Combined transarterial chemoembolization and thermal ablation in candidates to liver transplantation with hepatocellular carcinoma: pathological findings and post-transplant outcome

Radiol Med. 2024 Jul;129(7):1086-1097. doi: 10.1007/s11547-024-01830-x. Epub 2024 Jun 3.

Abstract

Objectives: Evaluating the pathological response and the survival outcomes of combined thermal ablation (TA) and transarterial chemoembolization (TACE) as a bridge or downstaging for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) > 3 cm.

Materials and methods: A retrospective review encompassed 36 consecutive patients who underwent combined TA-TACE as bridging or downstaging before LT. Primary objectives included necrosis of the target lesion at explant pathology, post-LT overall survival (OS) and post-LT recurrence-free survival (RFS). For OS and RFS, a comparison with 170 patients subjected to TA alone for nodules <3 cm in size was also made.

Results: Out of the 36 patients, 63.9% underwent TA-TACE as bridging, while 36.1% required downstaging. The average node size was 4.25 cm. All cases were discussed in a multidisciplinary tumor board to assess the best treatment for each patient. Half received radiofrequency (RF), and the other half underwent microwave (MW). All nodes underwent drug-eluting beads (DEB) TACE with epirubicin. The mean necrosis percentage was 65.9% in the RF+TACE group and 83.3% in the MW+TACE group (p-value = 0.099). OS was 100% at 1 year, 100% at 3 years and 94.7% at 5 years. RFS was 97.2% at 1 year, 94.4% at 3 years and 90% at 5 years. Despite the different sizes of the lesions, OS and RFS did not show significant differences with the cohort of patients subjected to TA alone.

Conclusions: The study highlights the effectiveness of combined TA-TACE for HCC>3 cm, particularly for bridging and downstaging to LT, achieving OS and RFS rates significantly exceeding 80% at 1, 3 and 5 years.

Keywords: Hepatocellular carcinoma (HCC); Liver transplantation; Microwave ablation; Pathologic response; Radiofrequency ablation; Trans-catheter-arterial chemoembolization (TACE).

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Hepatocellular* / pathology
  • Carcinoma, Hepatocellular* / surgery
  • Carcinoma, Hepatocellular* / therapy
  • Catheter Ablation / methods
  • Chemoembolization, Therapeutic* / methods
  • Combined Modality Therapy
  • Female
  • Humans
  • Liver Neoplasms* / pathology
  • Liver Neoplasms* / surgery
  • Liver Neoplasms* / therapy
  • Liver Transplantation*
  • Male
  • Microwaves / therapeutic use
  • Middle Aged
  • Neoplasm Staging
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome