Goebel Juliane, Sulke Maximilian, Lazik-Palm Andrea, Goebel Thomas, Dechêne Alexander, Bellendorf Alexander, Mueller Stefan, Umutlu Lale, Theysohn Jens
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany.
Clinic for Gastroenterology, Hepatology and Diabetology, Petrus Hospital, Wuppertal, Germany.
PLoS One. 2017 Jul 14;12(7):e0181488. doi: 10.1371/journal.pone.0181488. eCollection 2017.
Radioembolization for the treatment of hepatocellular carcinoma (HCC) induces liver volume changes referred to as "atrophy-hypertrophy complex". The aim of this study was to investigate lobar liver volume changes after unilateral radioembolization and to search for factors associated with hypertrophy of the untreated lobe.
Seventy-five patients were retrospectively evaluated. Inclusion criteria were: (1) right-lobar radioembolization for unresectable unilateral HCC, (2) available liver computed tomography scans before, 1, 3, and at least 6 months after radioembolization. Baseline patient characteristics included clinical features, laboratory results, spleen volume, and liver computed tomography. Absolute and relative (referred to the whole liver volume) liver lobe volumes (LLV) as well as relative LLV (rLLV) change per month were evaluated and compared.
Absolute and relative contralateral LLV continuously increased after radioembolization (p<0.001). Mean relative contralateral LLV increased from 36±11.6% before radioembolization to 50±15.3% 6 months after radioembolization. Median contralateral rLLV increase/month (within first 6 months) was 2.5%. Contralateral rLLV increase/month was significantly lower in patients with ascites (p = 0.017) or platelet count <100/nl (p = 0.009). An inverse correlation of contralateral rLVV increase/month with spleen volume (p = 0.017), patient age (p = 0.024), Child Pugh score (p = 0.001), and tumor burden (p = 0.001) was found.
Significant contralateral hypertrophy and ipsilateral atrophy were common after unilateral radioembolization. Small spleen volume, low patient age, low Child Pugh score, absence of ascites, platelet count ≥100/nl, and low tumor burden were associated with increased contralateral hypertrophy, indicating that younger patients with compensated cirrhosis might benefit most from radioembolization in a "bridge-to-resection" setting.
放射性栓塞治疗肝细胞癌（HCC）会引起肝脏体积变化，即“萎缩-肥大复合体”。本研究旨在探讨单侧放射性栓塞术后肝叶体积变化，并寻找与未治疗肝叶肥大相关的因素。
对75例患者进行回顾性评估。纳入标准为：（1）对不可切除的单侧HCC进行右叶放射性栓塞；（2）在放射性栓塞术前、术后1个月、3个月及至少6个月有可用的肝脏计算机断层扫描。基线患者特征包括临床特征、实验室检查结果、脾脏体积和肝脏计算机断层扫描。评估并比较绝对和相对（相对于全肝体积）肝叶体积（LLV）以及每月相对LLV（rLLV）变化。
放射性栓塞术后，对侧绝对和相对LLV持续增加（p<0.001）。平均对侧相对LLV从放射性栓塞术前的36±11.6%增加至术后6个月的50±15.3%。对侧rLLV每月增加中位数（前6个月内）为2.5%。腹水患者（p = 0.017）或血小板计数<100/nl患者（p = 0.009）的对侧rLLV每月增加明显更低。发现对侧rLVV每月增加与脾脏体积（p = 0.017）、患者年龄（p = 0.024）、Child Pugh评分（p = 0.001）和肿瘤负荷（p = 0.001）呈负相关。
单侧放射性栓塞术后对侧显著肥大和同侧萎缩常见。脾脏体积小、患者年龄低、Child Pugh评分低、无腹水、血小板计数≥100/nl及肿瘤负荷低与对侧肥大增加相关，表明在“桥接切除”情况下，代偿期肝硬化的年轻患者可能从放射性栓塞中获益最大。
