Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Ann Surg Oncol. 2011 Sep;18(9):2638-46. doi: 10.1245/s10434-011-1779-z. Epub 2011 May 17.
Locoregional therapy has been advocated as an effective treatment for patients with unresectable hepatocellular carcinoma (HCC), and the majority of patients with HCC receive locoregional therapy prior to liver transplantation (LT). We herein aim to determine the prognostic factors affecting the outcome in patients who receive pretransplantation therapy.
We conducted a retrospective study of the prospective data of patients who received locoregional therapy before undergoing LT for HCC. The clinicopathologic features of the patients were studied using univariate and multivariate analysis to determine prognostic factors.
Univariate and multivariate analysis of clinicopathologic features identified mean tumor necrosis (TN) ≥60% as the sole independent factor associated with lower HCC recurrence following LT. Further, the groups of patients with mean TN ≥60% who were within the University of California, San Francisco (UCSF) criteria and whose tumors beyond UCSF criteria were downstaged by TN following locoregional therapy had significantly better survival rates than the opposite groups. In-depth exploration of treatment modalities and pathological features indicated that HCC showed marked TN, while tumor nodules were well treated by locoregional therapy, and no viable tumors could be detected on radiological examination.
Mean TN ≥60% of tumor by locoregional therapy could offer better outcomes for patients with HCC undergoing LT. Therefore, locoregional therapy should be considered for patients with HCC awaiting LT or potential candidates for LT in order to induce TN as well as leading to diminished viable tumor burden and reducing the odds of HCC recurrence following LT.
局部区域治疗已被提倡作为不可切除肝细胞癌 (HCC) 患者的有效治疗方法，大多数 HCC 患者在接受肝移植 (LT) 之前接受局部区域治疗。我们旨在确定影响接受移植前治疗的患者结局的预后因素。
我们对接受 HCC 局部区域治疗后行 LT 的患者的前瞻性数据进行了回顾性研究。使用单变量和多变量分析研究患者的临床病理特征，以确定预后因素。
单变量和多变量分析临床病理特征发现，平均肿瘤坏死 (TN) ≥60%是 LT 后 HCC 复发率降低的唯一独立因素。此外，符合加利福尼亚大学旧金山分校 (UCSF) 标准且 TN 使超出 UCSF 标准的肿瘤降期的患者组，其生存时间明显优于相反的组。对治疗方式和病理特征的深入探讨表明，HCC 表现出明显的 TN，而肿瘤结节经局部区域治疗得到了很好的治疗，并且在影像学检查中无法检测到存活的肿瘤。
局部区域治疗后肿瘤的平均 TN ≥60%可为接受 LT 的 HCC 患者提供更好的结果。因此，应考虑为等待 LT 或潜在 LT 候选者的 HCC 患者提供局部区域治疗，以诱导 TN，从而减少存活肿瘤的负担并降低 LT 后 HCC 复发的几率。
