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

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgment

The authors thank the staff of the Henry Ford Health System Transplant Institute for their assistance.

Funding

Nothing to disclose. This work received no financial support.

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Authors and Affiliations

  1. Division of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, MI, USA

    Shingo Shimada MD, PhD, Tayseer Shamaa MD, Tommy Ivanics MD, MPH, Toshihiro Kitajima MD, Mohamed Adhnan MD, Kelly Collins MD, Michael Rizzari MD, Atsushi Yoshida MD, Marwan Abouljoud MD & Shunji Nagai MD, PhD

  2. Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, MI, USA

    Reena Salgia MD

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  1. Shingo Shimada MD, PhD
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Correspondence to Shunji Nagai MD, PhD.

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Shimada, S., Shamaa, T., Ivanics, T. et al. Multiple Pretransplant Treatments for Patients Without Pathological Complete Response may Worsen Posttransplant Outcomes in Patients with Hepatocellular Carcinoma. Ann Surg Oncol 30, 1408–1419 (2023). https://doi.org/10.1245/s10434-022-12789-2

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