Locoregional therapy as a bridge to liver transplantation for hepatocellular carcinoma within Milan criteria: from a transplant oncology viewpoint

The role of bridging locoregional therapy (LRT) for patients with hepatocellular carcinoma (HCC) within Milan criteria before liver transplantation (LT) has been controversial. Recently, Agopian et al. (1) retrospectively investigated the impact of bridging LRT on post-LT HCC recurrence and survival based on 3,601 patients undergoing LT from 2002 to 2013, collected in the US Multicenter HCC Transplant Consortium. They observed no significant differences in the recurrence-free survival (RFS) among patients not receiving RT and the type and combination of treatment modality [transarterial chemoembolization (TACE), thermal ablation (radiofrequency or microwave ablation), and others] used. The increasing number of LRT and the dynamic serum alpha-fetoprotein (AFP) changes were correlated with a higher risk of HCC recurrence. The authors concluded that LRT improved survival only in the subset of patients who achieved complete pathologic response (cPR) with a superior 5-year RFS of 72% compared to both untreated patients (69%; P=0.01) and LRT-treated patients not achieving cPR (67%; P=0.01). Admittedly, this is a benchmark study, and the authors should be congratulated on undertaking a sophisticated analysis in a large, heterogeneous cohort of patients