Vatche G A et al. – In this study, the effect of pretransplant bridging locoregional therapy (LRT) on hepatocellular carcinoma (HCC) recurrence and survival after liver transplantation (LT) in patients meeting Milan criteria (MC) was examined. The study reported that bridging LRT did not improve post–LT survival or HCC recurrence in most of the patients who fail to achieve complete pathologic response (cPR). Increasing LRT treatments and lack of alphafetoprotein response to LRT are independent markers for predicting post–LT recurrence.

Methods

• A total of 3601 MC patients with and without bridging LRT using competing risk Cox regression in consecutive patients from 20 US centers (2002–2013) were examined for recurrence–free survival and post–LT recurrence.

Results

• Similar recurrence–free survival at 1, 3, and 5–year (89%, 77%, 68% vs 85%, 75%, 68%; P = .490) and 5–year post–LT recurrence (11.2% vs 10.1%; P = .474) was shown for 747 LT recipients not receiving LRT compared to 2854 receiving LRT.
• Increased LRT [3 LRTs: hazard ratio (HR) 2.1, P < .001; 4+ LRTs: HR 2.5, P < .001), and unfavorable waitlist alphafetoprotein trend were significant predictors of post–LT recurrence unlike LRT modality
• Treated patients who achieved cPR had better 5–year RFS (72%) and lower post–LT recurrence (HR 0.52, P < .001) compared with both untreated patients (69%; P = .010; HR 1.0) and treated patients not achieving cPR (67%; P = .010; HR 1.31, P = .039).
• In these patients, multivariate analyses demonstrated increased recurrence compared with untreated patients after controlling for pretransplant and pathologic factors (HR 1.32, P = .044).