Downstaging hepatocellular carcinoma: A systematic review and pooled analysis

Area of Science:

• Hepatobiliary Surgery
• Transplantation Immunology
• Oncology

Background:

• Liver transplantation (LT) is a curative option for hepatocellular carcinoma (HCC).
• Patients exceeding Milan criteria often require downstaging to become LT candidates.
• Optimal downstaging protocols and outcomes for HCC are not well-defined.

Purpose of the Study:

• To determine the success rates of downstaging HCC to within Milan criteria.
• To evaluate post-LT recurrence and survival rates in HCC patients who underwent downstaging.
• To analyze outcomes based on treatment modality and study design.

Main Methods:

• Systematic literature review of MEDLINE and Embase databases (1996-2015).
• Search of national meeting abstracts (2010-2014).
• Calculation of pooled rates for downstaging success and post-LT recurrence.

Main Results:

• Pooled downstaging success rate was 48% (95% CI, 39-58%).
• No significant difference in success rates between transarterial chemoembolization (TACE) and transarterial radioembolization (TARE).
• Higher success rates observed in prospective versus retrospective studies (68% vs. 44%).
• Pooled post-LT HCC recurrence rate was 16% (95% CI, 11-23%).
• No significant difference in recurrence rates between TACE and TARE.

Conclusions:

• Downstaging HCC to within Milan criteria is successful in over 40% of patients.
• Post-transplant HCC recurrence rates are substantial at 16%.
• Systematic study and optimization of downstaging protocols are crucial to reduce recurrence risk.