Scientific Abstracts: Liver
Objective: Complete pathologic necrosis (CPN) at the time of liver transplantation predicts hepatocellular carcinoma (HCC) recurrence and long-term survival. The purpose of this study is to evaluate complete pathologic necrosis on explanted liver specimens in patients who underwent locoregional therapy (LRT) and subsequently received a liver transplant (LT) for hepatocellular carcinoma (HCC).
Methods: An IRB approved, single center retrospective of 912 patients with HCC who received LRT. Patients who subsequently underwent LT from 2000-2018 were included (n=187). LRT consisted of radiofrequency ablation, microwave ablation, and trans-arterial chemoembolization (TACE; drug eluding beads or lipiodol). Patients who did not receive liver transplantation (n = 725) were excluded from the analysis. Primary outcome was complete pathologic necrosis (CPN) defined as 100% necrosis with no viable tumor visualized on explant pathology. Patients were divided into early and late groups as follows: 2000-2010 (Early Era) 90 patients and 2010-2018 (Later Era) 97 patients. We evaluated LRT type, LRT technique (use of overlapping ablation, type of TACE, ablations, BCLC stage, tumor size, age and sex for effect on CPN. Univariate and multivariate logistic regression analysis was performed.
Results: Patients (Age:59 +/-7 years, Male= 84%) had BCLC 0: 18%, A: 80% or B: 2% HCC at diagnosis. Largest tumor size was 2.0 +/- 1.0 cm. Per patient, 2.0 +/- 1.0 LRT procedures were performed. Overall rate of CPN was 100/187 (53%). Increase in tumor size (per 1 cm) decreased likelihood of CPN [OR: 0.7 (CI: 0.5-0.9); p = 0.03]. In patients undergoing TACE, CPN was achieved in 24/50(48%). In patients undergoing ablation, CPN was achieved in 93/168 (55%). On univariate analysis, only tumor size and era of treatment was associated with CPN on explant. CPN was achieved in 40/90 (44%) during the Early Era vs. 60/97 (62%) in the Later Era [OR 0.49 (CI: 0.28-0.89), p = 0.017]. Size was a predictor of lack of CPN in the Early Era [OR 0.51 (CI: 0.28-0.9) p = 0.02] but not in the Later Era, [OR 0.84 (CI: 0.49 – 1.4) p = 0.52]. On multivariate analysis, patients who received LRT in the Later Era were more likely to achieve CPN as compared to the Early Era [OR 2.27 (1.2 – 4.2) 0.01] after adjusting for all other factors.
Conclusions: With time, higher rates of complete pathologic necrosis using locoregional therapy are observed in patients undergoing liver transplantation, which may be related to improving technique and technology.