Tajana Filipec Kanižaj, Department of Gastroenterology, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia,
Croat Med J. 2022 Aug 31;63(4):317-325. doi: 10.3325/cmj.2022.63.317.
To compare the long-term outcomes between liver transplant (LT) recipients with hepatocellular carcinoma (HCC) who were downstaged with transarterial-chemoembolization (TACE) to the Milan criteria (MC) and those initially meeting the MC.
This retrospective study enrolled 198 patients with HCC: 38 were downstaged and 160 patients initially met the MC. Post-LT survival and HCC recurrence-free survival were evaluated. We assessed the association of death and HCC recurrence with TACE, baseline (age, sex, disease etiology, Model of End-stage Liver Disease, tumor number and the sum of maximum tumor diameters, waiting time, alpha-fetoprotein level) and explant characteristics (tumor number and the sum of maximum tumor diameters, micro- and macrovascular invasion).
The recipient survival rates one, three, and five years after LT were 88.2%, 80.1%, and 75.9%, respectively. HCC recurrence-free probabilities were 92.3%, 87.9%, and 85%, respectively. The outcomes were comparable between the groups. In multivariate analysis, the number of tumors on the explant, age, and tumor recurrence were independent risk factors for death. Only the sum of maximum tumor diameters on the explant was an independent risk factor for HCC recurrence.
Patients successfully downstaged with TACE to the MC can achieve post-LT recipient and HCC recurrence-free survival comparable with patients initially within the MC. Good response to TACE as a criterion for LT may be a method of selecting patients with favorable biological characteristics.
比较经肝动脉化疗栓塞术（TACE）降期至米兰标准（MC）的肝癌（HCC）肝移植（LT）受者与初始符合 MC 的患者的长期预后。
本回顾性研究纳入了 198 例 HCC 患者：38 例经 TACE 降期，160 例初始符合 MC。评估 LT 后生存和 HCC 无复发生存。我们评估了 TACE、基线（年龄、性别、病因、终末期肝病模型、肿瘤数量和最大肿瘤直径之和、等待时间、甲胎蛋白水平）和移植肝特征（肿瘤数量和最大肿瘤直径之和、微血管和大血管侵犯）与死亡和 HCC 复发的相关性。
LT 后 1、3、5 年受者生存率分别为 88.2%、80.1%和 75.9%。HCC 无复发生存率分别为 92.3%、87.9%和 85%。两组间结果相当。多因素分析显示，移植肝肿瘤数量、年龄和肿瘤复发是死亡的独立危险因素。只有移植肝最大肿瘤直径之和是 HCC 复发的独立危险因素。
成功经 TACE 降期至 MC 的患者可获得与初始符合 MC 的患者相当的 LT 后受者和 HCC 无复发生存。TACE 良好反应作为 LT 的标准可能是选择具有良好生物学特征患者的一种方法。
