Response to transarterial chemoembolization may serve as selection criteria for hepatocellular carcinoma liver transplantation

// Jianyong Lei 1, 2, 6 , Jinjing Zhong 4 , Yefang Luo 5 , Lunan Yan 1 , Jinqiang Zhu 2 , Wentao Wang 1 , Bo Li 1 , Tianfu Wen 1 , Jiaying Yang 3 and Liver Surgery Group 1 Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China 2 Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China 3 Transplantation Center,West China Hospital of Sichuan University, Chengdu, China 4 Department of Pathology, West China Hospital of Sichuan University, Chengdu, China 5 West China School of Medicine, Sichuan University, Chengdu, China 6 Present address: Liver Surgery, West China Hospital of Sichuan University, Chengdu, China Correspondence to: Wentao Wang, email: wwtdoctor@163.com Keywords: hepatocellular carcinoma, liver transplantation, transarterial chemoembolization, selection Received: April 04, 2017     Accepted: August 02, 2017     Published: August 24, 2017 ABSTRACT Aims: This study sought to extend the inclusion criteria for hepatocellular carcinoma (HCC) liver transplantation (LT), particularly addressing the safety and effectiveness of pre-LT transarterial chemoembolization (TACE). Materials and Methods: Our study included 115 patients with HCC who underwent LT after TACE. The response measured after each TACE session was based on the mRECIST criteria: complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD). We defined CR and PR patients as responders (64 cases) and SD and PD patients as non-responders (51 cases). Results: The majority of responders could be identified after the first or second TACE sessions (57 cases, 89.1%). Overall survival rates at 1, 3 and 5 years were 95.3%, 89.1% and 75.0%, respectively, in the responder group, and these rates were much higher than those in the non-responder group (86.3%, 66.7% and 54.9%, P=10.016). In addition, the tumor-free survival rate in the responder group was also higher than in the non-responder group (P=0.009). In the responder group, a statistically improved long-term outcome was observed in patients whose HCC did not satisfy the Milan criteria (P<0.05). Univariate and multivariate Cox analyses showed that achieving CR or PR was the best predictor of survival and tumor-free survival following TACE. Conclusion: The response to TACE, particularly following the first two sessions, primarily and robustly predicted overall and tumor-free survival in HCC patients, particularly those whose HCC did not satisfy the Milan criteria.