Locoregional treatments before liver transplantation for hepatocellular carcinoma: A cohort study from the European Liver Transplant Registry

Abstract

Introduction Locoregional treatment while on the waiting list for liver transplantation (Ltx) for hepatocellular carcinoma (HCC) has shown to improve survival. However, effect of treatment types has not been investigated. We investigate the effect of types of locoregional treatment on survival after Ltx for HCC. Methods We investigated patients registered in the European Liver Transplant Registry (ELTR) database using multivariate Cox regression survival analysis. Results Information on locoregional therapy was registered in 4,978 of 23,124 patients and was associated with improved overall survival (hazard ratio (HR) 0.84 [0.73-0.96]) and HCC specific survival (HR 0.76 [0.59-0.98]). Radiofrequency ablation (RFA) was the one monotherapy associated with improved overall survival (HR 0.51 [0.40-0.65]). In addition, the combination of RFA and transarterial chemoembolization (TACE) improved survival as well (HR 0.74 [0.55-0.99]). Conclusion Adjusting for factors related to prognosis, disease severity and tumor aggressiveness, RFA was highly beneficial regarding overall and HCC specific survival. The effect may represent a selection of patients with favorable tumor biology. However, the treatment may be effective per se by halting tumor progression and inducing an immune response toward the cancer. ClinicalTrials.gov number: NCT02995096