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Prajapati et al. TACE in recurrent HCC after OLT

responded completely, then they were followed-up diagnosed on MRI. Clinically, ascites was present in 1
every 3-6 months with MRI. patient. The mean size of the index tumor was 3.3 cm
(SD 0.85 cm). Portal vein thrombosis or invasion was
Statistical analysis not present in any of the patients and extra-hepatic
Survivals were also stratified on the basis of age, metastases were present in 25% of the patients (n
gender, etiology, tumor burden, Okuda staging, ECOG = 2) at the time of initial presentation. The 1 patient
PS, Child-Pugh class and Cancer of the Italian Liver has T11 vertebral body metastasis and showed mildly
Program staging. A P-value of 0.05 was held as increased activity on computed tomography (CT)
significant. Survival was calculated from the time of positron emission tomography examination. The other
first transcatheter therapy. The Kaplan-Meier method patient had a single 9 mm lung metastasis on CT chest
with the long rank test was used to estimate survival and it was surgically resected. These both patients had
and difference. A patient was censored if he/she was alpha-fetoprotein (AFP) of greater than 2,400 ng/dL.
alive at the end of the study period. SPSS software, During DEB TACE therapies, 25% (n = 2) of patients
version 21.0 (IBM, Somers, NY) was used to perform received concurrent sorafenib systemic chemotherapy.
the statistical analyses. The 6 patients (75%) had solitary HCC and unilobar
involvement after OLT. The 30-day mortality was zero.
RESULTS
Survival analysis
Patient population The overall median and mean survivals from the
Eight patients had recurrence of HCC after OLT and time of 1st DEB TACE were 15.6 and 19.6 months
received 18 DEB TACE treatments (range 1 to 4) after accordingly. The mean recurrence free survival from
recurrence. The demographics, clinical, pathology the time of OLT was 50.5 months. The mean survival
and imaging characteristics of the patients are shown from the time of the OLT was 72.1 months. One
in Table 1. The mean age of the patients was 53.4 year and 2-year survivals from the time of 1st DEB
years (SD 4.6 years). The 5 patients had Child Pugh TACE were 62.5% (5/8) and 50% (4/8) respectively.
class A disease and 3 patients had Child Pugh class B The univariate survival analyses were performed for
disease at the time of presentation of recurrent HCC. different categories as shown in Table 2. Two patients
Cirrhosis was present in all patients, diagnosed by had significantly poor overall survivals from DEB TACE
imaging. The 7 patients had hepatitis C and 1 patient (3.27 and 3.4 months) as compared to other patients
had hepatitis B. The portal venous hypertension and both showed elevated serum AFP levels (> 2,400
(PHT) was present in 50% of patients. The PHT was ng/mL) and extra-hepatic metastases [Table 2]. The

Table 1: Demographics, clinical, imaging, staging and survival characteristics of recurrent HCC patients after OLT
treated with DEB TACE
Variables P 1 P 2 P 3 P 4 P 5 P 6 P 7 P 8
Age (years) 51.7 44.5 54.0 59.5 55.0 51.4 52.7 58.3
Living status Alive Dead Dead Dead Dead Dead Dead Dead
Gender Male Male Male Male Male Male Female Female
Race White Other White White White Black White Other
Etiology Hepatitis C Hepatitis B Hepatitis C Hepatitis C Hepatitis C Hepatitis C Hepatitis C Hepatitis C
Index tumor size (cm) 2.2 2.2 2.8 3.1 3.3 3.9 4.1 4.7
Number of the tumor 1 12 1 9 1 1 1 1
Histology grading of the Well or Poorly Poorly Well or Well or Well or Well or Well or
explant liver HCC moderately differentiated differentiated moderately moderately moderately moderately moderately
differentiated differentiated differentiated differentiated differentiated differentiated
Metastases at time No Yes No No No Yes No No
of recurrent HCC
presentation before DEB
TACE
Alfa-fetoprotein (ng/dL) of 5 >2,400 <5 10.6 11.8 >2,400 40.9 9.8
recurrent HCC
Child-Pugh class of A B A A B A A B
recurrent HCC
Tumor free survivals from 32.9 25 13.7 83.1 117 40.3 28.4 63.6
OLT (months)
Concurrent sorafenib No Yes No No No Yes No No
treatment
P: patient number; DEB TACE: doxorubicin drug eluting beads transcatheter arterial chemoembolization; OLT: orthotopic liver
transplantation; HCC: hepatocellular carcinoma
184 Hepatoma Research ¦ Volume 3 ¦ August 17, 2017