Identifying Subgroup at High Risk of Transarterial Chemoembolization Failure Among Patients with Hepatocellular Carcinoma Awaiting Liver Transplantation

Identifying Subgroup at High Risk of Transarterial Chemoembolization Failure Among Patients with Hepatocellular Carcinoma Awaiting Liver Transplantation

Background/Objectives: Transarterial chemoembolization (TACE) is the most widely used bridging treatment for hepatocellular carcinoma (HCC) before liver transplantation (LT) but may be associated with dropout and post-LT HCC recurrence. We aimed to identify a subgroup of HCC LT candidates at high ri...

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Main Authors: Edoardo Poli, Marc-Antoine Allard, Astrid Laurent-Bellue, Maïté Lewin, Catherine Guettier, Daniel Azoulay, Audrey Coilly, Alexandre Dos Santos, Jamila Faivre, Eric Vibert, Alina Pascale, Clara Prud’homme, Antonio Sa Cunha, Faouzi Saliba, Jean Charles Duclos-Vallée, René Adam, Didier Samuel, Daniel Cherqui, Olivier Rosmorduc
Format: Article
Language:English
Published: MDPI AG 2025-02-01
Series:Livers
Subjects:
hepatocellular carcinoma
transarterial chemoembolization
liver transplantation
TACE failure
liver cancer
Online Access:https://www.mdpi.com/2673-4389/5/1/9
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Summary:Background/Objectives: Transarterial chemoembolization (TACE) is the most widely used bridging treatment for hepatocellular carcinoma (HCC) before liver transplantation (LT) but may be associated with dropout and post-LT HCC recurrence. We aimed to identify a subgroup of HCC LT candidates at high risk of TACE-to-LT strategy failure (TLSF). Methods: All consecutive HCC LT candidates with French AFP-scores ≤ 2 who underwent at least one bridging TACE at Paul Brousse Hospital in 2013–2018 were included (n = 173). Dropout for HCC progression during waiting list and post-LT HCC recurrence was defined TLSF. Results: The one-year TLSF cumulative incidence was 15%. According to univariate analysis, pre-TACE AFP > 15 ng/mL was the only factor associated with decreased overall survival (OS) and TLSF-free survival (TLSF-FS) after the first TACE. The absence of complete radiological response (CRR) or pre-TACE AFP > 15 ng/mL were associated with reduced OS and TLSF-FS after a second TACE (n = 118). The cumulative incidence of TLSF reached 41% one year after the second TACE in patients with both AFP > 15 ng/mL and no CRR, while it was 7% for others (<i>p</i> < 0.001). Conclusions: HCC patients receiving bridging TACE, with pre-TACE AFP > 15 ng/mL and no CRR after two TACEs, are at high risk of delisting for HCC progression or of post-LT recurrence. Alternative therapeutic strategies should be proposed early for this better-defined population.
ISSN:2673-4389

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