Zakeri Nekisa, Sundareyan Ramanivas, Cain Owen, Good James, Shah Tahir, Shetty Shishir
National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.
Department of Hepatology and Liver Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
BJC Rep. 2025 May 20;3(1):36. doi: 10.1038/s44276-025-00136-3.
Stereotactic ablative radiotherapy (SABR) has emerged as a new treatment modality for hepatocellular carcinoma (HCC). Evaluation of tumour responses following SABR are currently based on conventional radiological criteria used for locoregional therapies. Whether these criteria accurately reflect tumour responses following SABR remains unknown. In this study, we provide a direct comparison of post-SABR radiological evaluation and explant histology for patients with HCC who underwent bridging SABR prior to liver transplantation.
Patients with HCC who received SABR as bridging therapy prior to liver transplantation (January 2016-December 2022) in a large UK liver transplant centre were included. Post-SABR imaging was reported by two specialist hepato-pancreato-biliary radiologists, and histological examination of the explanted liver was performed by experienced liver histopathologists.
Six patients with residual active HCC received SABR as bridging therapy prior to undergoing liver transplantation in our cohort. Of five patients with viable HCC detected on explant histology, recent radiological evaluation using LI-RADS treatment response criteria had suggested no evidence of residual active HCC for three patients, difficulty delineating residual disease from post-radiotherapy changes for one patient, and accurately identified viable tumour in one patient.
In our case series conventional radiological criteria underestimated HCC tumour viability following SABR compared to explant histology. As the role for SABR expands in the management of HCC, caution is needed with radiological interpretation of HCC responses to radiotherapy using standard LI-RADS criteria. Prospective study in a larger cohort is required to identify radiological criteria capable of more conclusively evaluating HCC responses to SABR.
立体定向消融放疗（SABR）已成为肝细胞癌（HCC）的一种新治疗方式。目前，SABR后肿瘤反应的评估基于用于局部区域治疗的传统放射学标准。这些标准是否能准确反映SABR后的肿瘤反应仍不清楚。在本研究中，我们对接受肝移植前进行桥接SABR的HCC患者的SABR后放射学评估与切除组织病理学进行了直接比较。
纳入在英国一家大型肝移植中心于2016年1月至2022年12月期间接受SABR作为肝移植前桥接治疗的HCC患者。SABR后的影像学检查由两名专业的肝胰胆放射科医生报告，切除肝脏的组织学检查由经验丰富的肝脏组织病理学家进行。
在我们的队列中，6例有残留活性HCC的患者在接受肝移植前接受了SABR作为桥接治疗。在外植组织学检查中检测到的5例有存活HCC的患者中，根据LI-RADS治疗反应标准进行的近期放射学评估显示，3例患者无残留活性HCC的证据，1例患者难以将残留疾病与放疗后改变区分开来，1例患者准确识别出存活肿瘤。
在我们的病例系列中，与外植组织病理学相比，传统放射学标准低估了SABR后HCC肿瘤的存活情况。随着SABR在HCC管理中的作用扩大，使用标准LI-RADS标准对HCC放疗反应进行放射学解释时需要谨慎。需要在更大的队列中进行前瞻性研究，以确定能够更确凿地评估HCC对SABR反应的放射学标准。
