Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK.
Br J Surg. 2020 Aug;107(9):1183-1191. doi: 10.1002/bjs.11559. Epub 2020 Mar 28.
Transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) awaiting liver transplantation is widespread, although evidence that it improves outcomes is lacking and there exist concerns about morbidity. The impact of TACE on outcomes after transplantation was evaluated in this study.
Patients with HCC who had liver transplantation in the UK were identified, and stratified according to whether they received TACE between 2006 and 2016. Cox regression methods were used to estimate hazard ratios (HRs) for death and graft failure after transplantation adjusted for donor and recipient characteristics.
In total, 385 of 968 patients (39·8 per cent) received TACE. Five-year patient survival after transplantation was similar in those who had or had not received TACE: 75·2 (95 per cent c.i. 68·8 to 80·5) and 75·0 (70·5 to 78·8) per cent respectively. After adjustment for donor and recipient characteristics, there were no differences in mortality (HR 0·96, 95 per cent c.i. 0·67 to 1·38; P = 0·821) or graft failure (HR 1·01, 0·73 to 1·40; P = 0·964). The number of TACE treatments (2 or more versus 1: HR 0·97, 0·61 to 1·55; P = 0·903) or the time of death after transplantation (within or after 90 days; P = 0·291) did not alter the outcome. The incidence of hepatic artery thrombosis was low in those who had or had not received TACE (1·3 and 2·4 per cent respectively; P = 0·235).
TACE delivered to patients with HCC before liver transplant did not affect complications, patient death or graft failure after transplantation.
在等待肝移植的肝细胞癌 (HCC) 患者中，经动脉化疗栓塞术 (TACE) 已广泛应用，但目前尚无证据表明其能改善预后，且存在对发病率的担忧。本研究评估了 TACE 对移植后结局的影响。
在英国，确定接受肝移植的 HCC 患者，并根据其是否在 2006 年至 2016 年期间接受 TACE 进行分层。使用 Cox 回归方法估计移植后死亡和移植物失败的风险比 (HR)，并根据供体和受者特征进行调整。
共 968 例患者中有 385 例 (39.8%) 接受了 TACE。接受或未接受 TACE 的患者移植后 5 年生存率相似：分别为 75.2%(95%可信区间 68.8%至 80.5%)和 75.0%(70.5%至 78.8%)。调整供体和受者特征后，死亡率无差异(HR 0.96，95%可信区间 0.67 至 1.38；P=0.821)或移植物失败率无差异(HR 1.01，0.73 至 1.40；P=0.964)。TACE 治疗次数 (2 次或更多与 1 次：HR 0.97，0.61 至 1.55；P=0.903)或移植后死亡时间(90 天内或 90 天后：P=0.291)均未改变结局。接受或未接受 TACE 的患者肝动脉血栓形成发生率均较低(分别为 1.3%和 2.4%；P=0.235)。
在肝移植前对 HCC 患者进行 TACE 治疗不会影响移植后的并发症、患者死亡或移植物失败。
