Abstract
Objective:
To establish the significance of complete pathologic response (cPR) on survival and locoregional treatment outcomes in a large US cohort.
Background:
cPR in hepatocellular carcinoma (HCC) is associated with improved post–liver transplant (LT) outcomes. cPR rates, modality-specific differences, and predictors remain undefined.
Materials and Methods:
Patients were identified from the United Network for Organ Sharing (UNOS) database (2012–2024). cPR was defined as the absence of a viable tumor on explant pathology. Logistic regression identified predictors of cPR, Fine-Gray models estimated the incidence of cPRand Kaplan-Meier analysis assessed survival.
Results:
Among 7398 LT recipients, 2167 (29.3%) achieved cPR. Imaging–pathology concordance was poor (30.5%), with imaging overestimating response in 42.6% of cases (κ=0.17,
P
18 vs. P
P
Conclusions:
Nearly one-third of LT recipients with HCC achieved cPR, which was associated with improved survival. Y-90 was independently associated with higher cPR rates, particularly when administered early and among patients with higher tumor burden.