Association between bridging therapy and posttransplant outcomes in patients with HCC within Milan criteria: A systematic review and meta-analysis.
| Title: | Association between bridging therapy and posttransplant outcomes in patients with HCC within Milan criteria: A systematic review and meta-analysis. |
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| Authors: | Arvind A; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.; Seif El Dahan K; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.; Malhotra R; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.; Daher D; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.; Rich NE; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.; Patel MS; Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA.; VanWagner LB; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.; Lieber SR; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.; Cotter TG; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.; Louissaint J; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.; Mufti AR; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.; Kulik L; Department of Internal Medicine, Northwestern Medicine, Chicago, Illinois, USA.; Pillai A; Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA.; Parikh ND; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.; Singal AG; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA. |
| Source: | Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2024 Jun 01; Vol. 30 (6), pp. 595-606. Date of Electronic Publication: 2024 Mar 05. |
| Publication Type: | Systematic Review; Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: Wolters Kluwer Health, Inc Country of Publication: United States NLM ID: 100909185 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-6473 (Electronic) Linking ISSN: 15276465 NLM ISO Abbreviation: Liver Transpl Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2023- : [Philadelphia] : Wolters Kluwer Health, Inc.; Original Publication: Philadelphia, PA : W.B. Saunders Co., c2000- |
| MeSH Terms: | Liver Transplantation*/adverse effects ; Carcinoma, Hepatocellular*/mortality ; Carcinoma, Hepatocellular*/therapy ; Carcinoma, Hepatocellular*/surgery ; Carcinoma, Hepatocellular*/pathology ; Liver Neoplasms*/mortality ; Liver Neoplasms*/therapy ; Liver Neoplasms*/surgery ; Liver Neoplasms*/pathology ; Neoplasm Recurrence, Local*/epidemiology ; Neoplasm Recurrence, Local*/prevention & control; Waiting Lists/mortality ; Chemoembolization, Therapeutic/adverse effects ; Chemoembolization, Therapeutic/methods ; Chemoembolization, Therapeutic/statistics & numerical data ; Humans ; Treatment Outcome ; Disease-Free Survival |
| Abstract: | Liver transplantation is the curative therapy of choice for patients with early-stage HCC. Locoregional therapies are often employed as a bridge to reduce the risk of waitlist dropout; however, their association with posttransplant outcomes is unclear. We conducted a systematic review using Ovid MEDLINE and EMBASE to identify studies published between database inception and August 2, 2023, which reported posttransplant recurrence-free survival and overall survival among patients transplanted for HCC within Milan criteria, stratified by receipt of bridging therapy. Pooled HRs were calculated for each outcome using the DerSimonian and Laird method for a random-effects model. We identified 38 studies, including 19,671 patients who received and 20,148 patients who did not receive bridging therapy. Bridging therapy was not associated with significant differences in recurrence-free survival (pooled HR: 0.91, 95% CI: 0.77-1.08; I2 =39%) or overall survival (pooled HR: 1.09, 95% CI: 0.95-1.24; I2 =47%). Results were relatively consistent across subgroups, including geographic location and study period. Studies were discordant regarding the differential strength of association by pretreatment tumor burden and pathologic response, but potential benefits of locoregional therapy were mitigated in those who received 3 or more treatments. Adverse events were reported in a minority of studies, but when reported occurred in 6%-15% of the patients. Few studies reported loss to follow-up and most had a risk of residual confounding. Bridging therapy is not associated with improvements in posttransplant recurrence-free or overall survival among patients with HCC within Milan criteria. The risk-benefit ratio of bridging therapy likely differs based on the risk of waitlist dropout.; (Copyright © 2024 American Association for the Study of Liver Diseases.) |
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| Grant Information: | R01 MD012565 United States MD NIMHD NIH HHS; U01 CA230694 United States CA NCI NIH HHS; K23 AA031310 United States AA NIAAA NIH HHS |
| Entry Date(s): | Date Created: 20240311 Date Completed: 20240516 Latest Revision: 20260414 |
| Update Code: | 20260414 |
| DOI: | 10.1097/LVT.0000000000000357 |
| PMID: | 38466889 |
| Database: | MEDLINE |
Systematic Review; Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't