Outcome of supraselective transarterial chemoembolization in patients with hepatocellular carcinoma

Author： Heinzow Hauke Sebastian Meister Tobias Nass Dominik Kööhler Michael Spieker Tilmann Wolters Heiner Domschke Wolfram Domagk Dirk

Publisher： Informa Healthcare

ISSN： 0036-5521

Source： Scandinavian Journal of Gastroenterology, Vol.46, Iss.2, 2011-02, pp. : 201-210

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Abstract

Abstract Objective. Hepatocellular carcinoma (HCC) is the most common tumor in cirrhotic patients with a median survival of only 8––10 months if untreated. Supraselective transarterial chemoembolization (STACE) is supposed to be a well-established method for treating HCC patients. In the present study, we evaluated the effect of STACE on post-transplant survival in patients with HCC. Material and Methods. The charts of 53 HCC patients were retrospectively analyzed. Twenty-seven patients had STACE as a bridging therapy while 26 patients were scheduled for liver transplantation (LTX) without prior STACE therapy. A total of 53% of the patients who underwent LTX preoperatively fulfilled the Milan criteria, while 70.6% fulfilled the expanded University of California, San Francisco (UCSF) transplant criteria. Primary endpoint was the post-transplant survival. Statistical analysis included Kaplan-Meier-method, log rank, and chi square tests. Results. Between the LTX groups (STACE vs. non-STACE), there was no significant difference in terms of age, Child classification, Okuda stage, co-morbidities, underlying disease, and post-transplant survival (p > 0.05). Independent of prior STACE, however, disease-free survival after LTX was highly significantly prolonged if LTX was performed within 3 months after initial diagnosis of HCC (p < 0.01) or if patients met the expanded transplant UCSF criteria (p == 0.02). Post-transplant survival did not depend on tumor size. Conclusions. We conclude that STACE performed prior to LTX does not secure any post-transplant survival benefit, while early LTX, i.e. within 3 months after HCC diagnosis, does improve survival regardless of whether STACE was performed or not. Additionally, fulfillment of the expanded transplant UCSF criteria leads to a prolonged post-transplant survival.