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Downstaging Outcomes for Hepatocellular Carcinoma: Results From the Multicenter Evaluation of Reduction in Tumor Size before Liver Transplantation (MERITS-LT) Consortium.
Mehta, Neil; Frenette, Catherine; Tabrizian, Parissa; Hoteit, Maarouf; Guy, Jennifer; Parikh, Neehar; Ghaziani, T Tara; Dhanasekaran, Renu; Dodge, Jennifer L; Natarajan, Brahma; Holzner, Matthew L; Frankul, Leana; Chan, Wesley; Fobar, Austin; Florman, Sander; Yao, Francis Y.
Afiliación
  • Mehta N; Division of Gastroenterology, Department of Medicine, University of California, San Francisco, California. Electronic address: neil.mehta@ucsf.edu.
  • Frenette C; Center for Organ and Cell Transplantation, Scripps Green Hospital, La Jolla, California.
  • Tabrizian P; Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Hoteit M; Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Guy J; Department of Transplantation, California Pacific Medical Center, San Francisco, California.
  • Parikh N; Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan.
  • Ghaziani TT; Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California.
  • Dhanasekaran R; Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California.
  • Dodge JL; Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California.
  • Natarajan B; Division of Gastroenterology, Department of Medicine, University of California, San Francisco, California.
  • Holzner ML; Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Frankul L; Center for Organ and Cell Transplantation, Scripps Green Hospital, La Jolla, California.
  • Chan W; Division of Gastroenterology, Department of Medicine, University of California, San Francisco, California.
  • Fobar A; Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan.
  • Florman S; Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Yao FY; Division of Gastroenterology, Department of Medicine, University of California, San Francisco, California; Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California.
Gastroenterology ; 161(5): 1502-1512, 2021 11.
Article en En | MEDLINE | ID: mdl-34331914
BACKGROUND & AIMS: United Network of Organ Sharing (UNOS) has adopted uniform criteria for downstaging (UNOS-DS) of hepatocellular carcinoma (HCC) before liver transplantation (LT), but the downstaging success rate and intention-to-treat outcomes across broad geographic regions are unknown. METHODS: In this first multiregional study (7 centers, 4 UNOS regions), 209 consecutive patients with HCC undergoing downstaging based on UNOS-DS criteria were prospectively evaluated from 2016 to 2019. RESULTS: Probability of successful downstaging to Milan criteria and dropout at 2 years from the initial downstaging procedure was 87.7% and 37.3%, respectively. Pretreatment with lectin-reactive α-fetoprotein ≥10% (hazard ratio, 3.7; P = .02) was associated with increased dropout risk. When chemoembolization (n = 132) and yttrium-90 radioembolization (n = 62) were compared as the initial downstaging treatment, there were no differences in Modified Response Evaluation Criteria In Solid Tumors response, probability of or time to successful downstaging, waiting list dropout, or LT. Probability of LT at 3 years was 46.6% after a median of 17.2 months. In the explant, 17.5% had vascular invasion, and 42.8% exceeded Milan criteria (understaging). The only factor associated with understaging was the sum of the number of lesions plus largest tumor diameter on the last pre-LT imaging, and the odds of understaging increased by 35% per 1-unit increase in this sum. Post-LT survival at 2 years was 95%, and HCC recurrence occurred in 7.9%. CONCLUSION: In this first prospective multiregional study based on UNOS-DS criteria, we observed a successful downstaging rate of >80% and similar efficacy of chemoembolization and yttrium-90 radioembolization as the initial downstaging treatment. A high rate of tumor understaging was observed despite excellent 2-year post-LT survival of 95%. Additional LRT to reduce viable tumor burden may reduce tumor understaging.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Listas de Espera / Trasplante de Hígado / Quimioembolización Terapéutica / Carcinoma Hepatocelular / Radiofármacos / Neoplasias Hepáticas Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Gastroenterology Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Listas de Espera / Trasplante de Hígado / Quimioembolización Terapéutica / Carcinoma Hepatocelular / Radiofármacos / Neoplasias Hepáticas Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Gastroenterology Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos