Response to transarterial chemoembolization as a biological selection criterion for liver transplantation in hepatocellular carcinoma
Response to transarterial chemoembolization as a biological selection criterion for liver transplantation in hepatocellular carcinoma
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DOI：
10.1002/lt.20837
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发表时间：
2006-08-01
影响因子：
4.6
通讯作者：
Pitton, Michael
中科院分区：
文献类型：
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作者：
Otto, Gerd;Herber, Sascha;Pitton, Michael
选择肝细胞癌（HCC）患者进行肝移植（LT）的标准是基于肿瘤大小和结节数量，而不是肿瘤生物学。本研究旨在评估经动脉化疗栓塞（TACE）在选择适合LT的肿瘤患者中的作用。96例连续HCC患者接受了多次TACE治疗，其中62例超过米兰标准。符合米兰标准的患者立即入组，超出入组标准的患者在成功TACE后肿瘤降级时入组。50名患者最终接受了移植。在这50名患者中，34名患者超过了米兰标准。在这96例患者中，总5年生存率为51.9%。而行肝移植患者的总有效率为80.9%，而未行肝移植患者的总有效率为0%（P < 0.0001）。肿瘤复发主要受等待期间通过持续TACE控制疾病的影响。在等待期间接受无进展TACE的患者（n = 39）中，5年后无复发率为94.5%。TACE初始缓解后LT前再次进展的患者（n = 11）的肿瘤复发率显著较高（无复发率35.4%; P = 0.0017）。在多变量分析中，TACE在等待时间内的无进展过程（P = 0.006;风险比，8.95）和手术标本中评估的有限数量的肿瘤结节（P = 0.025;风险比，0.116）被证明是无复发的重要预测因素。米兰标准对复发没有影响。我们的数据表明，与肿瘤大小或数量的初始评估相比，TACE的持续反应是更好的LT选择标准。
Criteria to select patients with hepatocellular carcinoma (HCC) for liver transplantation (LT) are based on tumor size and number of nodules rather than on tumor biology. The present study was undertaken to assess the role of transarterial chemoembolization (TACE) in selecting patients with tumors suitable for LT. Ninety-six consecutive patients with HCC were treated by repeatedly performed TACE, 62 of them exceeding the Milan criteria. Patients meeting the Milan criteria were immediately listed, and patients beyond the listing criteria were listed upon downstaging of the tumor following successful TACE. Fifty patients were finally transplanted. Of these 50 patients, 34 exceeded the Milan criteria. In these 96 patients, overall 5-year survival was 51.9%. However, it was 80.9% for patients undergoing LT and 0% for patients without transplantation (P < 0.0001). Tumor recurrence was primarily influenced by the control of the disease through continued TACE during the waiting time. Freedom from recurrence after 5 years was 94.5% in patients (n = 39) with progression-free TACE during the waiting time. Tumor recurrence was significantly higher in patients (n = 11) who after initial response to TACE progressed again before LT (freedom from recurrence 35.4%; P = 0.0017). Progression-free course of TACE during the waiting time (P = 0.006; risk ratio, 8.95), and a limited number of tumor nodules as assessed in the surgical specimen (P = 0.025; risk ratio, 0.116) proved to be significant predictors for freedom from recurrence in the multivariate analysis. Milan criteria were without impact on recurrence. Our data suggest that sustained response to TACE is a better selection criterion for LT than the initial assessment of tumor size or number.