Bridging and downstaging treatments for hepatocellular carcinoma in patients on the waiting list for liver transplantation

Table 3 Selected studies on downstaging therapy for hepatocellular carcinoma before liver transplantation n (%)

Ref.	Treatment	Pts	Inclusion criteria1	Successful downstage-Criteria-Rate	Transplanted pts	Recurrence free survival after LT	Intention to treat survival	Survival after LT
Graziadei et al[60]	TACE	36	HCC > 5 cm	Decreased size > 50%11/36 (31)	10	Recurrent HCC: 3 pts (30)	31% at 5 yr	41% at 4 yr
Otto et al[116]	TACE	62	Beyond MC	Decreased size ≥ 30%34/62 (55)	27	68% at 5 yr	NA	73.2% at 5 yr
Cillo et al[4]	TACE, RFA, PEI, Resection	40	Beyond MCWD or MD HCC	Maintenance of selection criteriaNA	31	Recurrent HCC: 0 pts	79% at 5 yr	> 90% at 3 yr
Chapman et al[108]	TACE	76	Beyond MC	MC18/76 (24)	17	50% at 5 yr	NA	93.8% at 5 yr
Yao et al[106]	TACE, RFA, Resection	61	1 HCC 5-8 cm2-3 HCCs 3-5 cm, total diameter ≤ 8 cm4-5 HCCs ≤ 3 cm total diameter ≤ 8 cm	UCSF43/61 (71)	35	92% at 2 yr	69% at 4 yr	92% at 2 yr
Ravaioli et al[115]	Multimodal (TACE, PEI, RFA, Resection)	48	1 HCC 5-8 cm2 HCCs 3-5 cm, total diameter ≤ 8 cm3-5 HCCs ≤ 4 cm total diameter ≤ 12 cm	MC and AFP < 400 ng/mL32/48 (67)	32	71% at 3 yr	62% at 3 yr	NA
Lewandowski et al[109]	TACE (43 patients)TARE (43 patients)	86	UNOS T3	MCTACE 11/35 (31)TARE 25/43 (58)	TACE 11TARE 9	TACE 73% at 1 yrTARE 89% at 1 yr	TACE 19% at 3 yrTARE 59% at 3 yr	NA
De Luna et al[107]	TACI	27	Beyond MC	MC17/27 (63)	15	NA	84.1% at 3 yr	78.8% at 3 yr
Jang et al[110]	TACE	386	Beyond MC	MC or complete tumor necrosis160/386 (41.5)	37	66.3% at 5 yr	NA	54.6% at 5 yr
Barakat et al[111]	TACE, TARE, RFA, Resection	32	Beyond UCSF (18 pts)Beyond MC (14 pts)	UNOS T218/32 (56.3)	13	Recurrent HCC: 2 pts (15.4%)	NA	75% at 2 yr
Bargellini et al[112]	TACE	33	Beyond MC	Complete or partial response, or stable disease according to mRECIST criteriaNA	33	74.4% at 5 yr	NA	72.5% at 5 yr
Bova et al[113]	TACE, TAE	48	Beyond MC	MCAFP < 100 ng/mL19/48 (39)	9	Recurrent HCC: 1 pt (11.1%)	NA	NA
Lei et al[114]	TACE, RFA, Resection, HIFU	58	Beyond MC Within UCSF	MCNA	58	63.8% at 5 yr	NA	74.1% at 5 yr

¹Patients with vascular invasion or extrahepatic tumor spread at baseline excluded in all series. HCC: Hepatocellular carcinoma; LT: Liver transplantation; TACE: Transarterial chemoembolization; MC: Milan criteria; NA: Not available; RFA: Radiofrequency ablation; PEI: Percutaneous ethanol injection; WD: Well differentiated; MD: Moderately differentiated; UCSF: University of California San Francisco; AFP: α-fetoprotein; TARE: Transarterial radio embolization; UNOS: United Network for Organ Sharing; TACI: Transarterial chemoinfusion; mRECIST: Modified Response Evaluation Criteria in Solid Tumors; TAE: Transarterial embolization; HIFU: High-intensity focused ultrasound; pts: Patients.