AASLD: Pre-Transplant Therapy Worsens Survival Rates in Liver Cancer

By Jane Salodof MacNeil

October 31, 2003

BOSTON, MA -- A 10-year review of liver transplants for hepatocellular carcinoma showed that patients who received adjuvant therapy prior to orthotopic liver transplantation (OLT) did worse than patients who had no prior treatment.

Between 1990 and 2000, researchers at Cedars-Sinai Medical Center in Los Angeles, California, United States, compared 54 patients who went directly to transplantation with 16 who underwent transarterial chemoembolization (TACE) and eight who received other treatments.

The patients who received no adjuvant therapy had survival rates of 84% at one year, 71% at three years, and 66% at five years. In contrast, all other patients who received TACE or another therapy had survival rates of 65%, 58%, and 46% at one, three, and five years, respectively.

TACE, widely used in patients waiting for a liver to become available for transplantation, produced the worst survival results: 58%, 50%, and 40% at one, three, and five years. The numbers of patients who underwent radiofrequency, surgical resection, and systemic chemotherapy were too small to analyze separately.

Investigator Nicholas N. Nissen, MD, assistant surgical director of a multi-organ transplant program at Cedars-Sinai, described the results as a surprise. He presented the study findings in a poster session at the 54th Annual Meeting of the American Association for the Study of Liver Diseases.

Nissen and his colleagues said they had been poring over the results and were convinced it was not a selection bias, as both groups of patients were fairly similar.

"This has raised a concern to us that pre-transplant treatments may not improve survival -- and more concerning, they may actually worsen survival," he said. "We feel this really requires us to re-evaluate the role of pre-transplant therapy."

Cedars-Sinai has not stopped pre-treatment therapy, according to Nissen, but is putting more effort into finding liver donors for early disease patients who face a long wait on transplant lists. In the absence of a donor, however, he said pre-transplant therapy might still be the best option for a patient whose tumor is growing to a stage where the patient could be disqualified as a transplant candidate.

"We still use pre-treatment therapy -- but more selectively," he said.

Study title: Pre-Transplant Adjuvant Therapy for Hepatocellular Carcinoma Results in a Survival Disadvantage. Abstract 1241.

Copyright © 1995-2003 Doctors Guide Publishing Limited.

This article posted November 29, 2003.