Correlation between radiological response after locoregional treatment and histopathological findings in patients undergoing liver transplant for hepatocarcinoma

Background and Objectives: Liver Imaging Reporting and Data System treatment response (LR-TR) algorithm has been developed to evaluate response after locoregional treatment (LRT) in patients with hepatocellular carcinoma (HCC). The aim of the study was to corroborate if the post-treatment radiological findings described using LR-TR correspond to the final histopathological results, and survival in relation to different LR-TR groups in patients underwent LRT before liver transplantation (LT). Methods: A retrospective single-center study was performed. Data of patients undergoing LT and LRT due to HCC between January 2010 and December 2022 were collected. Results: Four hundred and four patients were transplanted, of which 103 (25.5%) had HCC. Ninety-seven patients (93.2%) received LRT. 53% of treated patients had a complete response on pathological examination. Re-evaluation imaging was performed in 88 patients. 59% were classified as non-viable LR-TR, 32.5% as viable LR-TR, and 8.5% as equivocal LR-TR. Regarding the correlation between the degree of tumor necrosis and the post-treatment LR-TR category, 37% of patients evaluated as viable LR-TR had a “complete response” compared to 62.9% with “no complete response”. For those evaluated as non-viable LR-TR, 59.2% had a “complete response” compared to 40.8% with a “no complete response” (P = 0.123). There were no statistically significant differences in overall and disease-free survival between the viable LR-TR, non-viable LR-TR, and equivocal LR-TR groups (P = 0.3484 and P = 0.4152, respectively). Conclusion: We have not been able to establish whether radiological response correlates with anatomopathological outcomes, as well as survival in these groups. More prospective studies are needed to validate these findings.