Background. The characterization of tumor response after transarterial chemoembolization (TACE) in patients awaiting liver transplantation (LT) can identify candidates with favorable tumor biology. Recently, preoperative inflammation scores, such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been related to post-transplant HCC recurrence. We investigated the role of radiological response and inflammation scores in predicting tumor recurrence after LT. Methods. From 8/2005 to 12/2014, 70 patients treated by conventional (c-TACE, n=16) or Doxorubicin-Eluting Bead TACE (DEB-TACE, n=54) were included. Patients’ and tumors’ characteristics, including static and dynamic PLR, NLR and alfa-fetoprotein measurements, were reviewed; treatment response was classified according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) or European Association for the Study of the Liver (EASL) criteria as complete (CR), partial (PR), stable (SD) or progressive disease (PD). At pathology, necrosis was defined as a percentage of cumulative tumor area and classified as complete (100%), partial (50-99%) or inadequate (<50%). Results. According to the imaging before TACE, 22/70 (31.4%) and 12/70 (17.1%) patients were beyond Milan and University of San Francisco (UCSF) criteria, respectively. Complete and partial histological necrosis was achieved in 14/70 (20.0%) and 28/70 (40.0%) patients, respectively. Accuracy between radiological criteria and pathology was 72.9% (51/70) and 68.6% (48/70) for mRECIST and EASL, respectively. Among preoperative variables, mRECIST non-response to TACE at the last imaging before LT [Exp(b)=9.2, C.I. 1.6-51.3, p=0.012], the lack of fulfillment of UCSF criteria before TACE [Exp(b)=4.7, C.I. 1.1-19.3, p=0.033] and an increased (>150) PLR before LT [Exp(b)=5.9, C.I. 1.0-33.9, p=0.046] were independent predictors of tumor recurrence. Conclusion. mRECIST criteria and preoperative inflammation scores are useful to refine selection of TACE-treated candidates for LT.
Radiological response and inflamation scores predict tumor recurrence in patient treated with transarterial chemoembolization before liver transplantation / Nicolini, D.; Agostini, A.; Montalti, R.; Candelari, R.; Vincenzi, P.; Coletta, M.; Mincarelli, C.; Mandolesi, A.; Mocchegiani, F.; Vecchi, A.; Giovagnoni, A.; Vivarelli, M.. - (2015). (Intervento presentato al convegno 17th Congress of the European Society for Organ Transplantation (ESOT) From the heart of Europe to the world of transplantation tenutosi a Brussels, Belgium nel 13-16 September 2015).
Radiological response and inflamation scores predict tumor recurrence in patient treated with transarterial chemoembolization before liver transplantation.
R. Montalti;
2015
Abstract
Background. The characterization of tumor response after transarterial chemoembolization (TACE) in patients awaiting liver transplantation (LT) can identify candidates with favorable tumor biology. Recently, preoperative inflammation scores, such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been related to post-transplant HCC recurrence. We investigated the role of radiological response and inflammation scores in predicting tumor recurrence after LT. Methods. From 8/2005 to 12/2014, 70 patients treated by conventional (c-TACE, n=16) or Doxorubicin-Eluting Bead TACE (DEB-TACE, n=54) were included. Patients’ and tumors’ characteristics, including static and dynamic PLR, NLR and alfa-fetoprotein measurements, were reviewed; treatment response was classified according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) or European Association for the Study of the Liver (EASL) criteria as complete (CR), partial (PR), stable (SD) or progressive disease (PD). At pathology, necrosis was defined as a percentage of cumulative tumor area and classified as complete (100%), partial (50-99%) or inadequate (<50%). Results. According to the imaging before TACE, 22/70 (31.4%) and 12/70 (17.1%) patients were beyond Milan and University of San Francisco (UCSF) criteria, respectively. Complete and partial histological necrosis was achieved in 14/70 (20.0%) and 28/70 (40.0%) patients, respectively. Accuracy between radiological criteria and pathology was 72.9% (51/70) and 68.6% (48/70) for mRECIST and EASL, respectively. Among preoperative variables, mRECIST non-response to TACE at the last imaging before LT [Exp(b)=9.2, C.I. 1.6-51.3, p=0.012], the lack of fulfillment of UCSF criteria before TACE [Exp(b)=4.7, C.I. 1.1-19.3, p=0.033] and an increased (>150) PLR before LT [Exp(b)=5.9, C.I. 1.0-33.9, p=0.046] were independent predictors of tumor recurrence. Conclusion. mRECIST criteria and preoperative inflammation scores are useful to refine selection of TACE-treated candidates for LT.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
