Varma Vibha, Nekarakanti Phani K, Agarwal Shaleen, Dey Rajesh, Gupta Subash
Max Centre for Liver and Biliary Sciences, Max Super Specialty Hospital, Saket, New Delhi 110017, India.
J Clin Exp Hepatol. 2025 May-Jun;15(3):102490. doi: 10.1016/j.jceh.2024.102490. Epub 2024 Dec 19.
Locoregional therapy (LRT) in patients with hepatocellular carcinoma (HCC) before liver transplantation (LT) has a role in improving the tumor biology and post-LT survival outcome apart from downstaging and bridging. We retrospectively analyzed our database of adult living donor liver transplants (LDLT) for HCC, to compare the survival outcomes in Group-1 (upfront-LT, HCC within Milan/UCSF/AFP<1000 ng/ml) and Group-2 (LT post-LRT, HCC beyond UCSF/irrespective of tumor burden with AFP>1000 ng/ml). We also explored the risk factors for recurrence on follow-up.
A study group (n = 506, Group-1-348, Group-2 = 158) of patients with HCC who underwent LDLT between July 2006 and December 2022, excluding incidental HCC (n = 42), patients with other histology (n = 13) and in-hospital mortality (n = 43), were analyzed. Study cohort (n = 341), after propensity score matching, was analyzed for survival outcomes (overall survival, OS and disease-free survival, DFS) and risk factors for recurrence between Group-1 (n = 156) and Group-2 (n = 158).
Group-2 exhibited a trend towards better mean OS and DFS compared to Group-1 (OS-133 vs. 107-months, = NS, DFS-118 vs. 102-months, = NS). Long-term OS (10-year) for those within Milan and UCSF criteria was superior in Group-2, = NS. Complete pathological response (cPR) after LRT (46.8%), significantly improved OS and DFS compared to those with partial response and stable disease; 152 vs. 94 vs. 49 months, = 0.001, and 147 vs. 75 vs. 41 months, = 0.006, respectively. Recipient age, size of tumor, and pre-LT serum alpha-fetoprotein (AFP) were independent predictors of cPR. Independent risk factors for recurrence included pre-LT AFP, tumors beyond UCSF, perineural invasion, and high-grade tumors.
Locoregional therapy in HCC offers significantly better OS and DFS in those who had a complete pathological response. Risk factors for recurrence post-LT were AFP level, beyond UCSF tumors, and high-grade HCC with PNI on histology.
肝细胞癌（HCC）患者在肝移植（LT）前进行局部区域治疗（LRT），除了能使肿瘤降期和起到桥接作用外，还在改善肿瘤生物学特性及肝移植后生存结局方面发挥作用。我们回顾性分析了我们的成人活体供肝肝移植（LDLT）治疗HCC的数据库，以比较第1组（直接肝移植，米兰/加州大学旧金山分校标准内的HCC/甲胎蛋白[AFP]<1000 ng/ml）和第2组（LRT后肝移植，超出加州大学旧金山分校标准的HCC/无论肿瘤负荷且AFP>1000 ng/ml）的生存结局。我们还探讨了随访复发的危险因素。
对2006年7月至2022年12月期间接受LDLT的HCC患者研究组（n = 506，第1组 = 348，第2组 = 158）进行分析，排除意外发现的HCC（n = 42）、其他组织学类型患者（n = 13）和院内死亡患者（n = 43）。对倾向评分匹配后的研究队列（n = 341）分析第1组（n = 156）和第2组（n = 158）之间的生存结局（总生存，OS和无病生存，DFS）及复发危险因素。
与第1组相比，第2组的平均OS和DFS有更好的趋势（OS - 133对107个月，P = 无显著性差异，DFS - 118对102个月，P = 无显著性差异）。米兰和加州大学旧金山分校标准内患者的长期OS（10年）在第2组中更优，P = 无显著性差异。LRT后完全病理缓解（cPR）（46.8%）与部分缓解和病情稳定的患者相比，显著改善了OS和DFS；分别为152对94对49个月，P = 0.001，以及147对75对41个月，P = 0.006。受者年龄、肿瘤大小和肝移植前血清甲胎蛋白（AFP）是cPR的独立预测因素。复发的独立危险因素包括肝移植前AFP、超出加州大学旧金山分校标准的肿瘤、神经周围侵犯和高级别肿瘤。
HCC的局部区域治疗在获得完全病理缓解的患者中提供了显著更好的OS和DFS。肝移植后复发的危险因素是AFP水平、超出加州大学旧金山分校标准的肿瘤以及组织学上伴有神经周围侵犯的高级别HCC。
