Occult Hepatocellular Carcinoma Associated With Transjugular Intrahepatic Portosystemic Shunts in Liver Transplant Recipients.
Occult Hepatocellular Carcinoma Associated With Transjugular Intrahepatic Portosystemic Shunts in Liver Transplant Recipients.
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DOI：
10.1002/lt.26073
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Abt P
中科院分区：
文献类型：
--
作者：
Krumeich LN;Mancinelli J;Cucchiara A;Eddinger K;Aufhauser D Jr;Goldberg DW;Siegelman ES;Rosen M;Reddy KR;Hoteit M;Furth EE;Olthoff KM;Shaked A;Levine M;Abt P
肝细胞癌(肝细胞癌)的移植资格取决于米兰标准中肿瘤负担的影像识别。经颈静脉肝内门体分流术(TIPS)可降低门脉高压，但可能影响肝细胞癌的可视化。据推测，移植前提示的存在与隐匿性肝细胞癌和存活率降低相关。对2000-2017年间肝移植受者肝细胞癌患者进行单中心病例对照研究。主要终点是外植体病理上的隐匿性疾病。采用Logistic回归(LR)对候选变量的后向逐步剔除进行建模。次要终点包括无病生存期(DFS)和总生存期(OS)，采用Kaplan-Meier曲线和Cox回归分析。40例患者中有40例有隐匿性疾病(80.0%vs.43.1%，P<；0.001，优势比[OR]4.16，P<；0.001)。TIPS亚组之间的外植体肿瘤负担相同；因此，TIPS状态与DFS或OS降低无关。然而，超过米兰标准与DFS降低相关(风险比3.21，p=0.001)，而有单一可疑病变的患者的TIPS状态(N=316)与超出米兰标准的外植体肿瘤负担独立相关(OR13.47；p=0.001)。TIPS组之间等量的外植体肿瘤负荷表明，TIPS患者中的隐匿性疾病是由于影像诊断能力降低所致。门静脉血栓形成与隐匿性疾病有类似的相关性，提示了一种通过改变肝脏灌注量而产生的机制。移植前的影像提示与植体病理上的隐匿性肝细胞癌有关。TIPS并不独立地与DFS或OS减少相关，但与单一可疑病变患者超过米兰标准有关。TIPS的存在可能会改变成像的敏感性，并需要更高的怀疑指数。
Transplant eligibility for hepatocellular carcinoma (HCC) is determined by the imaging identification of tumor burden within Milan criteria. Transjugular intrahepatic portosystemic shunts (TIPS) reduce portal hypertension but may impact HCC visualization. It was hypothesized that the presence of pre-transplant TIPS would correlate with occult HCC and reduced survival. A single-center retrospective case control study was performed among liver transplant recipients with HCC (2000–2017). The primary endpoint was occult disease on explant pathology. Backward stepwise elimination of candidate variables was modeled with logistic regression (LR). Secondary endpoints included disease-free survival (DFS) and overall survival (OS), evaluated with Kaplan-Meier curves and Cox regression analysis. 40 of 640 patients had TIPS and more frequently exhibited occult disease (80.0% vs. 43.1%, p<0.001, odds ratio [OR] 4.16, p<0.001). Explant tumor burden was equivalent between TIPS subgroups; accordingly, TIPS status was not independently associated with reduced DFS or OS. However, exceeding Milan criteria was associated with reduced DFS (hazard ratio 3.21, p=0.001), and TIPS status in patients with a single suspected lesion (N=316) independently correlated with explant tumor burdens beyond Milan criteria (OR 13.47; p=0.001). Equivalent explant tumor burdens between TIPS groups suggests that occult disease in TIPS patients was due to reduced diagnostic capacity by imaging. Portal venous thrombosis similarly correlated with occult disease, suggesting a mechanism through altered hepatic perfusion. TIPS on pre-transplant imaging are associated with occult HCC on explant pathology. TIPS are not independently associated with reduced DFS or OS, but are associated with exceeding Milan criteria for patients with a single suspected lesion. The presence of TIPS may alter the sensitivity of imaging and necessitate a higher index of suspicion.
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影响因子：
9
作者：
Aufhauser DD Jr;Sadot E;Murken DR;Eddinger K;Hoteit M;Abt PL;Goldberg DS;DeMatteo RP;Levine MH
通讯作者：
Levine MH
DOI：
10.1102/1470-7330.2012.0044
发表时间：
2013-02-08
期刊：
Cancer imaging : the official publication of the International Cancer Imaging Society
影响因子：
--
作者：
Hennedige T;Venkatesh SK
通讯作者：
Venkatesh SK
影响因子：
1.6
作者：
Kitzing, Yu Xuan;Ng, Bernard H. K.;McCormack, Samuel
通讯作者：
McCormack, Samuel
影响因子：
2.9
作者：
Radeleff, Boris;Sommer, Christof-Matthias;Richter, Goetz Martin
通讯作者：
Richter, Goetz Martin
影响因子：
3.1
作者：
Umar, Nadia K.;Badshah, Maaz B.;Kwo, Paul Y.
通讯作者：
Kwo, Paul Y.