Department of Diagnostic and Interventional Radiology, University of Pisa, via Paradisa 2, 56100 Pisa, Italy.
Radiology. 2010 Apr;255(1):289-300. doi: 10.1148/radiol.09090927.
To retrospectively evaluate the clinical outcome of patients with hepatocellular carcinoma (HCC) who exceeded the Milan criteria, who underwent transarterial chemoembolization (TACE) before orthotopic liver transplantation (OLT), to determine the value of computed tomography (CT)-based tumor response to TACE as a preoperative selection criterion for OLT.
The study included 33 patients with HCC who exceeded the Milan criteria and underwent OLT after TACE. Informed written consent was obtained before TACE and OLT. Institutional review board approval was not required. Tumor response to TACE was evaluated at 1 month with CT according to amended Response Evaluation Criteria in Solid Tumours (RECIST) guidelines. In the explanted liver, degree of tumor necrosis (> or = 90%, 50%-89%, or < 50%), residual tumor stage and grade, and presence of microvascular invasion were assessed. Follow-up after OLT ranged from 1 to 143 months.
After TACE, CT showed complete tumor response (CR) in 18 (55%) patients. On the explanted liver, tumor necrosis was rated 90% or greater in 20 (61%) patients, with a good correlation with CT. Microvascular invasion was observed in nine (27%) of 33 patients; none of them were reported to have a CR at CT. The 5-year cumulative survival rate after OLT was 72.5%; it was significantly (P = .003) higher in patients with a CR (94.4%) compared with patients with a partial response (PR) (45.4%) and stable disease (50%). The 5-year cumulative recurrence-free rate after OLT was 74.4%; it was not affected by the tumor nodule size and number, whereas it was significantly (P = .008) higher in patients with a CR (94.4%) compared with patients with a PR (46.7%) and stable disease (50%).
In patients with HCC who exceeded the Milan criteria, a CR after TACE, on the basis of amended RECIST guidelines, is associated with excellent posttransplantation outcomes. Therefore, 1-month response to TACE assessed at CT may represent a valid selection criterion for OLT.
回顾性分析米兰标准外肝癌患者行肝动脉化疗栓塞（TACE）后行原位肝移植（OLT）的临床疗效，探讨 TACE 后 CT 肿瘤反应作为OLT 术前选择标准的价值。
本研究共纳入 33 例米兰标准外肝癌患者，TACE 后行 OLT。所有患者均签署了 TACE 和 OLT 的知情同意书，本研究无需伦理委员会审批。TACE 后 1 个月行 CT 评估肿瘤反应，根据改良实体瘤疗效评价标准（RECIST）评估肿瘤反应。在切除的肝脏标本中评估肿瘤坏死程度（＞90%、50%～89%和＜50%）、肿瘤分期和分级、微血管侵犯。OLT 后随访 1 至 143 个月。
TACE 后，18 例（55%）患者 CT 显示完全缓解（CR）。在切除的肝脏标本中，20 例（61%）患者肿瘤坏死程度达到 90%或以上，与 CT 有较好的相关性。33 例患者中有 9 例（27%）存在微血管侵犯，无一例 CT 显示为 CR。OLT 后 5 年累积生存率为 72.5%；CR 患者（94.4%）明显高于部分缓解（45.4%）和稳定疾病（50%）患者（P =.003）。OLT 后 5 年无复发生存率为 74.4%；该指标不受肿瘤结节大小和数量的影响，但 CR 患者（94.4%）明显高于部分缓解（46.7%）和稳定疾病（50%）患者（P =.008）。
在米兰标准外肝癌患者中，TACE 后根据改良 RECIST 标准的 CR 与移植后良好的结果相关。因此，TACE 后 1 个月的 CT 肿瘤反应可作为 OLT 的有效选择标准。
