Multiple Pretransplant Treatments for Patients Without Pathological Complete Response may Worsen Posttransplant Outcomes in Patients with Hepatocellular Carcinoma

Authors

Shingo Shimada, Henry Ford HealthFollow
Tayseer Shamaa, Henry Ford HealthFollow
Tommy Ivanics, Henry Ford HealthFollow
Toshihiro Kitajima, Henry Ford HealthFollow
Mohamed Adhnan, Henry Ford Health
Kelly Collins, Henry Ford HealthFollow
Michael Rizzari, Henry Ford HealthFollow
Atsushi Yoshida, Henry Ford HealthFollow
Marwan S. Abouljoud, Henry Ford HealthFollow
Reena Salgia, Henry Ford HealthFollow
Shunji Nagai, Henry Ford HealthFollow

Recommended Citation

Shimada S, Shamaa T, Ivanics T, Kitajima T, Adhnan M, Collins K, Rizzari M, Yoshida A, Abouljoud M, Salgia R, and Nagai S. Multiple Pretransplant Treatments for Patients Without Pathological Complete Response may Worsen Posttransplant Outcomes in Patients with Hepatocellular Carcinoma. Ann Surg Oncol 2022.

Document Type

Article

Publication Date

11-25-2022

Publication Title

Annals of surgical oncology

Abstract

BACKGROUND: Liver transplant (LT) candidates with hepatocellular carcinoma (HCC) often receive cancer treatment before transplant. We investigated the impact of pre-transplant treatment for HCC on the risk of posttransplant recurrence.

METHODS: Adult HCC patients with LT at our institution between 2013 and 2020 were included. The impact of pre-LT cancer treatments on the cumulative recurrence was evaluated, using the Gray and Fine-Gray methods adjusted for confounding factors. Outcomes were considered in two ways: 1) by pathologically complete response (pCR) status within patients received pre-LT treatment; and 2) within patients without pCR, grouped by pre-LT treatment as A) none; B) one treatment; C) multiple treatments.

RESULTS: The sample included 179 patients, of whom 151 (84%) received pretreatment and 42 (28% of treated) demonstrated pCR. Overall, 22 (12%) patients experienced recurrence. The 5-year cumulative post-LT recurrence rate was significantly lower in patients with pCR than those without pCR (4.8% vs. 19.2%, P = 0.03). In bivariable analyses, pCR significantly decreased risk of recurrence. Among the 137 patients without pCR (viable HCC in the explant), 28 (20%) had no pretreatment (A), 70 (52%) had one treatment (B), and 39 (20%) had multiple treatments (C). Patients in Group C had higher 5-year recurrence rates than those in A or B (39.6% vs. 8.2%, 6.5%, P = 0.004 and P < 0.001, respectively). In bivariable analyses, multiple treatments was significantly associated with recurrence.

CONCLUSIONS: pCR is a favorable prognostic factor after LT. When pCR was not achieved by pre-LT treatment, the number of treatments might be associated with post-LT oncological prognosis.

Medical Subject Headings

Transplant and Abdominal Surgery

PubMed ID

36434482

ePublication

ePub ahead of print