Gabr Ahmed, Abouchaleh Nadine, Ali Rehan, Vouche Michael, Atassi Rohi, Memon Khairuddin, Asadi Ali Al, Baker Talia, Caicedo Juan Carlos, Desai Kush, Fryer Jonathan, Hickey Ryan, Abeccassis Michael, Habib Ali, Hohlastos Elias, Ganger Daniel, Kulik Laura, Lewandowski Robert J, Riaz Ahsun, Salem Riad
Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.
Department of Surgery, Division of Organ Transplantation, Northwestern University, Chicago, IL, USA.
Eur J Radiol. 2017 Aug;93:100-106. doi: 10.1016/j.ejrad.2017.05.022. Epub 2017 May 20.
To analyze long-term outcomes in patients bridged/downstaged to orthotopic liver transplantation (OLT) by transarterial chemoembolization (TACE) or yttrium-90 radioembolization (Y90) for hepatocellular carcinoma (HCC).
172 HCC patients who underwent OLT after being treated with transarterial liver-directed therapies (LDTs) (Y90: 93; TACE: 79) were identified. Pre-LDT and pre-OLT clinical/imaging/laboratory characteristics including United Network for Organ Sharing (UNOS) staging and alpha-fetoprotein values (AFP) were tabulated. Post-OLT HCC recurrence was assessed by imaging follow-up per standard of care. Recurrence-free (RFS) and overall survival (OS) were calculated. Uni/multivariate and sub-stratification analyses were performed.
Time-to-OLT was longer in the Y90 group (Y90: 6.5 months; TACE: 4.8 months; p=0.02). With a median post-OLT follow-up of 26.1 months (IQR: 11.1-49.7), tumor recurrence was found in 6/79 (8%) TACE and 8/93 (9%) Y90 patients. Time-to-recurrence was 26.6 (CI: 7.0-49.5) and 15.9 months (CI: 7.8-46.8) for TACE and Y90, respectively (p=0.48). RFS (Y90: 79 months; TACE: 77 months; p=0.84) and OS (Y90: 57% alive at 100 months; TACE: 84.2 months; p=0.57) were similar. 54/155 patients (Y90: 29; TACE: 25) were downstaged to UNOS T2 or less. RFS hazard ratios for patients downstaged to ≤T2 versus those that were not were 0.6 (CI: 0.33-1.1) and 1.7 (CI: 0.9-3.1) respectively (p=0.13). 17/155 patients (Y90: 8; TACE: 9) that were >T2 were downstaged to UNOS T2 or less (within transplant criteria). Distribution (unilobar/bilobar), AFP, and pre-transplant UNOS stage affected RFS on univariate analyses.
Despite longer time-to-OLT for Y90 patients, post-OLT outcomes were similar between patients bridged or downstaged by TACE or Y90. A trend towards improved RFS for downstaged patients was identified.
分析经动脉化疗栓塞术（TACE）或钇-90放射性栓塞术（Y90）桥接/降期至原位肝移植（OLT）的肝细胞癌（HCC）患者的长期预后。
确定172例接受经动脉肝脏定向治疗（LDTs）（Y90：93例；TACE：79例）后接受OLT的HCC患者。将LDT前和OLT前的临床/影像/实验室特征（包括器官共享联合网络（UNOS）分期和甲胎蛋白值（AFP））制成表格。根据标准护理通过影像随访评估OLT后HCC复发情况。计算无复发生存期（RFS）和总生存期（OS）。进行单因素/多因素分析和亚分层分析。
Y90组至OLT的时间更长（Y90：6.5个月；TACE：4.8个月；p = 0.02）。OLT后中位随访26.1个月（IQR：11.1 - 49.7），TACE组6/79（8%）和Y90组8/93（9%）患者出现肿瘤复发。TACE组和Y90组至复发时间分别为26.6（CI：7.0 - 49.5）个月和15.9（CI：7.8 - 46.8）个月（p = 0.48）。RFS（Y90：79个月；TACE：77个月；p = 0.84）和OS（Y90：100个月时57%存活；TACE：84.2个月；p = 0.57）相似。155例患者中有54例（Y90：29例；TACE：25例）降期至UNOS T2期或更低分期。降期至≤T2期的患者与未降期患者的RFS风险比分别为0.6（CI：0.33 - 1.1）和1.7（CI：0.9 - 3.1）（p = 0.13）。155例患者中有17例（Y90：8例；TACE：9例）>T2期患者降期至UNOS T2期或更低分期（在移植标准范围内）。单因素分析显示，分布（单叶/双叶）、AFP和移植前UNOS分期影响RFS。
尽管Y90患者至OLT的时间更长，但TACE或Y90桥接或降期的患者OLT后预后相似。确定了降期患者RFS改善的趋势。
