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Abstract Details
Bland- versus Chemo-Embolization of Hepatocellular Carcinoma Prior to Transplantation
Kluger K, Halazun K, Barroso R, Fox A, Olsen S, Madoff D, Siegel A, Weintraub J, Susman J, Brown R, Cherqui D, Emond J. Liver Transpl. 2014 Feb 3. doi: 10.1002/lt.23846. [Epub ahead of print]
Author information
Department of Surgery, New York Presbyterian Hospital - Columbia Presbyterian Medical Center, New York, New York.
Abstract
There is conflicting literature regarding the superiority of transcatheter arterial chemoembolization (TACE) over bland transarterial embolization (TAE), and this has not been well studied pre-transplant. Twenty-five TAE patients were matched 2:1 based on initial radiographic tumor size and number with TACE patients in a retrospective case-controlled study. Patients were otherwise treated according to the same protocols. Method of embolization was chosen based on interventionalist practices at two sites within the program. Kaplan Meier survival analyses at 1- and 3- years were the primary endpoints. There were no significant demographic differences between the groups. Mean adjusted MELD at transplantation and waiting times were not significantly different between TAE and TACE (26±3 vs. 24±3 points, p=0.12; 13±8 vs. 11±10 months, p=0.43). TAE (16%) patients were less likely than TACE (40%) to require 2 procedures (p=0.036). Explant tumors were completely necrotic in 36% of TAE and 26% of TACE patients. The 3-year overall survival was 78% (TAE) and 74% (TACE) (p=0.66), and 3-year recurrence-free survival was 72% (TAE) and 68% (TACE) (p=0.67), respectively. On an intention-to-treat basis, there was no significant risk of waitlist drop-off according to whether TAE or TACE was performed (p=0.83). In conclusion, there were no significant differences in waitlist drop off, overall and recurrence-free survival between patients with HCC undergoing TAE and TACE prior to transplantation.