Does pathological response after transarterial chemoembolization for hepatocellular carcinoma in cirrhotic patients with cirrhosis predict outcome after liver resection or transplantation?
Does pathological response after transarterial chemoembolization for hepatocellular carcinoma in cirrhotic patients with cirrhosis predict outcome after liver resection or transplantation?
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DOI：
10.1016/j.jhep.2015.01.023
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发表时间：
2015-07-01
影响因子：
25.7
通讯作者：
Adam, Rene
中科院分区：
文献类型：
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作者：
Allard, Marc-Antoine;Sebagh, Mylene;Adam, Rene
背景和目标：探讨肝细胞癌（HCC）患者行肝动脉化疗栓塞（TACE）后病理学缓解（PR）的预后意义，并确定完全病理学缓解（CPR）的预测因素。方法：1990年至2010年，373例HCC患者接受TACE治疗，随后进行肝切除术或肝移植术。（LR：184例患者）或肝移植（LT：189例患者）。PR评价为每个肿瘤内非存活肿瘤面积的平均百分比。CPR被定义为没有任何可行的肿瘤面积在所有本nodules.Results：共59（32%）和37（20%）患者有CPR后LR和LT，分别。LR后，CPR患者的5年总生存率（OS）高于未CPR患者（58% vs. 34%; p = 0.0006），LT后更高（84% vs. 65%; p = 0.09）。两组的5年无复发生存率（RFS）显著更高（LR后24% vs. 13%; p = 0.008; LT后94% vs. 73%，p = 0.007）。在LR或LT后，>90%坏死的临界值成为患者生存的影响因素。在根据手术类型（LR或LT）分层的多变量分析中，PR >90%仍然是OS和RFS较好的独立因素。与CPR相关的独立因素有：肿瘤最大尺寸
Background & Aims: To investigate the prognostic significance of pathologic response (PR) after transarterial chemoembolization (TACE) in cirrhotic patients resected or transplanted for hepatocellular carcinoma (HCC), and to identify predictors of complete pathologic response (CPR).Methods: Between 1990 and 2010, 373 consecutive cirrhotic patients with HCC were treated by TACE followed by either liver resection (LR:184 patients) or liver transplantation (LT:189 patients). The PR was evaluated as the mean percentage of non-viable tumor area within each tumor. CPR was defined as the absence of any viable tumor area in all the present nodules.Results: A total of 59 (32%) and 37 (20%) patients had CPR after LR and LT, respectively. Five-year overall survival (OS) was higher in patients with CPR compared to those without, after LR (58% vs. 34%; p = 0.0006) and tends to be higher after LT (84% vs. 65%; p = 0.09). The 5-year recurrence-free survival (RFS) rates were significantly higher in both groups (24% vs. 13% after LR; p = 0.008 and 94% vs. 73% after LT, p = 0.007). A cut-off value of >90% necrosis emerged as an impacting factor on patient survival after LR or LT. On multivariate analysis stratified on the type of procedure (LR or LT), PR >90% remained an independent factor of better OS and RFS. Independent factors associated with CPR were: a maximal tumor size