通訊地址: Ho, M.-H.; Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 參考文獻: Maxwell Parkin, D., Bray, F., Ferlay, J., Pisani, P., Estimating the world cancer burden: Globocan 2000 (2001) International Journal of Cancer, 94 (2), pp. 153-156. , DOI 10.1002/ijc.1440; El-Serag, H.B., Mason, A.C., Rising incidence of hepatocellular carcinoma in the United States (1999) New England Journal of Medicine, 340 (10), pp. 745-750. , DOI 10.1056/NEJM199903113401001; Wakabayashi, H., Ushiyama, T., Ishimura, K., Izuishi, K., Karasawa, Y., Masaki, T., Watanabe, S., Maeta, H., Significance of reduction surgery in multidisciplinary treatment of advanced hepatocellular carcinoma with multiple intrahepatic lesions (2003) Journal of Surgical Oncology, 82 (2), pp. 98-103. , DOI 10.1002/jso.10203; Kim W.Ray, Brown Jr., R.S., Terrault, N.A., El-Serag, H., Burden of liver disease in the United States: Summary of a workshop (2002) Hepatology, 36 (1), pp. 227-242. , DOI 10.1053/jhep.2002.34734; Mazzaferro, V., Regalia, E., Doci, R., Andreola, S., Pulvirenti, A., Bozzetti, F., Montalto, F., Gennari, L., Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis (1996) New England Journal of Medicine, 334 (11), pp. 693-699. , DOI 10.1056/NEJM199603143341104; Jonas, S., Bechstein, W.O., Steinmuller, T., Herrmann, M., Radke, C., Berg, T., Settmacher, U., Neuhaus, P., Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis (2001) Hepatology, 33 (5), pp. 1080-1086. , DOI 10.1053/jhep.2001.23561; Yao, F.Y., Ferrell, L., Bass, N.M., Watson, J.J., Bacchetti, P., Venook, A., Ascher, N.L., Roberts, J.P., Liver transplantation for hepatocellular carcinoma: Expansion of the tumor size limits does not adversely impact survival (2001) Hepatology, 33 (6), pp. 1394-1403. , DOI 10.1053/jhep.2001.24563; Mor, E., Kaspa, R.T., Sheiner, P., Schwartz, M., Treatment of hepatocellular carcinoma associated with cirrhosis in the era of liver transplantation (1998) Annals of Internal Medicine, 129 (8), pp. 643-653; Ota, K., Teraoka, S., Kawai, T., Donor difficulties in Japan and Asian countries (1995) Transpl Proc, 27, pp. 83-86. , 1:STN:280:DyaK2M7osVymtQ%3D%3D; Mazziotti, A., Surgical treatment of hepatocellular carcinoma on cirrhosis: A Western experience (1998) Hepato-Gastroenterology, 45 (SUPPL. 3), pp. 1281-1287; Toso, C., Mentha, G., Kneteman, N.M., Majno, P., The place of downstaging for hepatocellular carcinoma (2010) J Hepatol, 52, pp. 930-936. , 20385428 10.1016/j.jhep.2009.12.032; Oldhafer, K.J., Chavan, A., Fruhauf, N.R., Flemming, P., Schlitt, H.J., Kubicka, S., Nashan, B., Galanski, M., Arterial chemoembolization before liver transplantation in patients with hepatocellular carcinoma: Marked tumor necrosis, but no survival benefit? (1998) Journal of Hepatology, 29 (6), pp. 953-959. , DOI 10.1016/S0168-8278(98)80123-2; Decaens, T., Roudot-Thoraval, F., Bresson-Hadni, S., Meyer, C., Gugenheim, J., Durand, F., Bernard, P.-H., Duvoux, C., Impact of pretransplantation transarterial chemoembolization on survival and recurrence after liver transplantation for hepatocellular carcinoma (2005) Liver Transplantation, 11 (7), pp. 767-775. , DOI 10.1002/lt.20418; Porrett, P.M., Peterman, H., Rosen, M., Lack of benefit of pre-transplant locoregional hapatic therapy for hepatocellular cancer in the current MELD era (2006) Liver Transpl, 12, pp. 665-673. , 16482577 10.1002/lt.20636; Lesurtel, M., Mullhaupt, B., Pestalozzi, B.C., Pfammatter, T., Clavien, P.-A., Transarterial chemoembolization as a bridge to liver transplantation for hepatocellular carcinoma: An evidence-based analysis (2006) American Journal of Transplantation, 6 (11), pp. 2644-2650. , DOI 10.1111/j.1600-6143.2006.01509.x; Poon, R.T.-P., Ngan, H., Lo, C.-M., Liu, C.-L., Fan, S.-T., Wong, J., Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence (2000) Journal of Surgical Oncology, 73 (2), pp. 109-114. , DOI 10.1002/(SICI)1096-9098(200002)73:2<109::AID-JSO10>3.0.CO;2-J; 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PY - 2011

Y1 - 2011

N2 - Background: Patients with hepatocellular carcinoma (HCC) often undergo locoregional therapy before liver transplant either to downstage the tumor or as bridge therapy. Our goal was to assess the risk factors for posttransplant tumor recurrence, specifically the extent of necrosis induced by locoregional therapy. Methods: We conducted a hospital-based retrospective analysis of 100 patients with HCC who received a liver transplant, 86 of whom had received pretransplant locoregional therapy. We evaluated various patient- and tumor-related parameters to determine the risk factors for recurrence. Furthermore, we grouped patients by the degree of tumor necrosis after locoregional therapy and identified the factors that were associated with a favorable tumor response. Results: Initial tumor extent beyond the University of San Francisco (UCSF) criteria, microvascular invasion, and attainment of less than 90% tumor necrosis after locoregional therapy were independent risk factors for tumor recurrence. In addition, there was a significant correlation between the tumor necrosis percentage and disease-specific survival rate. Among patients whose tumors initially exceeded the UCSF criteria, those with extensive locoregional therapy-induced tumor necrosis had lower recurrence rates. All recurrences after transplant occurred within 3 years, and recurrence rates in patients with extensive tumor necrosis at 1, 2, and 3 years were 3%, 6%, and 10%, respectively. Female gender and a solitary tumor were independently associated with extensive tumor necrosis. Conclusions: In HCC patients who are transplant candidates and undergo pretransplant locoregional therapy, the degree of induced tumor necrosis affects both tumor recurrence and survival rate. © 2011 Society of Surgical Oncology.

AB - Background: Patients with hepatocellular carcinoma (HCC) often undergo locoregional therapy before liver transplant either to downstage the tumor or as bridge therapy. Our goal was to assess the risk factors for posttransplant tumor recurrence, specifically the extent of necrosis induced by locoregional therapy. Methods: We conducted a hospital-based retrospective analysis of 100 patients with HCC who received a liver transplant, 86 of whom had received pretransplant locoregional therapy. We evaluated various patient- and tumor-related parameters to determine the risk factors for recurrence. Furthermore, we grouped patients by the degree of tumor necrosis after locoregional therapy and identified the factors that were associated with a favorable tumor response. Results: Initial tumor extent beyond the University of San Francisco (UCSF) criteria, microvascular invasion, and attainment of less than 90% tumor necrosis after locoregional therapy were independent risk factors for tumor recurrence. In addition, there was a significant correlation between the tumor necrosis percentage and disease-specific survival rate. Among patients whose tumors initially exceeded the UCSF criteria, those with extensive locoregional therapy-induced tumor necrosis had lower recurrence rates. All recurrences after transplant occurred within 3 years, and recurrence rates in patients with extensive tumor necrosis at 1, 2, and 3 years were 3%, 6%, and 10%, respectively. Female gender and a solitary tumor were independently associated with extensive tumor necrosis. Conclusions: In HCC patients who are transplant candidates and undergo pretransplant locoregional therapy, the degree of induced tumor necrosis affects both tumor recurrence and survival rate. © 2011 Society of Surgical Oncology.

KW - adult

KW - article

KW - cancer invasion

KW - cancer patient

KW - cancer recurrence

KW - female

KW - gender

KW - human

KW - liver cell carcinoma

KW - liver graft

KW - local therapy

KW - major clinical study

KW - male

KW - postoperative period

KW - preoperative period

KW - retrospective study

KW - survival rate

KW - tumor necrosis

KW - Carcinoma, Hepatocellular

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Liver Neoplasms

KW - Liver Transplantation

KW - Male

KW - Middle Aged

KW - Neoplasm Recurrence, Local

KW - Neoplasm Staging

KW - Prognosis

KW - Retrospective Studies

KW - Survival Rate

U2 - 10.1245/s10434-011-1803-3

DO - 10.1245/s10434-011-1803-3

M3 - Article

VL - 18

SP - 3632

EP - 3639

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 13

ER -