Published online Jan 27, 2020. doi: 10.4240/wjgs.v12.i1.17
Peer-review started: October 3, 2019
First decision: October 24, 2019
Revised: November 6, 2019
Accepted: November 28, 2019
Article in press: November 28, 2019
Published online: January 27, 2020
Loco-regional therapy for hepatocellular carcinoma (HCC) during the period awaiting liver transplantation (LT) appears to be a logical approach to reduce the risk of tumor progression and dropout in the waitlist. Living donor LT (LDLT) offers a flexible timing for transplantation providing timeframe for well preparation of transplantation.
To investigate outcomes in relation to the intention of pre-transplantation loco-regional therapy in LDLT for HCC patients.
A total of 308 consecutive patients undergoing LDLTs for HCC between August 2004 and December 2018 were retrospectively analyzed. Patients were grouped according to the intention of loco-regional therapy prior to LT, and outcomes of patients were analyzed and compared between groups.
Overall, 38 patients (12.3%) were detected with HCC recurrence during the follow-up period after LDLT. Patients who were radiologically beyond the University of California at San Francisco criteria and received loco-regional therapy as down-staging therapy had significant inferior outcomes to other groups for both recurrence-free survival (RFS, P < 0.0005) and overall survival (P = 0.046). Moreover, patients with defined profound tumor necrosis (TN) by loco-regional therapy had a superior RFS (5-year of 93.8%) as compared with others (P = 0.010).
LDLT features a flexible timely transplantation for patient with HCC. However, the loco-regional therapy prior to LDLT does not seem to provide benefit unless a certain effect in terms of profound TN is noted.
Core tip: Liver transplantation (LT) has become an ideal treatment for liver cirrhosis associated with hepatocellular carcinoma (HCC) as it simultaneously removes the tumors and cures the underlying liver cirrhosis. Living donor LT (LDLT) offers a flexible timing for transplantation providing timeframe for well preparation of transplantation. The study investigates the outcome in relation to the intention of pre-transplantation loco-regional therapy in LDLT for HCC. Although the study is still unable to establish a definitive therapeutic protocol to achieve a beneficial outcome of HCC after LDLT, achieving profound tumor necrosis by loco-regional therapy could also offer better outcomes for patients undergoing LDLT for HCC.