Response to TACE Linked with Lower Recurrence Risk after Liver Transplantation

Sustained Response to TACE Linked with Lower Recurrence Risk after Liver Transplantation

Among liver cancer patients who are potential candidates for liver transplantation, those who experience a sustained response to transarterial chemoembolization (TACE) appear to have a lower risk of cancer recurrence after liver transplantation. These results were published in the journal Liver Transplantation.

The liver is the largest organ in the body and is responsible for over 500 functions. These include the secretion of glucose, proteins, vitamins, and fats; the production of bile; the processing of hemoglobin; and the detoxification of numerous substances.

The most common type of liver cancer, hepatocellular carcinoma (HCC), is characterized by cancer that starts in cells of the liver and can spread through blood and lymph vessels to different parts of the body.

For selected patients with HCC that is confined to the liver but cannot be surgically removed, treatment with a liver transplantation may be considered. When patients are selected for liver transplantation, tumor size and the number of tumor nodules are taken into consideration, though other factors may also influence post-transplant survival.

TACE is a type of therapy in which the blood flow to the cancer is blocked and cancer cells are deprived of oxygen and nutrients. To explore whether response to TACE influences risk of recurrence after liver transplantation, researchers in Germany conducted a study among 96 patients with HCC. At the start of the study, 34 of the patients were transplant candidates based on tumor size and distribution, while the remainder had tumors that were too large or too numerous to be eligible for transplant. All patients received TACE every six weeks.

  • A total of 50 patients eventually underwent a liver transplantation. Twenty-seven of these patients had not initially been transplant candidates, but became candidates after their tumors responded to TACE.
  • The risk of cancer recurrence following liver transplantation was strongly influenced by whether or not patients had experienced cancer progression during TACE. Among the 11 patients who experienced a worsening of their cancer during TACE, five experienced a recurrence of HCC after liver transplantation. Among the 39 patients who did not experience any worsening of their cancer during TACE, only two experienced a recurrence of HCC after liver transplantation.
  • Five-year survival without a cancer recurrence was 35% among patients who experienced a worsening of their cancer during TACE, and 95% among patients who did not experience a worsening of their cancer during TACE.

The researchers conclude that information about the extent and duration of response to TACE may help guide the selection of liver transplant candidates. A sustained response to TACE was linked with a lower risk of cancer recurrence after liver transplantation.

Reference: Otto G, Herber S, Heise M et al. Response to Transarterial Chemoembolization as a Biological Selection Criterion for Liver Transplantation in Hepatocellular Carcinoma. Liver Transplantation. 2006;12:1260-1267.

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