Tong Y S, Huang T L, Chen T Y, Tsang L L C, Ou H Y, Yu C Y, Hsu H W, Xiong L W, Liao C C, Eng H L, Chen C L, Cheng Y F
Liver Transplantation Program and Departments of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Transplant Proc. 2018 Nov;50(9):2622-2625. doi: 10.1016/j.transproceed.2018.05.012. Epub 2018 May 24.
The aim of this study is to determine whether post-transarterial chemoembolization imaging (computed tomography or magnetic resonance imaging) could accurately predict the tumors' necrosis on pathologic specimens.
Transarterial chemoembolization with drug-eluting beads has been proven to be an effective way to bridge patients with hepatocellular carcinomas to liver transplantation.
From September 2012 to June 2017, 59 patients with a total of 78 hepatocellular carcinomas, who received transarterial chemoembolization with drug-eluting beads before liver transplantation in Kaohsiung Chang Gung Memorial Hospital, were included in the study. All patients and hepatocellular carcinomas have pre-transarterial chemoembolization and post-transarterial chemoembolization images (computed tomography or magnetic resonance imaging) and pathological findings for correlation. Tumor response was evaluated according to modified Response Evaluation Criteria in Solid Tumors. The ranges of necrotic percentage are 100%, 91-99%, 51-90%, and <50%.
The accuracy rate between the imaging and pathology correlation was 40% for computed tomography and 42% for magnetic resonance imaging. The recurrent rate of the complete respond group is 11.5%, the partial respond group is 16.0%, and the stationary group is 28.6%.
Computed tomography and magnetic resonance imaging sensitivity is not satisfactory for microscopic evaluation of residual tumors after transarterial chemoembolization with drug-eluting beads. However, survival is good after liver transplantation no matter what the microscopic findings were.
本研究旨在确定经动脉化疗栓塞成像（计算机断层扫描或磁共振成像）能否准确预测病理标本上肿瘤的坏死情况。
经动脉化疗栓塞联合载药微球已被证明是将肝细胞癌患者过渡到肝移植的有效方法。
2012年9月至2017年6月，高雄长庚纪念医院59例共78个肝细胞癌患者纳入研究，这些患者在肝移植前接受了经动脉化疗栓塞联合载药微球治疗。所有患者及肝细胞癌均有经动脉化疗栓塞前和栓塞后的图像（计算机断层扫描或磁共振成像）及病理结果用于相关性分析。根据实体瘤改良疗效评价标准评估肿瘤反应。坏死百分比范围为100%、91 - 99%、51 - 90%和<50%。
计算机断层扫描成像与病理相关性的准确率为40%，磁共振成像为42%。完全缓解组的复发率为11.5%，部分缓解组为16.0%，稳定组为28.6%。
对于经动脉化疗栓塞联合载药微球治疗后残余肿瘤的微观评估，计算机断层扫描和磁共振成像的敏感性并不令人满意。然而，无论微观检查结果如何，肝移植后的生存率都较好。
