E-ISSN 1305-3612
1 PIGI Laboratory, University of Pennsylvania; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA  
2 Department of Hepatology and Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA  
3 Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA,.  
Diagn Interv Radiol ; : -

Abstract

 

Purpose: Since the change in the United Network for Organ Sharing (UNOS) policy excluding patients with very early stage hepatocellular carcinoma (veHCC, single tumor nodule<2 cm) from receiving Model for End-stage Liver Disease (MELD) exception points, patients eligible to receive liver transplantation (LT) who fall in this category are commonly treated with locoregional therapy (LRT) after progression to UNOS T2 stage (1 nodule 2-5 cm or up to 3 nodules, none above 3 cm). The aim of the current study is to compare the outcomes of these patients treated with bridging LRT and LT with "wait and not treat" approach with patients treated with definitive LRT.

 

Methods: A retrospective study has been performed on patients with veHCC evaluated in multidisciplinary liver tumor clinic of a large academic center between 2004-11. Patients eligible for LT were assigned to the wait and not treat group while patients who were not eligible were assigned to the definitive LRT group. Tumor size, time to treatment, severity of liver disease, recurrence and survival from time of detection were reviewed and recorded.

 

Results: 19 patients were identified and treated with definitive LRT while 57 patients were treated with bridging LRT prior to LT after disease progression to T2 stage. Patients in the definitive LRT group were older (70.4±10.2 vs. 58.7±5.9 years, P <0.001) and had more co-morbid conditions compared to the wait and not treat group. Mean survival for definitive LRT group at the end of 5 years was 34.3±6.0 months with a median of 30.3 months (95% CI: 5.7-55.0) compared to 48.7±2.6 for the wait and not treat group, respectively (median not reached). 3 and 5-year survival rates for the definitive LRT group were 53.3% and 33.3% compared to 78.9% and 68.4% for the patients in the wait and not treat group. Survival rate at the end of 5 years was significantly better for the wait and not treat group (p value = 0.013).

 

Conclusion: Based on the findings of current retrospective study, treating veHCC (UNOS T1 stage) patients listed for LT with bridging LRT after disease progression to T2 stage appears to be safe and effective with high 5-year survival rates.

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