Pathologic Complete Response as a Prognostic Indicator in Bridging Therapy: A 25-Year Retrospective Study on Hepatocellular Carcinoma and Liver Transplantation Outcomes.

Aim: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, and liver transplantation (LT) remains the most effective curative option for eligible patients. Bridging therapies are often employed during the waiting period to control tumor progression and improve transplant eligibility. However, their prognostic impact remains controversial. We aimed to evaluate the effect of bridging therapy and pathological complete response (CR) on post-transplant outcomes in patients who underwent LT for HCC.

Patients and methods: In this retrospective study, 120 patients with HCC who underwent LT between 1998 and 2023 were analyzed. Bridging therapies included transarterial chemoembolization (TACE), transarterial radioembolization (TARE), radiofrequency ablation (RFA), and microwave ablation (MWA). Overall survival (OS), disease-free survival (DFS), and recurrence were compared between patients with and without bridging therapy. The prognostic significance of pathological CR was also assessed.

Results: Bridging therapy was administered to 24.2% of patients. There was no statistically significant difference in OS or DFS between patients who received bridging therapy and those who did not. However, a pathological CR was achieved in 27.6% of bridged patients and was significantly associated with improved OS (P = .018) and DFS (P = .05). No recurrence or mortality occurred in patients who achieved CR.

Conclusion: While bridging therapy did not independently affect post-transplant survival, achieving a pathological complete response emerged as a strong prognostic indicator. These findings highlight the clinical importance of treatment response and support the role of CR as a potential predictor of favorable long-term outcomes following LT in HCC patients.