桥接局部区域治疗可延长肝细胞癌肝移植等待患者的生存期。
Bridging Locoregional Therapy Prolongs Survival in Patients Listed for Liver Transplant with Hepatocellular Carcinoma.
作者信息
Xing Minzhi, Sakaria Sonali, Dhanasekaran Renumathy, Parekh Samir, Spivey James, Knechtle Stuart J, Zhang Di, Kim Hyun S
机构信息
Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, P.O. Box 208042, New Haven, CT, 06510, USA.
Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
出版信息
Cardiovasc Intervent Radiol. 2017 Mar;40(3):410-420. doi: 10.1007/s00270-016-1505-0. Epub 2016 Nov 29.
BACKGROUND AND AIMS
To evaluate the long-term survival benefit of bridging locoregional therapy (LRT) prior to orthotopic liver transplantation (OLT) in patients with hepatocellular carcinoma (HCC) within Milan criteria.
METHODS
Our transplant center registry was studied for all HCC patients within the Milan criteria who were listed for OLT from 1998 to 2013. Baseline clinical characteristics and median overall survival (OS) were calculated and stratified by LRT, OLT status, and wait times. Survival analysis was conducted using Kaplan-Meier estimation and log-rank test.
RESULTS
Of 265 listed, 205 underwent OLT (mean follow-up 7.6 years). Of 205, 111 received bridging LRT (A), and 94 did not (B). Both were similar in demographics and tumor characteristics (p > 0.05). Median OS from HCC for A/B were 86.4 vs. 68.9 months (p = 0.01). Median OS from OLT for A/B were 74.6 vs. 63.6 months (p = 0.03). On multivariate analysis, independent predictors for survival from HCC were bridging LRT (p = 0.002) and high wait time (p = 0.008); independent predictors for survival from OLT were bridging LRT (p = 0.005) and high wait time (p = 0.005). Of 60 who were listed but did not undergo transplant, 44 received LRT (C) and 16 received best supportive care (D). Median OS from HCC for C/D were 37.1 vs. 24.8 months (p = 0.03).
CONCLUSIONS
Bridging LRT and high wait times were independent positive prognostic factors for survival from HCC diagnosis and OLT.
背景与目的
评估米兰标准内肝细胞癌（HCC）患者原位肝移植（OLT）前进行桥接局部区域治疗（LRT）的长期生存获益。
方法
研究了我们移植中心登记的1998年至2013年符合米兰标准且列入OLT名单的所有HCC患者。计算基线临床特征和中位总生存期（OS），并按LRT、OLT状态和等待时间进行分层。采用Kaplan-Meier估计法和对数秩检验进行生存分析。
结果
在列入名单的265例患者中，205例接受了OLT（平均随访7.6年）。在205例患者中，111例接受了桥接LRT（A组），94例未接受（B组）。两组在人口统计学和肿瘤特征方面相似（p>0.05）。A组/B组从HCC诊断开始的中位OS分别为86.4个月和68.9个月（p=0.01）。A组/B组从OLT开始的中位OS分别为74.6个月和63.6个月（p=0.03）。多因素分析显示，HCC生存的独立预测因素为桥接LRT（p=0.002）和高等待时间（p=0.008）；OLT生存的独立预测因素为桥接LRT（p=0.005）和高等待时间（p=0.005）。在列入名单但未接受移植的60例患者中，44例接受了LRT（C组），16例接受了最佳支持治疗（D组）。C组/D组从HCC诊断开始的中位OS分别为37.1个月和24.8个月（p=0.03）。
结论
桥接LRT和高等待时间是HCC诊断和OLT生存的独立阳性预后因素。
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