Graziadei Ivo W, Sandmueller Heiko, Waldenberger Peter, Koenigsrainer Alfred, Nachbaur Karin, Jaschke Werner, Margreiter Raimund, Vogel Wolfgang
Department of Gastroenterology and Hepatology, University Hospitals Innsbruck, Austria.
Liver Transpl. 2003 Jun;9(6):557-63. doi: 10.1053/jlts.2003.50106.
Orthotopic liver transplantation (OLT) has been considered the best treatment option for patients with hepatocellular carcinoma (HCC). Because of a steadily increasing waiting time, a noteworthy proportion of patients are excluded from OLT because of tumor progression. A 20% and more dropout rate from the waiting list has recently been reported. In this prospective study, we evaluated the effect of preoperative transarterial chemoembolization (TACE) on preventing tumor progression while on the waiting list in patients meeting current selection criteria (solitary lesion < or = 5 cm, three lesions < or = 3 cm). In addition, we analyzed the outcome of a separate group of patients with advanced-stage HCC outside the selection criteria but with at least 50% tumor reduction after TACE (downstaging) to expand current criteria. Forty-eight patients met the selection criteria and were eligible for this study. Seven patients are still on the waiting list; 41 underwent OLT. None of these patients had to be removed from the list because of tumor progression after a mean waiting time of 178 days (23 patients > or =180 days). The 1-, 2-, and 5-year intention-to-treat survival was 98%, 98%, and 94%. The outcome after OLT was also excellent with 1-, 2-, and 5-year survival rates of 98%, 98%, and 93%. Tumor recurrence occurred only in 1 patient (2.4%). Fifteen patients with advanced-stage HCC were included in this study. Three developed a tumor progression and had to be removed from the list (20% dropout rate). Despite tumor reduction before OLT, these patients had a significantly less favorable outcome in the intention-to-treat analysis as well as in the posttransplantation survival. Tumor recurrence was seen in 30% of patients after OLT. In conclusion, TACE followed by OLT is associated with an excellent outcome in selected patients. Furthermore, TACE is highly efficacious in preventing tumor progression while waiting for OLT. Although TACE reduced tumor preoperatively, it failed to show a beneficial effect on patient survival in advanced-stage HCCs.
原位肝移植（OLT）一直被认为是肝细胞癌（HCC）患者的最佳治疗选择。由于等待时间持续增加，相当一部分患者因肿瘤进展而被排除在OLT之外。最近有报道称，等待名单上的退出率达到20%甚至更高。在这项前瞻性研究中，我们评估了术前经动脉化疗栓塞术（TACE）对符合当前选择标准（单个病灶≤5 cm，三个病灶≤3 cm）的患者在等待名单期间预防肿瘤进展的效果。此外，我们分析了另一组不符合选择标准但TACE后肿瘤缩小至少50%（降期）的晚期HCC患者的结局，以扩大当前标准。48例患者符合选择标准并 eligible for this study（原文此处表述有误，推测可能是“符合本研究条件”）。7例患者仍在等待名单上；41例接受了OLT。这些患者在平均等待178天（23例≥180天）后，没有一例因肿瘤进展而被从名单上移除。意向性治疗分析的1年、2年和5年生存率分别为98%、98%和94%。OLT后的结局也非常好，1年、2年和5年生存率分别为98%、98%和93%。仅1例患者（2.4%）发生肿瘤复发。15例晚期HCC患者纳入本研究。3例出现肿瘤进展，不得不从名单上移除（退出率20%）。尽管OLT前肿瘤缩小，但这些患者在意向性治疗分析以及移植后生存方面的结局明显较差。OLT后30%的患者出现肿瘤复发。总之，TACE联合OLT在选定患者中具有良好的结局。此外，TACE在等待OLT期间预防肿瘤进展方面非常有效。尽管TACE在术前缩小了肿瘤，但在晚期HCC患者中未能显示出对患者生存的有益影响。
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