Radunz Sonia, Treckmann Jürgen, Baba Hideo A, Best Jan, Müller Stefan, Theysohn Jens M, Paul Andreas, Benkö Tamás
Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany.
Department of Pathology and Neuropathology, University Hospital Essen, Essen, Germany.
Ann Transplant. 2017 Apr 14;22:215-221. doi: 10.12659/aot.902595.
BACKGROUND Bridging treatments are employed in liver transplant waitlist patients with hepatocellular carcinoma (HCC) because of the risk of tumor progression during the waiting time. Radioembolization is mostly employed in the control of large or multifocal HCCs when other locoregional treatment modalities cannot be applied because of the number or size of lesions. The purpose of this study was to evaluate our experience with the use of radioembolization as a bridge to transplantation and its effect on tumor recurrence and survival after liver transplantation. MATERIAL AND METHODS A retrospective review of 40 consecutive patients with HCC who underwent liver transplantation after radioembolization bridging treatment between January 2007 and December 2015 at the University Hospital Essen, Germany, was performed. Patients' characteristics, alpha-fetoprotein (AFP) levels, pathologic tumor response, tumor recurrence rate, and survival rates were examined through chart review. RESULTS Histopathological examination of the explanted liver specimen revealed complete tumor necrosis in 17 specimens, partial necrosis in 18 specimens, and no significant necrosis in five specimens. Median overall survival was 46 months. Nine patients developed recurrent HCC. Median time from liver transplantation to diagnosis of tumor recurrence was 15 months. There was a trend towards a lower risk of tumor recurrence for patients with complete necrosis on explant specimens. Patients with tumor recurrence demonstrated statistically significantly higher pre- and post-treatment AFP levels (p=0.0234 and p=0.0236) and statistically significantly more frequently microvascular invasion (p=0.0163). CONCLUSIONS Histopathological assessment of explanted livers revealed at least partial necrosis in 87.5% of patients. Patients with successful bridging treatment, i.e. complete necrosis of explant specimens, demonstrate a trend towards a lower risk of tumor recurrence.
由于肝细胞癌（HCC）患者在肝移植等待名单上等待期间存在肿瘤进展风险，因此采用了桥接治疗。当因病变数量或大小无法应用其他局部区域治疗方式时，放射性栓塞大多用于控制大型或多灶性HCC。本研究的目的是评估我们使用放射性栓塞作为移植桥接治疗的经验及其对肝移植后肿瘤复发和生存的影响。
对2007年1月至2015年12月在德国埃森大学医院接受放射性栓塞桥接治疗后进行肝移植的40例连续HCC患者进行回顾性研究。通过病历审查检查患者的特征、甲胎蛋白（AFP）水平、病理肿瘤反应、肿瘤复发率和生存率。
对切除的肝脏标本进行组织病理学检查发现，17个标本中肿瘤完全坏死，18个标本中部分坏死，5个标本中无明显坏死。中位总生存期为46个月。9例患者发生复发性HCC。从肝移植到诊断肿瘤复发的中位时间为15个月。移植标本完全坏死的患者肿瘤复发风险有降低趋势。肿瘤复发患者治疗前和治疗后的AFP水平在统计学上显著更高（p=0.0234和p=0.0236），微血管侵犯在统计学上显著更频繁（p=0.0163）。
切除肝脏的组织病理学评估显示87.5%的患者至少有部分坏死。桥接治疗成功的患者，即移植标本完全坏死的患者，肿瘤复发风险有降低趋势。
