[P-79] EFFICACY OF PRE-TRANSPLANT TRANS-ARTERIAL CHEMO-EMBOLIZATION IN PATIENTS WITH HEPATOCELLULAR CARCINOMA.

Vincent Peyregne, Ahmed Fahmy, Devon John, Thomas Diflo, Glyn Morgan, Lewis Teperman New York University Langone Medical Center, New York, USA

Introduction: owing to the drop-out on the wait-list due to Hepatocellular Carcinoma (HCC) progression, different approaches have been considered to treat HCCs prior to Liver Transplantation (OLT). Our study assessed the efficacy of Trans-Arterial Chemo-Embolization (TACE) and its influence on recurrence and survival.
Material and methods: from 2002 to 2007, 85 patients with HCC were identified,59 with TACE and 26 controls. Characteristics related to the patients and tumors were retrospectively recorded, including Magnetic Resonance Imaging (MRI) before TACE and before OLT to assess changes in size and Milan criteria status, pathology reports and outcome. Fischer exact test, Pierson χ² test and Student t-test were used when appropriate.
Results: groups were comparable for age, sex ratio, indication for OLT and type of graft. Main findings are summarized in Table 1.

Comparison of TACE and no TACE groups

Variable	TACE	No TACE	p value
Beyond Milan criteria on iMRI	22%	0%	0,000†
Diameter* - iMRI (cm)	3,8±2,2	1,6±1,4	0,000Φ
Tumor number - iMRI	1,7±1,1	±0,7	0,001Φ
Necrosis - last MRI	49%	10%	0,013†
Decrease in diameter* on MRI	62%	25%	0,008§
Milan “downstaging” on MRI	20%	0%	0,095§
Diameter* on explant (cm)	4,7±3,5	2,9±2,9	0,024Φ
Tumor number on explant	2,8±2,5	1,8±1,5	0,023Φ
Necrosis on explant	87%	16%	0,000†
Tumor differentiation (poor/moderate/well)	26/50/24%	12/36/52%	0,010†

iMRI: initial MRI; TACE: Trans-Arterial Chemo-Embolization; * total tumor diameter; † Pearson's χ2 test; § Fischer's exact test; Φ Studen t-test

Incidence of recurrence, recurrence-free and patient survivals were comparable in the 2 groups at 6 months, 1, 3 and 5 years.
Conclusions: TACE ellicited an objective decrease in tumor size. A trend toward downstaging was noted when initially beyond Milan criteria. Recurrence and survivals were not different, even though there were significantly more patients beyond Milan criteria in the TACE group, with more tumors, larger and less differentiated tumors. TACE should be considered for tumors beyond Milan criteria to improve access to OLT, once patients are made eligible for exception points, secondarily to treatment-induced “downstaging”.

Date: Wednesday, July 8, 2009
Session Info: Poster Session I (5:30 PM-7:00 PM)
Presentation Time: 5:30 PM
Room: Americas Hall I, Level 3