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Downstaging for hepatocellular cancer: Harm or benefit?

Bryce, K; Tsochatzis, EA; (2017) Downstaging for hepatocellular cancer: Harm or benefit? Translational Gastroenterology and Hepatology , 2 , Article 106. 10.21037/tgh.2017.11.18. Green open access

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Abstract

Downstaging of hepatocellular carcinoma (HCC) to enable liver transplantation has become an area of intense interest and research. It may allow a curative option in patients outside widely accepted transplantation criteria, with outcomes that, in some studies, are comparable to transplantation for patients within criteria. There have been conflicting opinions on the best downstaging protocols, criteria for downstaging eligibility and for assessment of response. We therefore aimed to review the literature and evidence for downstaging, as well as considering its drawbacks. Conclusion: Pooled analyses have suggested success in down staging in about half of patients treated, but with higher recurrence rates than patients initially within transplantation criteria. Studies with strict inclusion criteria and mandatory waiting time before transplantation reported survival equivalent to patients who did not require downstaging. In carefully selected patients, there is a role for down staging to provide the chance of transplantation and cure, with acceptable outcomes. Further multi center, well-designed studies are required to clarify who will mostly benefit. Until such data is available, downstaging criteria should be stated within transplantation programs and relevant decisions should be discussed by multidisciplinary teams.

Type: Article
Title: Downstaging for hepatocellular cancer: Harm or benefit?
Open access status: An open access version is available from UCL Discovery
DOI: 10.21037/tgh.2017.11.18
Publisher version: http://doi.org/10.21037/tgh.2017.11.18
Language: English
Additional information: © 2017 Translational Gastroenterology and Hepatology. All rights reserved. This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Transarterial chemoembolization (TACE); transarterial embolization (TAE); radiofrequency ablation; loco-regional treatment; selective internal radiation therapy (SIRT); Milan criteria; liver transplantation
URI: http://discovery.ucl.ac.uk/id/eprint/10041310
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