Background:Discordance in hepatocellular carcinoma(HCC)staging between pre-transplant imaging and explant pathology is associated with an increased risk of recurrence and death.Our aim was to evaluate variables that p...Background:Discordance in hepatocellular carcinoma(HCC)staging between pre-transplant imaging and explant pathology is associated with an increased risk of recurrence and death.Our aim was to evaluate variables that predicted concordance/discordance in the era of new generation locoregional therapies(LRT)and improved radiologic technology in diagnosis.Methods:A single-center retrospective study was performed on patients who received a liver transplant for HCC between 2008-2019.Pre-and post-LT variables,including type of LRT,downstaging(DS),transplant time period,and radiologic response to LRT,were analyzed for concordance/discordance.Kaplan-Meier analysis was used to assess post-LT survival.Results:Of 146 patients transplanted within Milan Criteria(MC),discordance rates(understaged)were 45%.Discordance was associated with≥3 HCC lesions at diagnosis but not newer generation LRT(transarterial radioembolization/stereotactic body radiation therapy),traditional LRT or combination.No differences in discordance were seen between transplant periods(2008-2013 vs.2014-2019),but those within MC in the earlier period had higher concordance rates.A trend was observed between DS and discordance.Conclusion:HCC stage discordance remains common and poorly predictable.Discordance was associated with three or more HCC lesions at the time of diagnosis.Patients within MC transplanted between 2008-2013 was associated with concordance,while a trend was noted between DS and discordance.No other pre-or post-LT variables predicted discordance/concordance.Discordance was associated with decreased survival.展开更多
文摘Background:Discordance in hepatocellular carcinoma(HCC)staging between pre-transplant imaging and explant pathology is associated with an increased risk of recurrence and death.Our aim was to evaluate variables that predicted concordance/discordance in the era of new generation locoregional therapies(LRT)and improved radiologic technology in diagnosis.Methods:A single-center retrospective study was performed on patients who received a liver transplant for HCC between 2008-2019.Pre-and post-LT variables,including type of LRT,downstaging(DS),transplant time period,and radiologic response to LRT,were analyzed for concordance/discordance.Kaplan-Meier analysis was used to assess post-LT survival.Results:Of 146 patients transplanted within Milan Criteria(MC),discordance rates(understaged)were 45%.Discordance was associated with≥3 HCC lesions at diagnosis but not newer generation LRT(transarterial radioembolization/stereotactic body radiation therapy),traditional LRT or combination.No differences in discordance were seen between transplant periods(2008-2013 vs.2014-2019),but those within MC in the earlier period had higher concordance rates.A trend was observed between DS and discordance.Conclusion:HCC stage discordance remains common and poorly predictable.Discordance was associated with three or more HCC lesions at the time of diagnosis.Patients within MC transplanted between 2008-2013 was associated with concordance,while a trend was noted between DS and discordance.No other pre-or post-LT variables predicted discordance/concordance.Discordance was associated with decreased survival.
