National Trends and Waitlist Outcomes of Locoregional Therapy Among Liver Transplant Candidates With Hepatocellular Carcinoma in the United States.
National Trends and Waitlist Outcomes of Locoregional Therapy Among Liver Transplant Candidates With Hepatocellular Carcinoma in the United States.
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DOI：
10.1016/j.cgh.2021.07.048
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发表时间：
2022-05
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--
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美国的政策变化延长了肝细胞癌 (HCC) 患者的总体等待时间。我们调查了美国肝移植（LT）候选人中局部区域治疗（LRT）使用的时间趋势以及相关的候补结果。从器官采购和移植网络数据库中提取了 2003 年至 2018 年列出的获得 HCC 例外的初级成人 LT 候选者的数据。检查外植体组织学，并使用多变量竞争风险分析来评估 LRT 类型与候补名单退出之间的关联。共有 31,609 名符合条件的患者至少有 1 项经批准的 HCC 例外情况，24,145 名 LT 候选者中有 34,610 名患者接受了治疗。记录至少 1 次 LRT 的比例从 2003 年的 42.3% 增加到 2018 年的 92.4%。化疗栓塞仍然是最常见的类型，其次是热消融，放射栓塞显着增加，从 2013 年的 3% 增加到 2018 年的 19%。在肿瘤负荷超出米兰标准、甲胎蛋白水平较高等的患者中观察到 LRT 的发生率增加。代偿性肝病。接受任何类型的轻轨都与较低的候补名单退出风险相关；轻轨数量没有显着差异。在治疗权重调整的逆概率分析中，与化疗栓塞相比，作为首次 LRT 的放射栓塞或消融与等待名单退出风险降低相关。在全国范围内患有 HCC 的 LT 候选者中，LRT，特别是放射栓塞，越来越多地被用来桥接 LT。肿瘤负荷较大的患者和代偿性肝病较严重的患者在等待 LT 期间接受了更多的治疗。过渡轻轨与较低的候补名单退出风险相关。
Policy changes in the United States have lengthened overall waiting times for patients with hepatocellular carcinoma (HCC). We investigated temporal trends in utilization of locoregional therapy (LRT) and associated waitlist outcomes among liver transplant (LT) candidates in the United States. Data for primary adult LT candidates listed from 2003 to 2018 who received HCC exception were extracted from the Organ Procurement and Transplantation Network database. Explant histology was examined, and multivariable competing risk analysis was used to evaluate the association between LRT type and waitlist dropout. There were 31,609 eligible patients with at least 1 approved HCC exception, and 34,610 treatments among 24,145 LT candidates. The proportion with at least 1 LRT recorded increased from 42.3% in 2003 to 92.4% in 2018. Chemoembolization remains the most frequent type, followed by thermal ablation, with a notable increase in radioembolization from 3% in 2013 to 19% in 2018. An increased incidence of LRT was observed among patients with tumor burden beyond Milan criteria, higher α-fetoprotein level, and more compensated liver disease. Receipt of any type of LRT was associated with a lower risk of waitlist dropout; there was no significant difference by number of LRTs. In inverse probability of treatment weighting–adjusted analysis, radioembolization or ablation as the first LRT was associated with a reduced risk of waitlist dropout compared with chemoembolization. In a large nationwide cohort of LT candidates with HCC, LRT, and in particular radioembolization, increasingly was used to bridge to LT. Patients with greater tumor burden and those with more compensated liver disease received more treatments while awaiting LT. Bridging LRT was associated with a lower risk of waitlist dropout.
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影响因子：
51.1
作者：
Clavien, Pierre-Alain;Lesurtel, Mickael;Bossuyt, Patrick M. M.;Gores, Gregory J.;Langer, Bernard;Perrier, Arnaud
通讯作者：
Perrier, Arnaud
影响因子：
29.4
作者：
Salem R;Gordon AC;Mouli S;Hickey R;Kallini J;Gabr A;Mulcahy MF;Baker T;Abecassis M;Miller FH;Yaghmai V;Sato K;Desai K;Thornburg B;Benson AB;Rademaker A;Ganger D;Kulik L;Lewandowski RJ
通讯作者：
Lewandowski RJ
影响因子：
25.7
作者：
Pompili, Maurizio;Saviano, Antonio;Giuliante, Felice
通讯作者：
Giuliante, Felice
影响因子：
13.5
作者：
Vitale, Alessandro;Volk, Michael L.;Cillo, Umberto
通讯作者：
Cillo, Umberto
影响因子：
4.6
作者：
Otto, Gerd;Herber, Sascha;Pitton, Michael
通讯作者：
Pitton, Michael