Outcomes of Neoadjuvant Transarterial Chemoembolization to Downstage Hepatocellular Carcinoma Before Liver Transplantation
Outcomes of Neoadjuvant Transarterial Chemoembolization to Downstage Hepatocellular Carcinoma Before Liver Transplantation
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DOI：
10.1097/sla.0b013e31818a07d4
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发表时间：
2008-10-01
影响因子：
9
通讯作者：
Brown, Daniel B.
中科院分区：
文献类型：
--
作者：
Chapman, William C.;Doyle, M. B. Majella;Brown, Daniel B.
目的：评估使用经动脉化疗栓塞（TACE）对晚期（美国肝脏肿瘤研究组Ⅲ/Ⅳ期）肝细胞癌（HCC）患者进行降期以使其符合原位肝移植（OLT）条件的结果。
方法：从1999年到2006年，202例HCC患者被转诊进行移植评估。如果通过TACE实现降期，76例（37.6%）Ⅲ/Ⅳ期HCC患者是潜在的移植候选者。根据随访影像学结果考虑OLT。追踪在米兰标准内成功降期的患者数量、使用实体瘤疗效评价标准评估的肿瘤反应、移植时的发现以及移植后的结果。
结果：76例患者中有18例（23.7%）充分降期，符合米兰标准有资格进行OLT。根据实体瘤疗效评价标准，76例中有27例（35.5%）部分缓解，22例（29%）病情稳定，27例（35.5%）病情进展。76例中符合其他条件的17例（22.4%）患者在成功降期后接受了OLT（13例为Ⅲ期；4例为Ⅳ期）。移植标本检查显示28个可识别的肿瘤，其中21个（75%）在TACE后的坏死率大于90%。在中位时间19.6个月（范围3.6 - 104.7个月）时，17例接受OLT的患者中有16例（94.1%）存活。1例患者在OLT后11个月因合并内科疾病死亡，17例OLT患者中有1例（6%）出现HCC复发。该患者接受了肺转移灶切除，从OLT至今已存活63.6个月。
结论：部分Ⅲ/Ⅳ期HCC患者可通过TACE降期至米兰标准。重要的是，成功降期并接受移植的患者具有良好的中期无病生存率和总体生存率，与Ⅱ期HCC相似。
Purpose: To evaluate outcomes of downstaging patients with advanced (American liver tumor study group stage III/IV) hepatocellular carcinoma (HCC) with transarterial chemoembolization (TACE) to allow eligibility for orthotopic liver transplant (OLT).Methods: From 1999 to 2006, 202 patients with HCC were referred for transplant evaluation. Seventy-six (37.6%) patients with stage III/IV HCC were potential transplant candidates if downstaging was achieved by TACE. OLT was considered based on follow-up imaging findings. The number of patients who were successfully downstaged within the Milan criteria, tumor response using Response Evaluation Criteria in Solid Tumors criteria, findings at explant, and outcomes after transplant were tracked.Results: Eighteen of 76 (23.7%) patients had adequate downstaging to qualify for OLT under the Milan criteria. By Response Evaluation Criteria in Solid Tumors, 27/76 (35.5%) patients had a partial response, 22/76 (29%) had stable disease, and 27/76 (35.5%) had progressive disease. Seventeen of 76 (22.4%) patients who met other qualifications underwent OLT after successful downstaging (13/38 stage III;4/38 stage IV). Explant review demonstrated 28 identifiable tumors in which post-TACE necrosis was greater than 90% in 21 (75%). At a median of 19.6 months (range 3.6-104.7), 16/17 (94.1%) patients who underwent OLT are alive. One patient expired I I months after OLT secondary to medical comorbidities, One of 17 (6%) OLT patients had recurrent HCC. This patient underwent resection of a pulmonary metastasis and is alive, 63.6 months from OLT.Conclusion: Selected patients with stage III/IV HCC can be downstaged to Milan criteria with TACE. Importantly, patients who are successfully downstaged and transplanted have excellent midterm disease-free and overall survival, similar to stage II HCC.