Kenta Inomata1, Hiroshi Yagi2, Taizo Hibi3, Masahiro Shinoda4, Kentaro Matsubara1, Yuta Abe1, Minoru Kitago1, Hideaki Obara1, Osamu Itano5, Shigeyuki Kawachi6, Minoru Tanabe7, Go Wakabayashi8, Motohide Shimazu9, Yuko Kitagawa1. 1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. 2. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. h_yagi@a3.keio.jp. 3. Department of Transplantation/Pediatric Surgery, Kumamoto University Graduate School of Medical Sciences, 2-39-1 Kurokami, Chuo-ku, Kumamoto, 860-8555, Japan. 4. Digestive Diseases Center, International University of Health and Welfare School of Medicine, 1-4-3 Mita, Minato-ku, Tokyo, 108-0073, Japan. 5. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan. 6. Department of Gastrointestinal Surgery, Tokyo Medical University Hachiouji Medical Center, 1163 Tate-machi, Hachiouji, Tokyo, 193-0998, Japan. 7. Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan. 8. Department of Surgery, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo, Saitama, 362-8588, Japan. 9. Department of Gastrointestinal Surgery, Medical Corporation Koryukai Tamakyuryo Hospital, 1163 Shimooyamada-machi, Machida, Tokyo, 194-0202, Japan.
Abstract
PURPOSE: The precise role of downstaging or bridge therapy for cirrhotic patients with hepatocellular carcinoma (HCC) beyond or within the Milan criteria (MC) before living donor liver transplantation (LDLT) remains undefined. METHODS: We conducted a single-center, retrospective cohort study of 40 cirrhotic patients with HCC who underwent LDLT from 2000 to 2018. Dynamic computed tomography images at the initial presentation and immediately before LDLT as well as the final histopathological findings were reviewed to determine whether they met or exceeded MC. RESULTS: Overall, 29 patients underwent various pre-transplant HCC treatments, including ablation and embolization (bridge therapy, n = 20; downstaging, n = 9). Of the 9 patients who were initially beyond the MC, 4 (44.4%) were successfully downstaged to within the MC. Five patients beyond the MC immediately before LDLT demonstrated a significantly worse 5-year overall survival rate than patients within the MC (16.7% vs. 82.2%, P = 0.004), regardless of the radiological HCC stage at presentation or the final pathological tumor status. All 3 recurrent patients had HCC beyond the MC immediately before transplant and died of their disease at 13, 24, and 50 months after transplantation. CONCLUSIONS: Successful downstaging for HCC cases beyond the MC provides similar outcomes to those within the MC at presentation, regardless of the histopathological findings.
PURPOSE: The precise role of downstaging or bridge therapy for cirrhotic patients with hepatocellular carcinoma (HCC) beyond or within the Milan criteria (MC) before living donor liver transplantation (LDLT) remains undefined. METHODS: We conducted a single-center, retrospective cohort study of 40 cirrhotic patients with HCC who underwent LDLT from 2000 to 2018. Dynamic computed tomography images at the initial presentation and immediately before LDLT as well as the final histopathological findings were reviewed to determine whether they met or exceeded MC. RESULTS: Overall, 29 patients underwent various pre-transplant HCC treatments, including ablation and embolization (bridge therapy, n = 20; downstaging, n = 9). Of the 9 patients who were initially beyond the MC, 4 (44.4%) were successfully downstaged to within the MC. Five patients beyond the MC immediately before LDLT demonstrated a significantly worse 5-year overall survival rate than patients within the MC (16.7% vs. 82.2%, P = 0.004), regardless of the radiological HCC stage at presentation or the final pathological tumor status. All 3 recurrent patients had HCC beyond the MC immediately before transplant and died of their disease at 13, 24, and 50 months after transplantation. CONCLUSIONS: Successful downstaging for HCC cases beyond the MC provides similar outcomes to those within the MC at presentation, regardless of the histopathological findings.
Entities:
Keywords:
Downstage; Hepatocellular carcinoma; Liver transplantation; Locoregional therapy; Milan criteria