Frequency of complete pathological necrosis in HCC of explanted livers: radioembolization with resin vs drug-eluting beads with doxorubicin

Complete pathological necrosis is associated with significant lower post-transplant recurrence of HCC than incomplete response. To identify complete pathological necrosis (CPN) in explanted liver in patients with hepatocellular carcinoma who have undergone their last preoperative treatment with either Drug Eluting Beads with Doxorubicin (DEB-TACE) vs radioembolization (RE) with resin spheres prior to orthotopic liver transplantation (OLT). Methods: Retrospective chart review at a single center, from 2013-2016. 41 patients underwent locoregional therapy with either DEB-TACE alone (n = 30) or RE alone/RE after TACE (n = 11) prior to OLT. OLT was performed in 38/41 of patients on the transplant list. The explanted livers were examined histologically for size of the lesion, necrosis, macrovascular invasion and distribution of microspheres in relation to tumor cells. Frequency of CPN between both groups was evaluated using the Fischer Exact Test to assess statistical significance. Results: Both groups were similar for age at diagnosis, etiology of cirrhosis, and mean tumor size. A total of 69 lesions in 38 patients underwent individual histological analysis. In the DEB-TACE cohort (n = 56 lesions), the mean histological tumor diameter was 1.9 cm [range, 0.3–5.4 cm] with a median pathological % necrosis of 72%. In the RE cohort (n = 13 lesions), the mean tumor diameter was 1.9, [range, 0.6–4.7 cm] with a median pathological % necrosis of 100%. The frequency of CPN was higher with RE (69.2%) vs DEB-TACE (21.4%) with statistical significance (p<.005). RE or DEB-TACE result in a high rate of pathological necrosis. A higher rate CPN was seen in the RE group compared to DEB-TACE with statistical significance. Further prospective studies are needed to validate these findings.