Prognostic effect of complete pathologic response following TACE on HCC patients undergoing - PowerPoint Presentation

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Prognostic effect of complete pathologic response following TACE on HCC patients undergoing liver resection or transplantation

Woo-

Hyoung

Kang, Shin Hwang, Young-

Joo

Lee, Ki-Hun Kim,

Chul

-Soo

Ahn

,

Deok

-Bog Moon,

Gi

-Won Song, Sung-

Gyu

Lee

Department of Surgery,

Asan

Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Neoadjuvant TACE

Background

Definite treatment with curative intent

Palliative

cytoreduction

therapy

Downstaging

treatment

Response test for suitability of LT

Combination

Complete Pathologic Response(CPR)

Liver Resection or Liver transplantation

Prognosis ??

Preop

-TACE, HCC patients

Background

Minimal risk group

of Tumor recurrence

: Solitary HCC ≤2 cm

: Absence of neoadjuvant treatment

: R0 resection

: BCLC stage A

Control Group

Study Group

Complete Pathologic Response(CPR) ??

Area of necrosis

≥

99% of the total tumor volume

Absence of viable tumor cells in any nodule.

Definition

Study Group

Study

design and patient selection

7783 HCC patients (January, 2000 ~ December, 2014)

Liver resection (LR) pathway

Liver transplantation (LT) pathway

TACE

TACE

LR

LR

Yes

No

n=5052

n=997

CPR

Single,

≤2 cm

No

n=887

Exclusion

Yes

LR

study group

Yes

LR

Control group

No

Exclusion

n=4576

n=110

n=476

n=6049

n=1334

No

Yes

LT

LT

n=738

n=596

CPR

No

Exclusion

n=505

One or two,

≤2 cm

Yes

LT

study group

LT

Control group

n=233

Yes

n=184

No

Exclusion

n=412

Group

Liver resection

Liver transplantation

Parameter

Study group

Control group

p-value

Study group

Control group

p-value

Patient number

110

476

233

184

Age (yrs)

54.9±8.5

55.6±9.1

0.864

53.7±7.4

53.0±6.7

1.000

Gender (Male / Female) (n)

93 / 17

341 / 135

0.005

191 / 42

147 / 37

0.589

TACE session

mean

1.4±1.2

NA

2.2±2.4

NA

Once (n)

81

NA

50

NA

≥2 (n)

29

NA

183

NA

Type of liver resection (n)

0.125

Anatomical

95

434

NA

NA

Non-anatomical

15

42

NA

NA

Maximal tumor diameter (cm)

4.2±2.8

1.5±0.4

0.000

2.5±1.3

1.5±0.4

0.000

Tumor number (n)

0.000

0.193

Single

95

476

0.000

164

140

0.193

Two

11

0

37

44

≥

3

4

0

32

0

Patietns

demographics

CPR

Minimal risk of tumor recurrence

Proportions of Recurrence

LT control

LT study

LR control

LR study

Postoperative months

Recurrence rate

(p=0.000)

(p=0.019)

Liver resection

Liver Transplantation

Study group

Control group

Study group

Control group

Intrahepatic recurrence

40 (85.1%)

122 (94.6%)

4 (23.5%)

3 (60.0%)

Extrahepatic recurrence

Lung

3 (6.4%)

2 (1.6%)

6 (35.3%)

1 (20.0%)

Bone

3 (6.4%)

3 (2.3%)

2 (11.8%)

0

Adrenal gland

1 (2.1%)

0

1 (5.9%)

0

Peritoneum

0

0

0

1 (20.0%)

Combined intra- and extrahepatic recurrence

0

2 (1.6%)

4 (23.5%)

0

(p=0.000)

Proportions of survival

LT control

LT study

LR control

LR study

Postoperative months

Overall survival

(p=0.000)

(p=0.112)

(p=0.000)

Conclusion

* Incidence of Complete pathologic response : 11%(LR) Vs 31.6%(LT)

*

Liver resection on CPR

surrogate pathologic predictor of improved post resection outcomes.

Not minimized the risk of tumor recurrence, as Control group

Resectable

HCC : not recommended Preoperative TACE

Since TACE-induced CPR

decrease only the active tumor load to the patients undergoing LR, CPR should not be interpreted as a reliable parameter permitting loose or less strict follow-up for HCC recurrence surveillance*

Liver Transplantation on CPRDown-staging therapy, Reduction of post-transplant tumor recurrenceCompared Resection(CRR or not), Prognostic Advantage

Thank You for your attention