Long-Term Prognostic Significance of TACE-Induced Complete Pathological Response in Patients with Hepatocellular Carcinoma Who Have Undergone Liver Transplantation

Abstract

Background: Complete pathological response (CPR) after transcatheter arterial chemoembolization (TACE) is associated with improved posttransplant outcomes in patients with hepatocellular carcinoma (HCC). This study evaluated the prognostic significance of TACE-induced CPR in patients with HCC who underwent liver transplantation (LT). Material/Methods: The records of 2238 patients who underwent primary LT for HCC between January 2006 and December 2020 were retrospectively reviewed; of these, 253 achieved explant pathology–confirmed TACE-induced CPR. Their clinical outcomes were analyzed. Results: These 253 patients underwent an average of 2.2±2.3 TACE sessions. The median number of non-viable tumors was 1, and the median maximal tumor size was 1.6 cm. At 1, 3, 5, 10, and 15 years, cumulative post-LT recurrence rates were 1.2%, 3.3%, 3.3%, 5.6%, and 5.6%, respectively; overall patient survival rates were 96.0%, 93.7%, 92.4%, 91.3%, and 82.1%, respectively. Larger tumors (>2 cm) and multiple non-viable tumors were in-dependently associated with higher recurrence and reduced survival rates (P£0.036). Cluster analysis identified patients with multiple non-viable tumors larger than 2 cm as a high-risk group; others comprised a low-risk group. Recurrence (P<0.001) and survival (P=0.018) rates were significantly lower in the high-risk group than in the low-risk group. Conclusions: TACE-induced CPR is a strong prognostic indicator of favorable long-term outcomes after LT in patients with HCC. Stratification based on non-viable tumor size and number can identify high-risk patients with CPR who require closer surveillance. Less intensive follow-up may be sufficient for low-risk patients.