Prospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2019; 25(37): 5687-5701
Published online Oct 7, 2019. doi: 10.3748/wjg.v25.i37.5687
Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging
Breno Boueri Affonso, Francisco Leonardo Galastri, Joaquim Mauricio da Motta Leal Filho, Felipe Nasser, Priscila Mina Falsarella, Rafael Noronha Cavalcante, Marcio Dias de Almeida, Guilherme Eduardo Gonçalves Felga, Leonardo Guedes Moreira Valle, Nelson Wolosker
Breno Boueri Affonso, Francisco Leonardo Galastri, Joaquim Mauricio da Motta Leal Filho, Felipe Nasser, Priscila Mina Falsarella, Rafael Noronha Cavalcante, Leonardo Guedes Moreira Valle, Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
Marcio Dias de Almeida, Guilherme Eduardo Gonçalves Felga, Department of Liver Transplant, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
Nelson Wolosker, Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
Author contributions: da Motta Leal Filho JM and Nasser F designed research/study; Affonso BB, Galastri FL, da Motta Leal Filho JM, Nasser F, Falsarella PM, Cavalcante RN, and Wolosker N performed research/study; Affonso BB, Galastri FL, Falsarella PM, de Almeida MD, Felga GEG, Valle LGM, and Wolosker N contributed important reagents; Affonso BB, Galastri FL, Nasser F, da Motta Leal Filho JM, Falsarella PM, de Almeida MD, and Valle LGM collected data; Affonso BB, Galastri FL, da Motta Leal Filho JM, Cavalcante RN and Falsarella PM analyzed data; Affonso BB and Valle LGM submit a manuscript; da Motta Leal Filho JM and Cavalcante RN wrote the paper.
Institutional review board statement: Process CEP/Einstein nº11/1704.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: Breno Affonso has no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Breno Boueri Affonso, PhD, Medical Assistant, Research Scientist, Staff Physician, Surgeon, Teacher, Interventional Radiologist, Department of Interventional Radiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, São Paulo 05651-901, São Paulo, Brazil. breno.affonso@einstein.br
Telephone: +55-11-982625115 Fax: +55-11-21510434
Received: June 1, 2019
Peer-review started: June 3, 2019
First decision: July 21, 2019
Revised: August 30, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: October 7, 2019
ARTICLE HIGHLIGHTS
Research background

Transarterial chemoembolization (TACE) is the most common neoadjuvant therapy modality in the pre-transplant setting and drug-eluting beads TACE (DEB-TACE) is therapy with fewer adverse effects.

Research motivation

Bridging and downstaging patients for liver transplantation (LT) outcomes comparation still have not been fully elucidate.

Research objectives

To determine long-term outcomes of patients with hepatocellular carcinoma (HCC) that underwent LT after DEB-TACE for downstaging vs bridging.

Research methods

Compare the overall survival, tumor recurrence, rate of LT, waiting time on list and radiological response for hepatocellular carcinoma after DEB-TACE in downstaging and bridging patients. This was a single-center, observational prospective study with controlled and uniform chemoembolization technique.

Research results

After TACE, only patients within Milan Criteria (MC) were transplanted. More patients underwent LT in bridging group 65.9% (P = 0.001). Downstaging population presented: higher number of nodules 2.81 (P = 0.001); larger total tumor diameter 8.09 (P = 0.001); multifocal HCC 78% (P = 0.001); more post-transplantation recurrence 25% (P = 0.02). Patients with maximal tumor diameter up to 7.05cm were more likely to receive LT (P = 0.005). Median time on the waiting list was significantly longer in downstaging group 10.6 mo (P = 0.028). Five-year post-transplant overall survival was 73.5% in downstaging and 72.3% bridging groups (P = 0.31), and recurrence-free survival was 62.1% in downstaging and 74.8% bridging groups (P = 0.93). Radiological response: Complete response was observed more frequently in bridging group (P = 0.004). There were no difference between the groups in five-years post-transplant overall survival and recurrence-free survival.

Research conclusions

Tumors initially exceeding the MC down-staged after DEB-TACE, can achieve post-transplant survival and HCC recurrence-free probability, at five years, just like patients within MC in patients undergoing DEB-TACE.

Research perspectives

It is worth investing in patients in the downstaging group to meet their liver transplant criteria because of the results within 5 years after transplantation.