Abstract

Transarterial chemoembolization (TACE) is a commonly used bridge therapy for patients awaiting liver transplantation (LT) and for downstaging patients initially not meeting the Milan criteria (MC). The primary aim of the study was to analyze whether a difference exists between selective/superselective versus lobar TACE in determining tumor necrosis as assessed by pathological analysis of the whole lesion obtained at the time of LT. The secondary aim was to investigate the relationship between tumor size and the capacity of TACE to induce necrosis. Data from 67 consecutive patients, who underwent LT for hepatocellular carcinoma (HCC) on cirrhosis from 2003 to 2009 and were treated exclusively with TACE as bridge (no=53) or downstaging (no=14) therapies, were extracted from a prospective database. We identified 122 nodules, 53.3% treated with selective/superselective TACE. The mean histological necrosis was 64.7%; complete tumor necrosis was obtained in 42.6% of the nodules. Selective/superselective TACE achieved both significantly higher mean necrosis than that obtained by lobar TACE and a higher rate of complete necrosis (75.1% vs. 52.8%, p=0.002) and 53.8% vs. 29.8%, (p=0.013, respectively). A significant direct relationship was observed between tumor diameter and mean tumor necrosis (59.6% in <2 cm, 68.4% in 2.1-3 cm and 76.2% in >3cm lesions). Histological necrosis was maximal for tumors >3 cm: 91.8% in selective/superselective TACE and 66.5% after lobar procedures. Independent predictors of complete tumor necrosis were selective/superselective TACE (P=0.049) and treatment of single nodules (P=0.008). Repeated sessions were more frequently needed for nodules treated with lobar TACE (31.6% vs 59.3%; P=0.049).

CONCLUSION: Selective/superselective TACE were more successful than lobar procedures in achieving complete histological necrosis and TACE was more effective in 3-5cm tumors than in smaller ones.