Actual therapeutic efficacy of pre-transplant treatment on hepatocellular carcinoma and its impact on survival after salvage living donor liver transplantation
Actual therapeutic efficacy of pre-transplant treatment on hepatocellular carcinoma and its impact on survival after salvage living donor liver transplantation
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DOI：
10.1007/s00535-009-0043-9
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发表时间：
2009-06-01
影响因子：
6.3
通讯作者：
Kanematsu, Takashi
中科院分区：
文献类型：
--
作者：
Eguchi, Susumu;Hidaka, Masaaki;Kanematsu, Takashi
肝移植前（LT）治疗肝细胞癌（HCC）的确切疗效和对LT后生存率的影响仍然存在争议，就挽救LT。在1997年8月至2007年12月间在长崎大学医院移植的79例患者中，29例（36.7%）根据米兰标准使用计算机断层扫描和磁共振成像显示为HCC。18例（62.1%）24个病灶接受了除肝切除外的LT前治疗。术前行肝动脉化疗栓塞（TACE）治疗10例，经皮无水乙醇注射（PEI）+ TACE治疗1例，PEI治疗6例，消融治疗7例。根据术前影像学检查，19个病变（79.1%）在LT治疗前被认为是坏死的。但组织学检查仍有9个病灶（9/19 47%）存在活的HCC。首次预治疗和LT之间的中位间隔为22个月，而末次预LT治疗和LT为11个月。所有残留病灶的病例均未发现肉瘤性肝癌或压迫性门静脉癌栓。1例LT后发生腹膜复发，其中在LDLT前进行了PEI和RFA。LDLT后的无病生存率与未行LT前治疗的病例相当。一半的术前“被认为是”的坏死病灶在LT前治疗后仍含有活的HCC细胞。总体而言，尽管经皮治疗可能在免疫抑制下扩散播散性肿瘤细胞生长，但LT前治疗史并不妨碍或干扰后续LT。
The exact efficacy of pre-liver transplant (LT) therapy for hepatocellular carcinoma (HCC) and the impact on survival after LT remain controversial in regard to salvage LT.Of 79 patients transplanted in Nagasaki University Hospital between August 1997 and December 2007, 29 patients (36.7%) were indicated for HCC based on the Milan criteria using computed tomography and magnetic resonance imaging. Pre-LT therapy other than liver resection had been performed in 18 cases (62.1%) for 24 lesions. Treated lesions were analyzed histologically using thin slices of the whole explanted liver.Pre-LT therapy included transarterial chemoembolization (TACE) for 10 lesions, percutaneous ethanol injection (PEI) + TACE for 1 lesion, PEI in 6 lesions and ablation therapy in 7 lesions. Under preoperative imaging study, 19 lesions (79.1%) were "thought-to-be" necrotic by pre-LT therapy. However, histologically, viable HCCs were still observed in 9 lesions (9/19 47%). A median interval between the first pre-therapy and LT was 22 months, while last pre-LT therapy and LT was 11 months. No sarcomatous HCC or forced portal venous tumor thrombus was found in all cases with residual lesions. One peritoneal recurrence has occurred after LT, in whom PEI and RFA had been performed before LDLT. The disease free survival after LDLT was comparable to that of cases without pre-LT therapy.Half of the preoperatively "thought-to-be" necrotic lesions still contained viable HCC cells after the pre-LT treatment. Overall, the history of pre-LT therapy does not preclude or interfere with subsequent LT, although percutaneous treatment may spread disseminated tumor cell growth under immunosuppression.