University of Bologna, Bologna, Italy.
Hepatology. 2011 May;53(5):1580-9. doi: 10.1002/hep.24246.
Transarterial chemoembolization (TACE) is commonly used as a bridge therapy for patients awaiting liver transplantation (LT) and for downstaging patients initially not meeting the Milan criteria. The primary aim of this study was to analyze whether a difference exists between selective/superselective and lobar TACE in determining tumor necrosis by a pathological analysis of the whole lesion at the time of LT. The secondary aim was to investigate the relationship between the tumor size and the capacity of TACE to induce necrosis. Data were extracted from a prospective database of 67 consecutive patients who underwent LT for hepatocellular carcinoma and cirrhosis from 2003 to 2009 and were treated exclusively with TACE as a bridging (n = 53) or downstaging therapy (n = 14). We identified 122 nodules; 53.3% were treated with selective/superselective TACE. The mean histological necrosis level was 64.7%; complete tumor necrosis was obtained in 42.6% of the nodules. In comparison with lobar TACE, selective/superselective TACE led to significantly higher mean levels of necrosis (75.1% versus 52.8%, P = 0.002) and a higher rate of complete necrosis (53.8% versus 29.8%, P = 0.013). A significant direct relationship was observed between the tumor diameter and the mean tumor necrosis level (59.6% for lesions < 2 cm, 68.4% for lesions of 2.1-3 cm, and 76.2% for lesions > 3 cm). Histological necrosis was maximal for tumors > 3 cm: 91.8% after selective/superselective TACE and 66.5% after lobar procedures. Independent predictors of complete tumor necrosis were selective/superselective TACE (P = 0.049) and the treatment of single nodules (P = 0.008). Repeat sessions were more frequently needed for nodules treated with lobar TACE (31.6% versus 59.3%, P = 0.049).
Selective/superselective TACE was more successful than lobar procedures in achieving complete histological necrosis, and TACE was more effective in 3- to 5-cm tumors than in smaller ones.
本研究旨在分析经肝移植（LT）时对整个病变进行病理分析时，选择性/超选择性与节段性 TACE 之间在确定肿瘤坏死方面是否存在差异。次要目的是探讨肿瘤大小与 TACE 诱导坏死能力之间的关系。
从 2003 年至 2009 年期间连续接受 LT 治疗的 67 例 HCC 和肝硬化患者的前瞻性数据库中提取数据，这些患者仅接受 TACE 作为桥接（n = 53）或降期治疗（n = 14）。我们共发现 122 个结节，其中 53.3%接受了选择性/超选择性 TACE 治疗。平均组织学坏死水平为 64.7%，42.6%的结节完全坏死。与节段性 TACE 相比，选择性/超选择性 TACE 导致的平均坏死水平显著更高（75.1%比 52.8%，P = 0.002），完全坏死的比例更高（53.8%比 29.8%，P = 0.013）。肿瘤直径与平均肿瘤坏死水平之间存在显著的直接关系（<2 cm 的病变为 59.6%，2.1-3 cm 的病变为 68.4%，>3 cm 的病变为 76.2%）。对于>3 cm 的肿瘤，组织学坏死最大：选择性/超选择性 TACE 后为 91.8%，节段性 TACE 后为 66.5%。完全肿瘤坏死的独立预测因子为选择性/超选择性 TACE（P = 0.049）和单个结节的治疗（P = 0.008）。节段性 TACE 治疗的结节更频繁地需要重复治疗（31.6%比 59.3%，P = 0.049）。
选择性/超选择性 TACE 在实现完全组织学坏死方面比节段性方法更成功，TACE 在 3-5 cm 肿瘤中的效果优于较小肿瘤。
