Efficacy of transarterial chemoembolization prior to liver transplantation for hepatocellular carcinoma as found in pathology

Background/Aims: To analyze the efficacy of chemoembolization prior to liver transplantation in liver explants. Methodology: We reviewed pathological findings in the explanted livers of 21 patients with histologically proven hepatocellular carcinoma and liver cirrhosis who underwent transarterial chemoembolization (TACE) prior to liver transplantation. Nine patients had solitary nodules with a median diameter of 4cm (range 1.5-7cm), 7 patients had 2 or 3 tumors with a median total diameter of 5.9cm (range 3-9cm) and 5 patients had a multifocal tumor prior to TACE. Pathological up-staging of the clinical tumor classification was documented as "tumor-progression." Concurrence of clinical and pathological findings was documented as "steady disease". "Tumor regression" described those cases in which the pathological classification downgraded the clinical findings. Results: There was no treatment-related morbidity in these patients' group. Tumor regression was proved in 11/21 patients (52.4%) whereas steady disease was observed in 7/21 patients (33.4%). In 5 patients (23.8%) no vital tumor was found by pathological examination. Tumor regression was observed only in one of the five patients having a multifocal tumor prior to TACE. Tumor progression was observed in 3/21 patients (14.3%). Conclusions: Our data show that TACE provides acceptable local tumor control as bridging treatment before liver transplantation. Although the majority of our patients (15/21, 71.4%) had 2 or more tumor lesions at the beginning of treatment, tumor progression was observed in only a minority (14.3%) of patients. However, multifocal tumors could not be successfully under-staged through this treatment and, furthermore, vital tumor was always observed in pathology; the usefulness of TACE in multifocal disease has to be re-estimated.