Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil.
Department of Liver Transplant, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil.
World J Gastroenterol. 2019 Oct 7;25(37):5687-5701. doi: 10.3748/wjg.v25.i37.5687.
Prospective study of 200 patients with hepatocellular carcinoma (HCC) that underwent liver transplant (LT) after drug-eluting beads transarterial chemoembolization (DEB-TACE) for downstaging versus bridging. Overall survival and tumor recurrence rates were calculated, eligibility for LT, time on the waiting list and radiological response were compared. After TACE, only patients within Milan Criteria (MC) were transplanted. More patients underwent LT in bridging group. Five-year post-transplant overall survival, recurrence-free survival has no difference between the groups. Complete response was observed more frequently in bridging group. Patients in DS group can achieve post-transplant survival and HCC recurrence-free probability, at five years, just like patients within MC in patients undergoing DEB-TACE.
To determine long-term outcomes of patients with HCC that underwent LT after DEB-TACE for downstaging bridging.
Prospective cohort study of 200 patients included from April 2011 through June 2014. Bridging group included patients within MC. Downstaging group (out of MC) was divided in 5 subgroups (G1 to G5). Total tumor diameter was ≤ 8 cm for G1, 2, 3, 4 ( = 42) and was > 8 cm for G5 ( = 22). Downstaging ( = 64) and bridging ( = 136) populations were not significantly different. Overall survival and tumor recurrence rates were calculated by the Kaplan-Meier method. Additionally, eligibility for LT, time on the waiting list until LT and radiological response were compared.
After TACE, only patients within MC were transplanted. More patients underwent LT in bridging group 65.9% ( = 0.001). Downstaging population presented: higher number of nodules 2.81 ( = 0.001); larger total tumor diameter 8.09 ( = 0.001); multifocal HCC 78% ( = 0.001); more post-transplantation recurrence 25% ( = 0.02). Patients with maximal tumor diameter up to 7.05 cm were more likely to receive LT ( = 0.005). Median time on the waiting list was significantly longer in downstaging group 10.6 mo ( = 0.028). Five-year post-transplant overall survival was 73.5% in downstaging and 72.3% bridging groups ( = 0.31), and recurrence-free survival was 62.1% in downstaging and 74.8% bridging groups ( = 0.93). Radiological response: complete response was observed more frequently in bridging group ( = 0.004).
Tumors initially exceeding the MC down-staged after DEB-TACE, can achieve post-transplant survival and HCC recurrence-free probability, at five years, just like patients within MC in patients undergoing DEB-TACE.
对 200 例肝细胞癌（HCC）患者进行前瞻性研究，这些患者在接受载药微球经导管动脉化疗栓塞术（DEB-TACE）降期或桥接治疗后接受肝移植（LT）。计算总生存率和肿瘤复发率，比较 LT 的资格、等待名单上的时间和影像学反应。TACE 后，只有符合米兰标准（MC）的患者接受移植。桥接组有更多的患者接受 LT。移植后 5 年的总生存率和无复发生存率在两组间无差异。桥接组更常观察到完全缓解。DS 组患者可在 5 年内达到移植后生存和 HCC 无复发生存的概率，与接受 DEB-TACE 的 MC 内患者相似。
确定接受 DEB-TACE 降期桥接治疗后行 LT 的 HCC 患者的长期结果。
2011 年 4 月至 2014 年 6 月期间前瞻性纳入 200 例患者。桥接组包括符合 MC 的患者。降期组（超出 MC）分为 5 个亚组（G1 至 G5）。G1、2、3、4 组的总肿瘤直径均≤8cm（ = 42），G5 组的总肿瘤直径>8cm（ = 22）。降期（ = 64）和桥接（ = 136）两组无显著差异。通过 Kaplan-Meier 法计算总生存率和肿瘤复发率。此外，还比较了 LT 的资格、等待名单上的时间和影像学反应。
TACE 后，只有符合 MC 的患者接受移植。桥接组有更多的患者接受 LT（65.9%， = 0.001）。降期组表现为：更多的结节数 2.81（ = 0.001）；更大的总肿瘤直径 8.09（ = 0.001）；多灶性 HCC 78%（ = 0.001）；更多的移植后复发 25%（ = 0.02）。最大肿瘤直径达 7.05cm 的患者更有可能接受 LT（ = 0.005）。降期组的中位等待时间明显较长 10.6 个月（ = 0.028）。降期组和桥接组移植后 5 年总生存率分别为 73.5%和 72.3%（ = 0.31），无复发生存率分别为 62.1%和 74.8%（ = 0.93）。影像学反应：桥接组更常观察到完全缓解（ = 0.004）。
在 DEB-TACE 后最初超出 MC 的肿瘤降期后，可在 5 年内达到移植后生存和 HCC 无复发生存的概率，与接受 DEB-TACE 的 MC 内患者相似。
