Khurana Aman, Chai Nathan, Gibson Amanda, Owen Joseph, Sobieh Ahmed, Hawk Gregory, Lee James
University of California, San Diego, USA.
University of Kentucky, Lexington, USA.
Abdom Radiol (NY). 2025 Jan 25. doi: 10.1007/s00261-025-04811-4.
Liver transplant (LT) is an effective treatment for hepatocellular carcinoma (HCC) in appropriately selected patients. Locoregional therapy (LRT) is often performed to extend a patient's eligibility for LT. Imaging has a modest sensitivity of approximately 40-77% for detecting pathologically viable HCC in post-LRT patients. The impact on overall survival (OS) and disease-free survival (DFS) is unclear. We hypothesize that Liver Imaging Reporting & Data Systems Treatment Response (LI-RADS TR) category is equivalently correlated with long-term survival and overall disease-free progression when compared to explant pathology findings. We additionally hypothesize that neoadjuvant LRT can improve OS and DFS in LT patients initially within MC.
Patients found to have HCC on explant between January 2005 and December 2021 were included. A total of 167 patients were divided into treatment (any pre-LT LRT except for Y-90 therapy) and control (no pre-LT LRT) groups. Of the patients who received pre-LT LRT, imaging studies were reviewed by two abdominal radiologists using 2018 LI-RADS criteria. Statistical analysis was performed using Kaplan-Meier survival curves and Cox proportional hazard models to assess OS and DFS.
No statistically significant difference in OS or DFS (p = 0.23 and p = 0.22 respectively) was initially found. Given significant difference in age between the groups (p < 0.0001), Cox proportional hazard models were used to adjust for age with statistical significance reached for better OS and DFS in the treatment group (p = 0.05 and p = 0.05 respectively). Contrary to our hypothesis, there was no difference between treatment response groups regarding overall survival or disease-free survival, presumably because of low number of HCC recurrences in our patient population (4%).
Despite not reaching statistical significance, LI-RADS TR categorization demonstrates a good interreader agreement (Kappa 0.6), helping radiologists feel comfortable that modest sensitivity of the LI-RADS TR treatment response category for detecting pathologically active malignancy does not confer a negative clinical outcome.
肝移植（LT）是对经过适当选择的肝细胞癌（HCC）患者的一种有效治疗方法。局部区域治疗（LRT）常用于扩大患者接受LT的资格范围。成像对于检测接受LRT治疗后的患者中病理上存活的HCC的灵敏度适中，约为40%-77%。其对总生存期（OS）和无病生存期（DFS）的影响尚不清楚。我们假设，与肝移植病理结果相比，肝脏影像报告和数据系统治疗反应（LI-RADS TR）分类与长期生存和总体无病进展具有同等相关性。我们还假设，新辅助LRT可以改善最初处于米兰标准（MC）内的LT患者的OS和DFS。
纳入2005年1月至2021年12月间肝移植时发现患有HCC的患者。总共167例患者被分为治疗组（除钇-90治疗外的任何LT前LRT）和对照组（未进行LT前LRT）。在接受LT前LRT的患者中，两名腹部放射科医生使用2018年LI-RADS标准对影像研究进行了评估。使用Kaplan-Meier生存曲线和Cox比例风险模型进行统计分析，以评估OS和DFS。
最初未发现OS或DFS有统计学显著差异（分别为p = 0.23和p = 0.22）。鉴于两组之间年龄存在显著差异（p < 0.0001），使用Cox比例风险模型对年龄进行调整后，治疗组的OS和DFS达到统计学显著水平（分别为p = 0.05和p = 0.05）。与我们的假设相反，治疗反应组之间在总生存期或无病生存期方面没有差异，可能是因为我们患者群体中HCC复发的数量较少（4%）。
尽管未达到统计学显著水平，但LI-RADS TR分类显示出良好的阅片者间一致性（Kappa值为0.6），这有助于放射科医生放心，即LI-RADS TR治疗反应分类检测病理上活跃恶性肿瘤的适度灵敏度不会带来负面临床结果。
