Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition.
Departments of Medicine.
Am J Clin Oncol. 2020 May;43(5):325-333. doi: 10.1097/COC.0000000000000678.
The objective of this study was to compare posttransplant outcomes in patients undergoing bridging locoregional therapy (LRT) with Y-90 transarterial radioembolization (TARE) based protocol compared with transarterial chemoembolization based protocol for hepatocellular carcinoma (HCC) prior liver transplantation (LT).
Patients listed for LT with HCC within the Milan criteria at our center who had bridging LRT were treated according to transarterial chemoembolization (TACE) based protocol from May 2012 to April 2014 and a TARE based protocol from October 2014 to December 2017. Early posttransplant survival and tumor recurrence were compared between the groups. Tumor response to LRT, microvascular invasion (mVI), and the rate of delisting was also evaluated.
One hundred three patients who were listed for LT with HCC within the Milan criteria received LRT. LT was performed in 65 patients, 28 treated with TARE protocol and 37 on TACE protocol. There were no statistical differences in baseline pretransplant characteristics and tumor recurrence. There was a trend toward improved 3-year survival in the TARE group (92.9% vs. 75.7%; P=0.052). The mVI was seen in 1/28 (3.6%) explants in the TARE group compared with 10/37 (27%) in the TACE group (P=0.013). The TARE group also required fewer LRT treatments (1.46 vs. 2.43; P=0.001) despite no difference in time on the transplant list.
Despite requiring fewer LRT treatments, there was significantly less mVI in the explants of patients treated with TARE protocol LRT as a bridge to LT as well as a trend toward improved 3-year survival. Therefore, TARE may be associated with improved tumor control and reduced post-LT recurrence.
本研究旨在比较 Y-90 经动脉放射栓塞术（TARE）桥接区域性治疗（LRT）与基于经动脉化疗栓塞术（TACE）的方案用于肝癌（HCC）患者肝移植（LT）前桥接 LRT 的移植后结局。
本中心符合米兰标准的 HCC 患者在 LT 名单上，在 LT 前接受 LRT。2012 年 5 月至 2014 年 4 月采用 TACE 方案，2014 年 10 月至 2017 年 12 月采用 TARE 方案。比较两组患者的早期移植后生存率和肿瘤复发情况。还评估了 LRT 的肿瘤反应、微血管侵犯（mVI）和退市率。
103 例 HCC 患者符合米兰标准，接受了 LRT。65 例患者接受了 LT，28 例患者接受了 TARE 方案，37 例患者接受了 TACE 方案。两组患者的基线移植前特征和肿瘤复发无统计学差异。TARE 组的 3 年生存率有提高的趋势（92.9% vs. 75.7%；P=0.052）。TARE 组 1 例（3.6%）肝移植标本有 mVI，而 TACE 组 10 例（27%）有 mVI（P=0.013）。尽管在移植名单上的时间没有差异，但 TARE 组需要的 LRT 治疗次数更少（1.46 次 vs. 2.43 次；P=0.001）。
尽管 TARE 组需要的 LRT 治疗次数较少，但移植标本的 mVI 明显较少，3 年生存率也有提高的趋势。因此，TARE 可能与改善肿瘤控制和降低 LT 后复发率有关。
