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Predictive Factors of Downstaging of Hepatocellular Carcinoma Beyond the Milan Criteria Treated with Intra-arterial Therapies

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Abstract

Purpose

This study was designed to analyze the clinical results in patients suitable for liver transplantation with hepatocellular carcinoma (HCC) who exceeded Milan criteria, which underwent intra-arterial therapies (IAT), to determine predictive factors of successful downstaging.

Methods

A total of 277 consecutive patients with cirrhosis and HCC were treated by IAT (transarterial oily chemoembolization, transarterial chemoembolization, transarterial embolization) in a single center. Eighty patients exceed the Milan criteria. Patients with infiltrative HCC, hypovascular HCC, and portal vein thrombosis were excluded, with a final study population of 48 patients. Tumor response to IAT was evaluated with CT and/or MRI according to modified RECIST criteria. Successful downstaging was defined as a reduction in the number and size of viable tumors to within the Milan criteria, and serum alpha-fetoprotein (AFP) <100 ng/mL, for at least 6 months.

Results

Nineteen patients (39 %) had their tumors successfully downstaged; 29 patients (61 %) did not. Multivariate analysis showed that AFP level <100 ng/mL and 3-year calculated survival probability using the Metroticket calculator were the only independent predictors of successful downstaging (p < 0.023 and p < 0.049 respectively).

Conclusions

Biological characteristics of HCC as AFP levels <100 ng/mL and high 3-year calculated survival probability may predict a good response to downstage after IAT.

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Conflict of interest

All authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, (ISMETT), Via Tricomi 1, 90100, Palermo, Italy

    Valentina Bova, Roberto Miraglia, Luigi Maruzzelli & Angelo Luca

  2. Department of Hepatology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, (ISMETT), Via Tricomi 1, 90100, Palermo, Italy

    Giovanni Battista Vizzini

Authors
  1. Valentina Bova
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  2. Roberto Miraglia
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  3. Luigi Maruzzelli
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  4. Giovanni Battista Vizzini
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  5. Angelo Luca
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Corresponding author

Correspondence to Roberto Miraglia.

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Bova, V., Miraglia, R., Maruzzelli, L. et al. Predictive Factors of Downstaging of Hepatocellular Carcinoma Beyond the Milan Criteria Treated with Intra-arterial Therapies. Cardiovasc Intervent Radiol 36, 433–439 (2013). https://doi.org/10.1007/s00270-012-0458-1

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