Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: https://twitter.com/AndrewKolarich.
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Vasc Interv Radiol. 2022 Oct;33(10):1222-1229.e1. doi: 10.1016/j.jvir.2022.06.016. Epub 2022 Jun 28.
To evaluate differences in waitlist mortality and dropout in liver transplant candidates with hepatocellular carcinoma (HCC) who undergo radiofrequency (RF) ablation versus transarterial chemoembolization (TACE).
From 2004 to 2013, 11,824 patients with HCC in the Scientific Registry of Transplant Recipients who underwent RF ablation or TACE were included and followed until December 31, 2019, or 5 years, whichever came first, and were stratified by the Milan criteria. Competing risk and Cox regression analyses to compare waitlist mortality and dropout were performed using adjusted hazard ratios (asHRs, with RF ablation group as reference). Regression models were adjusted for age, race, sex, calculated Model for End-Stage Liver Disease score, tumor size, and number.
There was no difference in waitlist mortality and dropout for patients outside the Milan criteria (n = 1,226) who underwent TACE (19.2%) or RF ablation (19.0%) (asHR, 0.91; 95% CI, 0.79-1.03). There was also no difference for patients inside the Milan criteria (n = 10,598) in waitlist mortality/dropout (TACE 13.4% vs RF ablation 12.9%) (asHR, 1.29; 95% CI, 0.79-2.09). A subgroup analysis within the Milan criteria demonstrated no difference between TACE and RF ablation treatments in patients with a single tumor of ≤3 cm (asHR, 0.92; 95% CI, 0.77-1.10), with a single tumor of >3 cm (asHR, 1.03; 95% CI, 0.79-1.34), or with >1 tumor (asHR, 0.89; 95% CI, 0.72-1.09).
Using the national registry data, no difference was found in waitlist mortality and dropout for transplant candidates with HCC who received TACE versus RF ablation.
评估接受射频消融（RF 消融）与经动脉化疗栓塞（TACE）的肝细胞癌（HCC）肝移植候选者在等待名单上的死亡率和退出率的差异。
2004 年至 2013 年，科学移植受者登记处（SRTR）纳入了 11824 名接受 RF 消融或 TACE 的 HCC 患者，并随访至 2019 年 12 月 31 日或 5 年，以先到者为准，并根据米兰标准分层。使用调整后的危险比（asHR，以 RF 消融组为参考）进行竞争风险和 Cox 回归分析，以比较等待名单上的死亡率和退出率。回归模型根据年龄、种族、性别、计算的终末期肝病模型评分、肿瘤大小和数量进行调整。
对于不符合米兰标准（n=1226）的患者，TACE（19.2%）或 RF 消融（19.0%）的等待名单死亡率和退出率无差异（asHR，0.91；95%CI，0.79-1.03）。对于符合米兰标准的患者（n=10598），等待名单死亡率/退出率（TACE 13.4% vs RF 消融 12.9%）也无差异（asHR，1.29；95%CI，0.79-2.09）。米兰标准内的亚组分析表明，对于单个肿瘤≤3cm（asHR，0.92；95%CI，0.77-1.10）、单个肿瘤>3cm（asHR，1.03；95%CI，0.79-1.34）或多个肿瘤（asHR，0.89；95%CI，0.72-1.09）的患者，TACE 和 RF 消融治疗之间在等待名单死亡率和退出率方面无差异。
使用国家登记处数据，接受 TACE 与 RF 消融的 HCC 肝移植候选者在等待名单上的死亡率和退出率无差异。
