Berardi Giammauro, Guglielmo Nicola, Cucchetti Alessandro, Usai Sofia, Colasanti Marco, Meniconi Roberto Luca, Ferretti Stefano, Mariano Germano, Angrisani Marco, Sciuto Rosa, Di Stefano Federica, Ventroni Guido, Riu Pascale, Giannelli Valerio, Pellicelli Adriano, Lionetti Raffaella, D'Offizi Giampiero, Vennarecci Giovanni, Maritti Micaela, Tritapepe Luigi, Cianni Roberto, Ettorre Giuseppe Maria
Department of General Surgery and Transplantation Unit, San Camillo Forlanini Hospital, Rome, Italy.
Department of Medical Surgical Science and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Transplantation. 2025 Jan 1;109(1):e54-e63. doi: 10.1097/TP.0000000000005204. Epub 2024 Sep 17.
Transarterial radioembolization (TARE) is an effective treatment to control tumor growth and improve survival in hepatocellular carcinoma (HCC). The role of TARE in downstaging patients to liver transplantation (LT) is unclear. The aim of this study was to investigate the downstaging efficacy of TARE for intermediate and advanced HCC.
Intention-to-treat analysis with multistate modeling was performed. Patients moved through 5 health states: (1) from TARE to listing, (2) from TARE to death without listing, (3) from listing to LT, (4) from listing to death without LT, and (5) from transplant to death. Factors affecting the chance of death after TARE were considered to stratify outcomes.
Two hundred fourteen patients underwent TARE. Of those, 43.9% had radiological response, 29.9% were listed, and 22.8% were transplanted. The probability of being alive without LT was 40.5% 1 y after TARE and 11.5% at 5 y. The chance of being listed was 9.4% at 1 y and 0.9% at 5 y. The probability of dying after TARE without LT was 38% at 1 y and 73% at 5 y. The overall survival of patients receiving LT was 61% at 5 y after transplant. Tumor beyond up-to-seven criteria, alfafetoprotein >400 ng/mL, and albumin-bilirubin ≥2 were associated with death. Three risk groups were associated with different response, chances of being listed, and receiving LT. Median survival was 3 y for low-risk, 1.9 y for intermediate-risk, and 9 mo for high-risk patients ( P < 0.001).
In intermediate and advanced HCC, TARE allows for a 44% chance of response, 30% downstaging, and 23% probability of permitting LT. Patient's and tumor's characteristics allow for risk stratification and predict survival from TARE.
经动脉放射性栓塞术（TARE）是控制肝细胞癌（HCC）肿瘤生长和提高生存率的一种有效治疗方法。TARE在使患者病情降期以进行肝移植（LT）方面的作用尚不清楚。本研究的目的是探讨TARE对中晚期HCC的降期疗效。
采用多状态建模进行意向性分析。患者经历5种健康状态：（1）从TARE到列入移植名单，（2）从TARE到未列入名单而死亡，（3）从列入名单到进行肝移植，（4）从列入名单到未进行肝移植而死亡，以及（5）从移植到死亡。考虑影响TARE后死亡几率的因素以对结果进行分层。
214例患者接受了TARE。其中，43.9%有放射学反应，29.9%被列入移植名单，22.8%接受了肝移植。TARE后1年未进行肝移植而存活的概率为40.5%，5年时为11.5%。1年时被列入名单的几率为9.4%，5年时为0.9%。TARE后未进行肝移植而死亡的概率1年时为38%，5年时为73%。接受肝移植患者的5年总生存率为61%。超过七项标准的肿瘤、甲胎蛋白>400 ng/mL以及白蛋白-胆红素≥2与死亡相关。三个风险组与不同的反应、列入名单的几率以及接受肝移植相关。低风险患者的中位生存期为3年，中风险患者为1.9年，高风险患者为9个月（P<0.001）。
在中晚期HCC中，TARE有44%的反应几率、30%的降期几率以及23%的允许进行肝移植的概率。患者和肿瘤的特征可进行风险分层并预测TARE后的生存情况。
