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Response to Therapy as a Criterion for Awarding Priority to Patients With Hepatocellular Carcinoma Awaiting Liver Transplantation.
- Source :
- Annals of Surgical Oncology: An Oncology Journal for Surgeons; Sep2010, Vol. 17 Issue 9, p2290-2302, 13p, 1 Diagram, 4 Charts, 3 Graphs
- Publication Year :
- 2010
-
Abstract
- Background: How to prioritize patients with hepatocellular carcinoma (HCC) for liver transplantation (LT) remains controversial. This study was designed to assess the effectiveness of a policy for prioritizing HCC patients according to their response to pre-LT therapy. Methods: The study period was from 2000 to 2008. Dropout criteria included macroscopic vascular invasion, metastases, and poorly differentiated grade at pre-LT biopsy. A specific treatment algorithm was adopted to treat HCC before LT, and the effect of treatment was evaluated 3 months after listing or after the diagnosis of HCC for patients diagnosed while already on the waiting list. Patients were divided into two groups: group 1, patients with disease that completely or partially responded to therapy; and group 2, patients with stable, progressive, or untreatable disease. Group 2 patients were prioritized for LT unless full restaging and repeat biopsy identified dropout criteria. Results: At the 3-month visit, 62 HCC patients (42%) were assigned to group 2 and 85 (58%) to group 1. Eleven of 12 dropouts due to tumor progression came from group 2 ( P < 0.01). Response to therapy was the sole predictor of dropout probability, independent of tumor stage (competing risk analysis). The 42 patients in group 2 who were transplanted had much the same 3-year post-LT survival rate as the 57 transplanted patients in group 1 (with survival rates of 82% and 83%, respectively; P > 0.05), but a slightly higher risk of post-LT HCC recurrence (13% and 2%, respectively; P = 0.04). Conclusions: Response to therapy is a potentially effective tool for prioritizing HCC patients for LT. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 10689265
- Volume :
- 17
- Issue :
- 9
- Database :
- Complementary Index
- Journal :
- Annals of Surgical Oncology: An Oncology Journal for Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 52965504
- Full Text :
- https://doi.org/10.1245/s10434-010-0993-4