Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin.
Department of Surgery (Transplant Surgery), University of Wisconsin-Madison, Madison, Wisconsin.
J Vasc Interv Radiol. 2022 Sep;33(9):1045-1053. doi: 10.1016/j.jvir.2022.05.019. Epub 2022 Jun 3.
To evaluate the efficacy and safety of microwave (MW) ablation as first-line locoregional therapy (LRT) for bridging patients with hepatocellular carcinoma (HCC) to liver transplant.
This retrospective study evaluated 88 patients who received percutaneous MW ablation for 141 tumors as first-line LRT for HCC and who were listed for liver transplantation at a single medical center between 2011 and 2019. The overall survival (OS) rate statuses after liver transplant, waitlist retention, and disease progression were evaluated using the Kaplan-Meier techniques.
Among the 88 patients (72 men and 16 women; mean age, 60 years; Model for End-Stage Liver Disease score, 11.2) who were listed for transplant, the median waitlist time was 9.4 months (interquartile range, 5.5-18.9). Seventy-one (80.7%) patients received transplant after a median waitlist time of 8.5 months. Seventeen (19.3%) patients were removed from the waitlist; of these, 4 (4.5%) were removed because of tumors outside of the Milan criteria (HCC-specific dropout). No difference in tumor size or alpha-fetoprotein was observed in the transplanted versus nontransplanted patients at the time of ablation (2.1 vs 2.1 cm and 34.4 vs 34.7 ng/mL for transplanted vs nontransplanted, respectively; P > .05). Five (5.1%) of the 88 patients experienced adverse events after ablation; however, they all recovered. There were no cases of tract seeding. The local tumor progression (LTP) rate was 7.2%. The OS status after liver transplant at 5 years was 76.7%, and the disease-specific survival after LTP was 89.6%, with a median follow-up of 61 months for all patients.
MW ablation appears to be safe and effective for bridging patients with HCC to liver transplant without waitlist removal from seeding, adverse events, or LTP.
评估微波（MW）消融作为原发性局部区域治疗（LRT）桥接肝细胞癌（HCC）患者进行肝移植的疗效和安全性。
本回顾性研究评估了 2011 年至 2019 年期间在单一医疗中心接受经皮 MW 消融治疗 141 个肿瘤的 88 例 HCC 患者，他们被列为肝移植候选者。采用 Kaplan-Meier 技术评估肝移植后、保留在等待名单上和疾病进展的总生存率（OS）状态。
在 88 例（72 名男性和 16 名女性；平均年龄 60 岁；终末期肝病模型评分 11.2）被列入移植名单的患者中，中位等待名单时间为 9.4 个月（四分位距 5.5-18.9）。71 例（80.7%）患者在等待名单中位时间 8.5 个月后接受移植。17 例（19.3%）患者被移出等待名单；其中 4 例（4.5%）因肿瘤超出米兰标准（HCC 特异性脱落）而被移出。消融时移植与未移植患者的肿瘤大小或甲胎蛋白无差异（移植组 2.1 cm，未移植组 2.1 cm；移植组 34.4 ng/ml，未移植组 34.7 ng/ml；均 P＞0.05）。88 例患者中有 5 例（5.1%）在消融后出现不良事件；然而，他们都恢复了。没有发生经皮穿刺道种植的病例。局部肿瘤进展（LTP）率为 7.2%。肝移植后 5 年的 OS 状态为 76.7%，LTP 后的疾病特异性生存率为 89.6%，所有患者的中位随访时间为 61 个月。
MW 消融术似乎是一种安全有效的方法，可桥接 HCC 患者进行肝移植，而不会因种植、不良事件或 LTP 而从等待名单中移除。
