在肝细胞癌动脉内治疗期间，经介入锥形束计算机断层扫描检测到的高血供偶然瘤是否会影响等待肝移植患者的治疗计划？
Should Hypervascular Incidentalomas Detected on Per-Interventional Cone Beam Computed Tomography during Intra-Arterial Therapies for Hepatocellular Carcinoma Impact the Treatment Plan in Patients Waiting for Liver Transplantation?
作者信息
Derbel Haytham, Galletto Pregliasco Athena, Mulé Sébastien, Calderaro Julien, Zaarour Youssef, Saccenti Laetitia, Ghosn Mario, Reizine Edouard, Blain Maxime, Laurent Alexis, Brustia Raffaele, Leroy Vincent, Amaddeo Giuliana, Luciani Alain, Tacher Vania, Kobeiter Hicham
机构信息
Medical Imaging Department, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France.
Institut Mondor de Recherche Biomédicale, Inserm U955, Team n° 18, 94010 Creteil, France.
出版信息
Cancers (Basel). 2024 Jun 26;16(13):2333. doi: 10.3390/cancers16132333.
BACKGROUND
Current guidelines do not indicate any comprehensive management of hepatic hypervascular incidentalomas (HVIs) discovered in hepatocellular carcinoma (HCC) patients during intra-arterial therapies (IATs). This study aims to evaluate the prognostic value of HVIs detected on per-interventional cone beam computed tomography (CBCT) during IAT for HCC in patients waiting for liver transplantation (LT).
MATERIAL AND METHODS
In this retrospective single-institutional study, all liver-transplanted HCC patients between January 2014 and December 2018 who received transarterial chemoembolization (TACE) or radioembolization (TARE) before LT were included. The number of ≥10 mm HCCs diagnosed on contrast-enhanced pre-interventional imaging (PII) was compared with that detected on per-interventional CBCT with a nonparametric Wilcoxon test. The correlation between the presence of an HVI and histopathological criteria associated with poor prognosis (HPP) on liver explants was investigated using the chi-square test. Tumor recurrence (TR) and TR-related mortality were investigated using the chi-square test. Recurrence-free survival (RFS), TR-related survival (TRRS), and overall survival (OS) were assessed according to the presence of HVI using Kaplan-Meier analysis.
RESULTS
Among 63 included patients (average age: 59 ± 7 years, H/F = 50/13), 36 presented HVIs on per-interventional CBCT. The overall nodule detection rate of per-interventional CBCT was superior to that of PII (median at 3 [Q1:2, Q3:5] vs. 2 [Q1:1, Q3:3], respectively, < 0.001). No significant correlation was shown between the presence of HVI and HPP ( = 0.34), TR ( = 0.095), and TR-related mortality (0.22). Kaplan-Meier analysis did not show a significant impact of the presence of HVI on RFS ( = 0.07), TRRS (0.48), or OS ( = 0.14).
CONCLUSIONS
These results may indicate that the treatment plan during IAT should not be impacted or modified in response to HVI detection.
背景
当前指南未针对在肝细胞癌（HCC）患者动脉内治疗（IAT）期间发现的肝血管丰富性偶然瘤（HVI）给出任何全面管理建议。本研究旨在评估在等待肝移植（LT）的HCC患者IAT期间，介入时锥形束计算机断层扫描（CBCT）检测到的HVI的预后价值。
材料与方法
在这项回顾性单机构研究中，纳入了2014年1月至2018年12月期间所有在LT前接受过经动脉化疗栓塞术（TACE）或放射性栓塞术（TARE）的肝移植HCC患者。采用非参数Wilcoxon检验比较介入前增强成像（PII）诊断出的≥10 mm HCC数量与介入时CBCT检测到的数量。使用卡方检验研究肝外植体上HVI的存在与预后不良的组织病理学标准（HPP）之间的相关性。使用卡方检验研究肿瘤复发（TR）和TR相关死亡率。采用Kaplan-Meier分析根据HVI的存在评估无复发生存期（RFS）、TR相关生存期（TRRS）和总生存期（OS）。
结果
在纳入的63例患者（平均年龄：59±7岁，男/女=50/13）中，36例在介入时CBCT上显示有HVI。介入时CBCT的总体结节检出率优于PII（中位数分别为3[四分位间距1：2，四分位间距3：5]和2[四分位间距1：1，四分位间距3：3]，<0.001）。HVI的存在与HPP（=0.34）、TR（=0.095）和TR相关死亡率（0.22）之间未显示出显著相关性。Kaplan-Meier分析未显示HVI的存在对RFS（=0.07）、TRRS（0.48）或OS（=0.14）有显著影响。
结论
这些结果可能表明，IAT期间的治疗计划不应因检测到HVI而受到影响或改变。
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