Downstaging prior to liver transplantation for hepatocellular carcinoma: advisable but at the price of an increased risk of cancer recurrence

Article Article scientifique Article Downstaging prior to liver transplantation for hepatocellular carcinoma: advisable but at the price of an increased risk of cancer recurrence - a retrospective study eng 2019 author Toso Christian 92271 author Meeberg Glenda author Andres Axel 105988 author Shore Carolina 781376 author Saunders Colleen author Bigam David L author Shapiro Andrew Mark James author Compagnon Philippe 894594 author Berney Thierry 63319 author Majno Pietro 80596 author Kneteman Norman 163-172 10.1111/tri.13337 30152891 0934-0874 The use of downstaging prior to liver transplantation for hepatocellular carcinoma (HCC) still needs refinement. This study included patients with HCC listed for transplantation according to the Total Tumour Volume (TTV) ≤115 cm3 and alpha fetoprotein (AFP) ≤400 ng/ml criteria, with and without previous downstaging. Overall, 455 patients were listed, and 286 transplanted. Post-transplant follow-up was 38.5 ± 1.7 months. Patients downstaged to TTV115/AFP400 (n = 29) demonstrated similar disease-free survivals (DFS, 74% vs. 80% at 5 years, P = 0.949), but a trend to more recurrences (14% vs. 5.8%, P = 0.10) than those always within TTV115/AFP400 (n = 257). Similarly, patients downstaged to Milan criteria (n = 80) demonstrated similar DFS (76% vs. 86% at 5 years, P = 0.258), but more recurrences (11% vs. 1.7%, P = 0.001) than those always within Milan (n = 177). Among patients downstaged to Milan, those originally beyond TTV115/AFP400 (n = 27) had similar outcomes as those originally beyond Milan, but within TTV115/AFP400 (n = 53). However, the likelihood of being within Milan at transplant was lower for patients with more advanced original HCCs (P < 0.0001). Overall, despite an expected increase in post-transplant HCC recurrence, similar survivals can be achieved with and without downstaging, using the TTV115/AFP400 transplantation criteria, and including patients with advanced original HCCs. Downstaging should continue to be performed. Cancer Downstaging Liver clinical Outcome Dewey 617 Swiss National Science Foundation Surgical management of hepatocellular carcinoma PP00P3_165837 CH Careers 57 Département de chirurgie 222 false 357 La transplantation d'îlots de Langerhans 623 562 Transplantation et hépatologie 905 Transplant International 32 2 166cdc1d-9a70-4f74-a507-bb4d316e6c19 Article (Published version) Restricted Toso_et_al-2019-Transplant_International.pdf 309749 application/pdf c5aa6540-f371-47c8-b1b4-18b6da62519e Supplemental data Restricted tri13337-sup-0001-figs1.pdf 19536 application/pdf restrictedAccess Faculté de médecine / Section de médecine clinique / Département de chirurgie

Title	Published in	Year	Views	Downloads

Downstaging prior to liver transplantation for hepatocellular carcinoma: advisable but at the price of an increased risk of cancer recurrence - a retrospective study	Transplant International	2019	329	1
Même pas mal	Revue médicale suisse	2016	419	0

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