Percutaneous combined treatment (transarterial chemoembolisation + thermal ablation) in patients with hepatocellular carcinoma enlisted for liver transplant: pathological findings and follow-up
Federica Piccione, Turin / Italy
Author Block: F. Piccione, M. Calandri, A. Doriguzzi Breatta, P. Fonio, M. M. E. Fronda, C. Gazzera, E. Susanna; Turin/ITPurpose: The study aimed at evaluating the efficacy of a combined thermal ablation (TA) and trans-arterial chemoembolisation (TACE) treatment as a bridge or downstaging method for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) > 3 cm in size.Methods or Background: A retrospective review encompassed 700 consecutive patients subjected to OLT for HCC, focusing on 36 patients who underwent combined TA and TACE as bridge or downstaging. Primary objectives included assessing explanted liver pathology, emphasising necrosis of the targeted lesion, post-OLT overall survival (OS) and post-OLT recurrence free survival (RFS). A comparison in terms of post-OLT OS and RFS with 170 patients subjected to TA alone for nodules < 3 cm in size was also performed.Results or Findings: Out of the 36 patients, - 9% underwent the combined therapy as a bridge, while 36.1% required downstaging to meet the Milan criteria. The average treated node size was 4.25 cm (+/- DS). Half received radiofrequency (RF) treatment and the other half underwent microwave (MW) treatment. All nodes underwent drug-eluting beads (DEB) TACE. 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 between the study cohort and the cohort of patients subjected to TA alone.
Conclusion: Combined therapy (TA and TACE) is effective for HCC > 3 cm, particularly for bridging and downstaging to OLT, achieving OS and RFS rates exceeding 80% at 1, 3, and 5 years.Limitations: Retrospective single-centre study limits the scope of this study.Funding for this study: No funds were received for this study.Has your study been approved by an ethics committee? YesEthics committee - additional information: Waiting for a response.