Di Martino Marcello, Vitale Alessandro, Ferraro Daniele, Maniscalco Marilisa, Pisaniello Donatella, Arenga Giuseppe, Falaschi Federica, Terrone Alfonso, Iacomino Alessandro, Galeota Lanza Alfonso, Esposito Ciro, Cillo Umberto, Vennarecci Giovanni
Department of Hepatobiliary and Liver Transplantation Surgery, A.O.R.N. Cardarelli, 80128 Napoli, Italy.
Department of Surgical, Oncological and Gastroenterological Sciences, Padova University, 35121 Padova, Italy.
Cancers (Basel). 2022 Oct 18;14(20):5102. doi: 10.3390/cancers14205102.
Background: Locoregional therapies (LRTs) are commonly used to increase the number of potential candidates for liver transplantation (LT). The aim of this paper is to assess the outcomes of LRTs prior to LT in patients with hepatocellular carcinoma (HCC) beyond the listing criteria. Methods: In accordance with the PRISMA guidelines, we searched the Medline and Web of Science databases for reports published before May 2021. We included papers assessing adult patients with HCC considered for LT and reporting intention-to-treat (ITT) survival outcomes. Two reviewers independently identified and extracted the data and evaluated the papers. Outcomes analysed were drop-out rate; time on the waiting list; and 1, 3 and 5 year survival after LT and based on an ITT analysis. Results: The literature search yielded 3,106 records, of which 11 papers (1874 patients) met the inclusion criteria. Patients with HCC beyond the listing criteria and successfully downstaged presented a higher drop-out rate (OR 2.05, 95% CI 1.45−2.88, p < 0.001) and a longer time from the initial assessment to LT than those with HCC within the listing criteria (MD 1.93, 95% CI 0.91−2.94, p < 0.001). The 1, 3 and 5 year survival post-LT and based on an ITT analysis did not show significant differences between the two groups. Patients with HCC beyond the listing criteria, successfully downstaged and then transplanted, presented longer 3 year (OR 3.77, 95% CI 1.26−11.32, p = 0.02) and 5 year overall survival (OS) (OR 3.08, 95% CI 1.15−8.23, p = 0.02) in comparison with those that were not submitted to LT. Conclusions: Patients with HCC beyond the listing criteria undergoing downstaging presented a higher drop-out rate in comparison with those with HCC within the listing criteria. However, the two groups did not present significant differences in 1, 3 and 5 year survival rates based on an ITT analysis. Patients with HCC beyond the listing, when successfully downstaged and transplanted, presented longer 3 and 5-year OS in comparison with those who were not transplanted.
局部区域治疗（LRTs）常用于增加肝移植（LT）潜在候选者的数量。本文旨在评估超出列入标准的肝细胞癌（HCC）患者在LT前接受LRTs的疗效。方法：按照PRISMA指南，我们在Medline和Web of Science数据库中检索了2021年5月之前发表的报告。我们纳入了评估考虑接受LT的成年HCC患者并报告意向性治疗（ITT）生存结果的论文。两名评审员独立识别和提取数据并评估论文。分析的结果包括失访率、等待名单上的时间以及LT后1年、3年和5年生存率，并基于ITT分析。结果：文献检索产生了3106条记录，其中11篇论文（1874例患者）符合纳入标准。超出列入标准且成功降期的HCC患者与列入标准内的HCC患者相比，失访率更高（OR 2.05，95%CI 1.45−2.88，p<0.001），从初始评估到LT的时间更长（MD 1.93，95%CI 0.91−2.94，p<0.001）。基于ITT分析，两组LT后的1年、3年和5年生存率没有显著差异。超出列入标准、成功降期然后接受移植的HCC患者与未接受LT的患者相比，3年（OR 3.77，95%CI 1.26−11.32，p = 0.02）和5年总生存期（OS）更长（OR 3.08，95%CI 1.15−8.23，p = 0.02）。结论：与列入标准内的HCC患者相比，超出列入标准接受降期治疗的HCC患者失访率更高。然而，基于ITT分析，两组在1年、3年和5年生存率方面没有显著差异。超出列入标准的HCC患者成功降期并接受移植后，与未接受移植的患者相比，3年和5年OS更长。
