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CardioVascular and Interventional Radiology

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01-04-2013 | Clinical Investigation

Predictive Factors of Downstaging of Hepatocellular Carcinoma Beyond the Milan Criteria Treated with Intra-arterial Therapies

Authors: Valentina Bova, Roberto Miraglia, Luigi Maruzzelli, Giovanni Battista Vizzini, Angelo Luca

Published in: CardioVascular and Interventional Radiology | Issue 2/2013

Abstract

Purpose

This study was designed to analyze the clinical results in patients suitable for liver transplantation with hepatocellular carcinoma (HCC) who exceeded Milan criteria, which underwent intra-arterial therapies (IAT), to determine predictive factors of successful downstaging.

Methods

A total of 277 consecutive patients with cirrhosis and HCC were treated by IAT (transarterial oily chemoembolization, transarterial chemoembolization, transarterial embolization) in a single center. Eighty patients exceed the Milan criteria. Patients with infiltrative HCC, hypovascular HCC, and portal vein thrombosis were excluded, with a final study population of 48 patients. Tumor response to IAT was evaluated with CT and/or MRI according to modified RECIST criteria. Successful downstaging was defined as a reduction in the number and size of viable tumors to within the Milan criteria, and serum alpha-fetoprotein (AFP) <100 ng/mL, for at least 6 months.

Results

Nineteen patients (39 %) had their tumors successfully downstaged; 29 patients (61 %) did not. Multivariate analysis showed that AFP level <100 ng/mL and 3-year calculated survival probability using the Metroticket calculator were the only independent predictors of successful downstaging (p < 0.023 and p < 0.049 respectively).

Conclusions

Biological characteristics of HCC as AFP levels <100 ng/mL and high 3-year calculated survival probability may predict a good response to downstage after IAT.

Mazzaferro V, Regalia E, Doci R et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334(11):693–699PubMedCrossRef

Bruix J, Sherman M (2005) Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 42(5):1208–1236PubMedCrossRef

Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362(9399):1907–1917PubMedCrossRef

Llovet JM, Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 37:429–442PubMedCrossRef

Sen G, Rai R, Manas DM (2003) Factors predictive of 5-year survival after transarterial chemoembolization for inoperable hepatocellular carcinoma. Br J Surg 90:1022PubMedCrossRef

Yao FY (2006) Expanding criteria for hepatocellular carcinoma: down-staging with a view to liver transplantation. Semin Liver Dis 26:239–247PubMedCrossRef

Yao FY, Ferrell L, Bass NM et al (2001) Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 33(6):1394–1403PubMedCrossRef

Yao FY, Kerlan RK Jr, Hirose R et al (2008) Excellent outcome following downstaging of HCC prior to liver transplantation: an intention-to-treat analysis. Hepatology 48:819–827PubMedCrossRef

Ravaioli M, Grazi GL, Piscaglia F et al (2008) Liver transplantation for HCC: results of downstaging in patients initially outside the Milan selection criteria. Am J Transplant 8:2547–2557PubMedCrossRef

10.

Graziadei IW, Sandmueller H, Waldenberger P et al (2003) Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome. Liver Transpl 9:557–563PubMedCrossRef

11.

Barakat O, Wood PR, Ozaki CF et al (2010) Morphological features of advanced hepatocellular carcinoma as a predictor of downstaging and liver transplantation: an intention-to-treat analysis. Liver Transpl 16:289–299PubMed

12.

Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:52–60PubMedCrossRef

13.

Bruix J, Sherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022PubMedCrossRef

14.

Mazzaferro V, Llovet J, Miceli R et al (2009) Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol 10:35–43PubMedCrossRef

15.

Brown DB, Cardella JF, Sacks D et al (2009) Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol 20(7 suppl):S219–S226PubMedCrossRef

16.

Gordon-Weeks AN, Snaith A, Petrinic T et al (2011) Systematic review of outcome of downstaging hepatocellular cancer before liver transplantation in patients outside the Milan criteria. Br J Surg 98(9):1201–1208PubMedCrossRef

17.

Lammer J, Malagari K, Vogl T et al (2010) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33(1):41–52PubMedCrossRef

18.

Burrel M, Reig M, Forner A et al (2012) Survival of patients with hepatocellular carcinoma treated by transarterial chemoembolisation (TACE) using DC beads. Implications for clinical practice and trial design. J Hepatol 56(6):1330–1335PubMedCrossRef

Title: Predictive Factors of Downstaging of Hepatocellular Carcinoma Beyond the Milan Criteria Treated with Intra-arterial Therapies
Authors: Valentina Bova
Roberto Miraglia
Luigi Maruzzelli
Giovanni Battista Vizzini
Angelo Luca
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 2/2013
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-012-0458-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predictive Factors of Downstaging of Hepatocellular Carcinoma Beyond the Milan Criteria Treated with Intra-arterial Therapies

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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