Hodavance Michael S, Vikingstad Eric M, Griffin Andrew S, Pabon-Ramos Waleska M, Berg Carl L, Suhocki Paul V, Kim Charles Y
Divisions of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, 2311 Erwin Rd., Durham, NC 27710.
Gastroenterology, Duke University Medical Center, Box 3808, 2311 Erwin Rd., Durham, NC 27710.
J Vasc Interv Radiol. 2016 Jan;27(1):39-45. doi: 10.1016/j.jvir.2015.08.032. Epub 2015 Oct 21.
To assess the effectiveness of bland transarterial embolization of hepatocellular carcinoma (HCC) as a "bridge" to transplantation.
In this retrospective study, 117 patients with HCC that met Milan criteria underwent bland embolization as their initial and sole therapy for treatment of HCC (88 men and 29 women; mean age, 60.4 y; range, 35-88 y). Subsequent postembolization contrast-enhanced computed tomography or magnetic resonance imaging studies were reviewed to determine whether Milan criteria were met in an intent-to-transplant analysis. Freedom from progression beyond Milan criteria and survival were calculated by Kaplan-Meier technique. Predictors of progression and survival were also assessed.
After embolization, 87% and 78% of patients' disease still met Milan criteria at 6 and 12 months, respectively. The median time until disease progression beyond Milan criteria was 22.6 months (95% confidence interval, 16.2-29 mo). α-Fetoprotein levels, number of lesions, United Network for Organ Sharing stage, Model for End-stage Liver Disease score, and cirrhosis etiology did not correlate significantly with stability within Milan criteria. A total of 34 patients (29%) underwent eventual liver transplantation at a median of 3.3 months (range, 0.5-20.9 mo). Liver transplantation was a significant independent predictor of longer survival (6.9 y vs 2.6 y; P < .001). The major complication rate within 30 days of embolization was 2.6%, including one mortality.
Bland transarterial embolization as a bridging strategy to maintain HCC within Milan criteria was successful in 78% of patients at 1 year, which compares favorably with other locoregional embolotherapies.
评估肝细胞癌（HCC）单纯经动脉栓塞作为肝移植“桥梁”的有效性。
在这项回顾性研究中，117例符合米兰标准的HCC患者接受单纯栓塞作为HCC的初始且唯一治疗方法（88例男性和29例女性；平均年龄60.4岁；范围35 - 88岁）。回顾栓塞后对比增强计算机断层扫描或磁共振成像研究，以在意向性移植分析中确定是否符合米兰标准。采用Kaplan-Meier技术计算无米兰标准以外疾病进展的生存率和总生存率。还评估了疾病进展和生存的预测因素。
栓塞后，分别有87%和78%的患者疾病在6个月和12个月时仍符合米兰标准。疾病进展超出米兰标准的中位时间为22.6个月（95%置信区间，16.2 - 29个月）。甲胎蛋白水平、病灶数量、器官共享联合网络分期、终末期肝病模型评分和肝硬化病因与米兰标准内的稳定性无显著相关性。共有34例患者（29%）最终接受了肝移植，中位时间为3.3个月（范围0.5 - 20.9个月）。肝移植是更长生存期的显著独立预测因素（6.9年对2.6年；P <.001）。栓塞后30天内的主要并发症发生率为2.6%，包括1例死亡。
单纯经动脉栓塞作为一种将HCC维持在米兰标准内的桥接策略，在1年时78%的患者中取得成功，与其他局部区域栓塞治疗相比具有优势。
