肝移植桥接治疗期间的肝细胞癌进展。
Hepatocellular carcinoma progression during bridging before liver transplantation.
机构信息
Department of Surgery, University Medical Centre Regensburg, Regensburg, Germany.
Department of Surgery, Robert-Bosch Hospital, Stuttgart, Germany.
出版信息
BJS Open. 2021 Mar 5;5(2). doi: 10.1093/bjsopen/zrab005.
BACKGROUND
Recipient selection for liver transplantation in hepatocellular carcinoma (HCC) is based primarily on criteria affecting the chance of long-term success. Here, the relationship between pretransplant bridging therapy and long-term survival was investigated in a subgroup analysis of the SiLVER Study.
METHODS
Response to bridging, as defined by comparison of imaging at the time of listing and post-transplant pathology report, was categorized into controlled versus progressive disease (more than 20 per cent tumour growth or development of new lesions).
RESULTS
Of 525 patients with HCC who had liver transplantation, 350 recipients underwent pretransplant bridging therapy. Tumour progression despite bridging was an independent risk factor affecting overall survival (hazard ratio 1.80; P = 0.005). For patients within the Milan criteria (MC) at listing, mean overall survival was longer for those with controlled versus progressive disease (6.8 versus 5.8 years; P < 0.001). Importantly, patients with HCCs outside the MC that were downsized to within the MC before liver transplantation had poor outcomes compared with patients who never exceeded the MC (mean overall survival 6.2 versus 6.6 years respectively; P = 0.030).
CONCLUSION
Patients with HCCs within the MC that did not show tumour progression under locoregional therapy had the best outcomes after liver transplantation. Downstaging into the limits of the MC did not improve the probability of survival.Prognostic factors determining the long-term success of liver transplantation in patients with hepatocellular carcinoma are still under discussion. A subgroup analysis of the SiLVER trial showed that disease control under bridging therapy is strongly associated with improved prognosis in terms of overall survival. However, in tumours exceeding the limits of the Milan criteria, downstaging did not restore the probability of survival compared with that of patients within the Milan criteria.
背景
肝细胞癌（HCC）肝移植的受者选择主要基于影响长期成功率的标准。在这里，我们对 SiLVER 研究的亚组分析中研究了移植前桥接治疗与长期生存之间的关系。
方法
根据在列入名单时的影像学与移植后病理报告的比较，将桥接的反应分为得到控制的疾病与进展性疾病（肿瘤生长超过 20%或出现新病变）。
结果
在接受肝移植的 525 例 HCC 患者中，有 350 例患者接受了移植前桥接治疗。尽管进行了桥接，但肿瘤进展仍然是影响总生存的独立危险因素（风险比 1.80；P=0.005）。对于列入名单时符合米兰标准（MC）的患者，肿瘤得到控制的患者的总生存时间长于进展性疾病患者（6.8 年比 5.8 年；P<0.001）。重要的是，在移植前缩小到 MC 范围内的 MC 以外的 HCC 患者的生存结果与从未超过 MC 的患者相比较差（分别为 6.2 年和 6.6 年；P=0.030）。
结论
在局部治疗下没有出现肿瘤进展的 MC 范围内 HCC 患者在肝移植后具有最佳的结果。降期到 MC 范围内并不能提高生存概率。决定肝细胞癌患者肝移植长期成功的预后因素仍在讨论中。SiLVER 试验的亚组分析表明，桥接治疗下的疾病控制与总体生存率的改善预后密切相关。然而，在超出米兰标准的肿瘤中，与符合米兰标准的患者相比，降期并不能恢复生存概率。
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