Dumont-UCLA (University of California, Los Angeles) Transplant and Liver Cancer Centers, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY.
Ann Surg. 2020 Apr;271(4):616-624. doi: 10.1097/SLA.0000000000003253.
The aim of the study was to determine the rate, predictors, and impact of complete pathologic response (cPR) to pretransplant locoregional therapy (LRT) in a large, multicenter cohort of hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT).
LRT is used to mitigate waitlist dropout for patients with HCC awaiting LT. Degree of tumor necrosis found on explant has been associated with recurrence and overall survival, but has not been evaluated in a large, multicenter study.
Comparisons were made among patients receiving pre-LT LRT with (n = 802) and without (n = 2637) cPR from the United States Multicenter HCC Transplant Consortium (UMHTC), and multivariable predictors of cPR were identified using logistic regression.
Of 3439 patients, 802 (23%) had cPR on explant. Compared with patients without cPR, cPR patients were younger; had lower Model for End-stage Liver Disease (MELD) scores, AFP levels, and neutrophil-lymphocyte ratios (NLR); were more likely to have tumors within Milan criteria and fewer LRT treatments; and had significantly lower 1-, 3-, and 5-year incidence of post-LT recurrence (1.3%, 3.5%, and 5.2% vs 6.2%, 13.5%, and 16.4%; P < 0.001) and superior overall survival (92%, 84%, and 75% vs 90%, 78%, and 68%; P < 0.001). Multivariable predictors of cPR included age, sex, liver disease diagnosis, MELD, AFP, NLR, radiographic Milan status, and number of LRT treatments (C-statistic 0.67).
For LT recipients with HCC receiving pretransplant LRT, achieving cPR portends significantly lower posttransplant recurrence and superior survival. Factors predicting cPR are identified, which may help prioritize patients and guide LRT strategies to optimize posttransplant cancer outcomes.
本研究旨在确定在接受肝移植（LT）的大量多中心肝细胞癌（HCC）患者中，移植前局部区域治疗（LRT）后完全病理缓解（cPR）的发生率、预测因素和影响。
LRT 用于减轻 HCC 等待 LT 的患者在等待名单上的淘汰率。在切除标本中发现的肿瘤坏死程度与复发和总生存率有关，但尚未在大型多中心研究中进行评估。
对来自美国多中心 HCC 移植联盟（UMHTC）的接受 LT 前 LRT 的患者（n=802）和未接受 cPR 的患者（n=2637）进行比较，并使用逻辑回归确定 cPR 的多变量预测因素。
在 3439 例患者中，802 例（23%）在切除标本中获得 cPR。与未获得 cPR 的患者相比，cPR 患者年龄较小；MELD 评分、AFP 水平和中性粒细胞-淋巴细胞比值（NLR）较低；更有可能符合米兰标准内的肿瘤和较少的 LRT 治疗；并且 LT 后复发的 1 年、3 年和 5 年发生率显著降低（1.3%、3.5%和 5.2%比 6.2%、13.5%和 16.4%；P<0.001），整体生存率也显著提高（92%、84%和 75%比 90%、78%和 68%；P<0.001）。cPR 的多变量预测因素包括年龄、性别、肝病诊断、MELD、AFP、NLR、影像学米兰状态和 LRT 治疗次数（C 统计量 0.67）。
对于接受移植前 LRT 的 HCC LT 受者，获得 cPR 预示着 LT 后复发率显著降低，生存率更高。确定了预测 cPR 的因素，这可能有助于确定患者的优先级并指导 LRT 策略，以优化 LT 后癌症的结局。
