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SIR 2025

Interventional Oncology

Scientific Session

Session: Interventional Oncology 2

Complete Pathologic Necrosis using Bridging Locoregional Therapy Impacting Long-Term Outcomes in Patients with Hepatocellular Carcinoma Post-Liver Transplantation

Monday, March 31, 2025
3:09 PM – 3:18 PM CT
Location: Music City Center, 209 ABC
Purpose: Complete Pathologic Necrosis using Bridging Locoregional Therapy Impacting Long-Term Outcomes in Patients with Hepatocellular Carcinoma Post-Liver Transplantation

Materials and Methods: The United Network for Organ Sharing (UNOS) database was used to identify all patients with treatment-naïve HCC measuring < 3 cm who underwent a single LRT (transarterial chemoembolization [TACE], transarterial radioembolization [TARE], or thermal ablation [TA]) and received LT between 2012 and 2022. Patients were determined to have CPN if they had 100% necrosis of all tumors on explant. Associations between LRT type, CPN, and recurrence rate were evaluated using chi-squared tests or Fisher’s Exact tests. Survival from transplantation was stratified by CPN and assessed using Kaplan-Meier analysis and Log-Rank test. Hazard Ratios (HR) for survival were calculated using a Cox proportional hazards model.

Results: Of the 16,925 with HCC who underwent LT, a total of 2,869 patients (median age 63 years; 77.6% male) received a single modality of bridging LRT for HCC between 2012 and 2022 (1,860 [64.8%] TACE; 374 [13.0%] TARE; 635 [22.1%] TA). The rate of achieving CPN differed significantly between treatment groups: 21.2% for TACE, 38.0% for TARE, and 39.1% for TA (p< 0.0001). Specifically, TARE and TA had a significantly higher rates of CPN compared to TACE (p< 0.0001). Patients with CPN had a significantly lower rate of recurrence post-LT compared with those who had no CPN (2.0% vs. 6.4%, p< 0.0001). Survival post LT was dictated by achieving CPN with 1-, 2- and 5-year survival rate for the CPN cohort at 97%, 94% and 87% compared to 95%, 91% and 81% for those who do not achieve CPN (p=0.0011) and a HR of 0.701 (95% CI: 0.565-0.869, p=0.0012).

Conclusion: In patients with HCC undergoing LT, achieving CPN by LRT is associated with a significantly lower rate of HCC recurrence and prolonged overall survival. Additionally, there are significant differences in CPN rate based on LRT modality used to bridge HCC patients to LT with thermal ablation and TARE achieving higher rates of CPN compared to TACE.