接受肝移植的肝细胞癌患者的术前化疗栓塞：急诊手术与择期手术对患者生存率和肿瘤复发率的影响。

Preoperative chemoembolization in patients with hepatocellular carcinoma undergoing liver transplantation: influence of emergent versus elective procedures on patient survival and tumor recurrence rate.

作者信息

Stockland A H, Walser E M, Paz-Fumagalli R, McKinney J M, May G R

机构信息

Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA.

出版信息

Cardiovasc Intervent Radiol. 2007 Sep-Oct;30(5):888-93. doi: 10.1007/s00270-007-9111-9.

DOI:10.1007/s00270-007-9111-9

PMID:17619218

Abstract

Our purpose was to compare the recurrence rate and survival in patients with hepatocellular carcinoma (HCC) who had elective transarterial chemoembolization (TACE), immediate preoperative TACE, or no treatment prior to orthotopic liver transplantation (OLT). A total of 132 patients with HCC had TACE prior to OLT. Eighteen patients had no TACE before OLT and functioned as a control group. The urgent group included 35 patients embolized less than 24 h before OLT and the elective group included 97 patients embolized greater than 1 day before transplantation. These groups were compared with regard to tumor staging, hepatic synthetic function, and post-TACE tumor necrosis and survival and recurrence rates. Patients were followed for a mean of 780 days post OLT (1-2912 days). The tumor staging was similar between groups but the Childs-Pugh score in the urgent and untreated group was significantly higher than that of the other groups. The degree of necrosis at explant was also significantly different between the two treated groups, with an average 35% necrosis in the patients embolized less than 24 h before OLT vs 77% in the elective group (p < 0.002). Recurrence rate in the urgent group was 8 of 35 (23%) in a median of 580 days, 20 of 97 (21%) in a median of 539 days in the elective group, and 2 of 18 (11%) in a median of 331 days in the no-TACE group. Survival at 1, 3, and 5 years was 91%, 80%, and 72% in the elective group, 79%, 58%, and 39% in the urgent group, and 69%, 61%, and 41% in the no-TACE group, respectively. The urgent and no-TACE groups had significantly worse survival compared with the other groups; however, the tumor recurrence rates were statistically the same among all three groups. TACE within 24 h of OLT causes an average of 35% necrosis and elective TACE increases necrosis further to 77%. Despite this difference, the tumor recurrence rate in the three groups is equivalent and no different from that in the group that received no treatment before OLT. The decreased survival in the immediate and no-TACE groups was due to non-cancer-related deaths.

摘要

我们的目的是比较肝细胞癌（HCC）患者接受择期经动脉化疗栓塞术（TACE）、术前即刻TACE或在原位肝移植（OLT）前未接受治疗的复发率和生存率。共有132例HCC患者在OLT前接受了TACE。18例患者在OLT前未接受TACE，作为对照组。急诊组包括35例在OLT前不到24小时接受栓塞的患者，择期组包括97例在移植前1天以上接受栓塞的患者。对这些组在肿瘤分期、肝脏合成功能、TACE后肿瘤坏死情况以及生存率和复发率方面进行了比较。患者在OLT后平均随访780天（1 - 2912天）。各组之间肿瘤分期相似，但急诊组和未治疗组的Childs-Pugh评分显著高于其他组。两个治疗组之间移植时的坏死程度也有显著差异，OLT前不到24小时接受栓塞的患者平均坏死率为35%，而择期组为77%（p < 0.002）。急诊组35例中有8例（23%）复发，中位复发时间为580天；择期组97例中有20例（21%）复发，中位复发时间为539天；未接受TACE组18例中有2例（11%）复发，中位复发时间为331天。择期组1年、3年和5年生存率分别为91%、80%和72%，急诊组为79%、58%和39%，未接受TACE组为69%、61%和41%。急诊组和未接受TACE组的生存率明显低于其他组；然而，三组之间的肿瘤复发率在统计学上是相同的。OLT前24小时内进行TACE平均导致35%的坏死，择期TACE可使坏死率进一步提高到77%。尽管存在这种差异，但三组的肿瘤复发率相当，与OLT前未接受治疗组的复发率没有差异。即刻治疗组和未接受TACE组生存率降低是由于非癌症相关死亡。