Risk Score Model for Liver Transplant Outcomes after Preoperative Locoregional Therapy for Hepatocellular Carcinoma
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ORIGINAL RESEARCH
Risk Score Model for Liver Transplant Outcomes after Preoperative Locoregional Therapy for Hepatocellular Carcinoma Abu Bakar Hafeez Bhatti 1 Haseeb Haider Zia 1
&
Muhammad Hassan 1 & Atif Rana 2 & Nusrat Yar Khan 1 & Zahid Amin Khan 2 &
Accepted: 9 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose The role of preoperative locoregional therapy (LRT) for hepatocellular carcinoma (HCC) before liver transplantation (LT) remains unclear. Moreover, LRT in the setting of living donor liver transplantation (LDLT) merits further exploration. The objective of the current study was to determine risk factors for poor outcomes after LDLT in patients who received locoregional therapy (LRT). Methods We reviewed patients (n = 46) who underwent LDLT after LRT. Multivariate analysis was performed to determine independent predictors of recurrence-free survival (RFS). Risk scores were developed to define prognostic groups. Results Median tumor size was 3.7 (1.2–12) cm and tumor number was 1 (1–6). Macrovascular invasion was seen in 10/46 (21.7%) patients. There was a significant difference in 5-year RFS with > 3 tumor nodules (P = 0.005), tumors outside University of California San Francisco criteria (P = 0.03), bilobar disease (P = 0.002), AFP > 600 ng/ml (P = 0.006), and poor response to LRT (P = 0.007). On multivariate analysis, bilobar disease (HR = 2.9, P = 0.01), AFP > 600 ng/ml (HR = 2.3 P = 0.008), and poor response to LRT (HR = 2, P = 0.02) were predictors of 5-year RFS. The 5-year RFS in low risk (score = 0), intermediate risk (score = 1–3), and high risk (score = 4–7) groups was 86%, 76%, and 9% (P < 0.0001). There was no recurrence seen in 4/4 (100%) patients with macrovascular invasion in the low-intermediate risk group. The 5-year RFS in the low-intermediate risk group within and outside Milan criteria was 100% and 74% (P = 0.1). Conclusions LDLT can provide excellent long-term RFS in patients after preoperative LRT in the low and intermediate risk groups. Keywords Living donor liver transplant . Hepatocellular carcinoma . Locoregional therapy . Recurrence . Down staging
Introduction Liver transplantation (LT) is an established treatment for patients with hepatocellular carcinoma (HCC) and cirrhosis [1]. Ideal outcomes are achieved when LT is performed for HCC within traditional transplant criteria [2]. Certain patients outside these criteria have comparable long-term outcomes and
* Abu Bakar Hafeez Bhatti [email protected]; [email protected] 1
Division of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Sector H-8/ 4, Pitras Bukhari Road, Islamabad 44000, Pakistan
2
Division of Interventional Radiology, Shifa International Hospital Islamabad, Islamabad, Pakistan
merit access to LT [3]. Worldwide, boundaries on tumor size and number have been pushed to increase eligible patient pool for transplantation [4–6]. Moreover, instead of relying merely on tumor-related features,
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