Rates of Complete Pathologic Necrosis Among Locoregional Therapy Modalities for 3-5 cm Hepatocellular Carcinomas Undergoing Transplantation

Sunday, March 30, 2025

4:03 PM – 4:12 PM CT

Location: Music City Center, 208 AB

Presenting Author(s)

Breanna Collins, BS (she/her/hers)

Medical Student
University of California, San Diego School of Medicine, United States

Author/Co-author(s)

CK

Cody A. Keller, MD

Resident Physician
University of California, San Diego, United States
Vasan Jagadeesh

Medical Student
University of California, San Diego School of Medicine, United States
JM

Jeet Minocha, MD (he/him/his)

Professor, Division of Interventional Radiology
University of California San Diego, United States
GS

Gabriel Schnickel, MD

Faculty hepatobiliary and transplant surgery physician
University of California San Diego, United States
AB

Adam Burgoyne, MD, PhD

Associate Clinical Professor
University of California, San Diego, United States
ZB

Zachary Berman, MD

Associate Clinical Professor
University of California, San Diego, United States

Purpose: Liver transplantation is the gold standard for hepatocellular carcinoma (HCC) therapy. Most undergo bridging locoregional therapy (LRT) until transplantation with post-transplant outcomes correlated with degree of complete pathologic necrosis (CPN). Ablative modalities are available for small tumors, but the optimal modality remains unclear for lesions between 3cm-5cm in size where it is more difficult to achieve adequate margins given the size of the tumor with thermal ablation. This study compared the rates of CPN among patients with HCCs 3cm-5cm in size who underwent transarterial radioembolization (TARE), transarterial chemoembolization (TACE), ablation, or a combination of modalities.

Materials and Methods: A retrospective analysis was performed of consecutive 3cm-5cm lesions from patients who underwent transplant from 2010-2023 at a single institution. A lesion was defined as having CPN if the histopathological findings obtained at gross dissection of the explant livers reported greater than or equal to 98% tumor necrosis. TARE, ablation, and any combination including them were considered ablative approaches compared to TACE alone.

Results: A total of 89 lesions from 67 patients (52 male) were included with a mean age at transplant of 63 years. The etiology of chronic liver disease in these patients included HCV (43%), EtOH (24%), MASH (13%), HBV (7%), or a combination (12%). A lesion level analysis found that ablative modalities are superior to non-ablative modalities in achieving CPN (63% vs 34% respectively, p = 0.01). Broken down by modality, the combination of TACE/ablation produced the highest likelihood of CPN (75%), followed by TARE with TACE (70%), TARE alone (56%), TACE alone (34%), and ablation alone (33%). TACE/ablation combined were significantly more effective than TACE alone (p = 0.01), and there was a trend toward TACE/ablation being more effective than ablation alone (p = 0.22). TACE/ablation and TARE had similar rates of CPN (p = 0.33).

Conclusion: Complete pathologic necrosis has been shown to improve post-transplant outcomes, though for tumors between 3-5 cm in size the optimal treatment to achieve CPN is not known. This study found that combination therapies with thermal ablation are superior to TACE alone, and TARE and TACE/ablation have similar rates of CPN.