1. Multidisciplinary team approach to hepatocellular carcinoma management in a liver transplant center from Romania
Cerban R.1, Iacob S.1, Croitoru A.1, Popescu I.3, Dumitru R.2, Grasu M.2, Ester C.1. Pietrareanu C.1, Ghioca M.1, Gheorghe C.1 and Gheorghe L.1
¹ Center for Digestive Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest Romania
2 Radiology Department, Fundeni Clinical Institute, Bucharest Romania
3 Dan Setlacec Centre of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
Poster 10
INTRODUCTION / BACKGROUND & AIMS
RESULTS
Optimal care of the patient with hepatocellular carcinoma (HCC) requires the involvement of multiple specialists. The aim of our study is to evaluate the outcome following the decision taken in a Multidisciplinary Liver Tumor Board for the treatment of HCC.
PACIENTS AND METHODS
In this prospective study from January 2015 to October 2017 we included 255 treatment naive patients, diagnosed with HCC. All patients were discussed in the Tumor Board by a multidisciplinary team.
RESULTS
Kaplan-Meier Survival Analysis of 255 patients
All patients (M=160, F=95) with an average age of 62 years (±8.1) that were included had cirrhosis (HCV-related in 55.9%).
Short-term mortality rate (3 months) was 17.6% (45 patients), 77.8% of those patients being in the BSC group and the rest (10 patients) died on the transplant list due to complications of cirrhosis.
Characteristics
Values (n=255)
Age, median years (range)
62 ± 8,1
Gender, n (male)
160 (62,7%)
Etiology
HCV
142 (55,9%)
HBV
67 (26,2%)
Alcohol
41 (16.1%)
Others
5 (1,96%)
Child-Pugh class A
128 (50,2,2%) B
75 (29,4%) C
52v(20,4)
Platelet, x10³/L
79,6 ± 57,3
Creatinine, mg/dL
1,4 ± 1,1
Albumin, g/L
2,9 ± 0,8
Bilirubin, mg/dL
3,1 ± 1,9
ALT, UI/L
64 ± 59,3
INR
1,7 ± 0,8
MELD score
14,5 (7-28)
Characteristics
Values (n=255)
Tumor number 1
102 (40%) 2
49 (18,4%) 3
37 (14,5%)
>3
67 (26,2%)
Tumor size, mm
49,6 ± 19,3
Tumor size (>5cm)
74 (29%)
Portal vein thrombosis
57 (10,1%)
AFP, ng/ml
239,8 (3,2-7280)
Liver transplant after TACE procedure
20 (22,2%)
Succes rate
Resection
9 (81,8%)
Ablation
19 (79,3%)
TACE
57 (63,9%)
Follow up duration, months
18 (3-37)
Recurrence
37(58,3%)
Short term, mortality (3 months), n
Dead
45 (17,6%)
Alive
210 (82,5%)
Survival outcome end of follow up, n
88 (34,5%)
146 (57,2%)
Unknown
21 (8,23%)
Thirty four patients had complete tumor response (CR) after one TACE
p<0,001
There was a significant transient decrease in the mean platelet level after TACE (p=0.006).
255 treatment naive patients
Resection
11 patients
RFA
24 patients
Sorafenib
45 patients
TACE
90 patients LT
48 patients
Intraop. RFA
14 patients
Percut. RFA
10 patients
BSC
50 patients
Lipiodol
62 patients
DEBDOX
28 patients
CONCLUSIONS
Therapeutic interventions should be decided on a case by case analysis. Surgery has comparable outcome to RFA but is more invasive. TACE was the most frequent procedure performed on HCC patients in our center, and is was shown to be a safe and effective therapy.