Multimodality locoregional treatment strategies for bridging HCC patients before liver transplantation.

IF 0.6 4区医学 Q4 SURGERY

European Surgery-Acta Chirurgica Austriaca Pub Date : 2017-01-01 Epub Date: 2017-09-04 DOI:10.1007/s10353-017-0487-8

Georg P Györi, D Moritz Felsenreich, Gerd R Silberhumer, Thomas Soliman, Gabriela A Berlakovich

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引用次数: 0

Abstract

Background: It is current practice that patients with hepatocellular carcinoma (HCC) listed for liver transplantation should receive locoregional treatment if the suspected waiting time for transplantation is longer than 6 months, even in the absence of prospective randomized data. Aim of this study was the comparison of single versus multimodality locoregional treatment strategies on outcomes after liver transplantation.

Methods: This is a retrospective analysis of 150 HCC patients listed for liver transplantation at our center between 2004 and 2011. Outcomes were analyzed according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) in relation to intention-to-treat and overall survival after liver transplantation.

Results: Overall, 92 patients (63%) were transplanted in this cohort. The intention-to-treat 1‑, 3‑, 5‑year waiting list survival was 80, 59, and 50% respectively. In RFA-(radiofrequency ablative) and TACE-(transarterial chemoembolisation)-based regimens, rates of transplanted patients were comparable (69 vs. 58%, p = ns). No difference was seen in overall survival after liver transplantation when comparing TACE- and RFA-based regimens. Patients receiving multimodality locoregional therapy had lower overall survival after transplantation (p = 0.05).

Conclusion: TACE- and RFA-based regimens showed equal outcomes in terms of transplantation rate, tumor response, and post-transplant survival. Patients in need of more than one treatment modality might identify a cohort with poorer post-transplant survival.

Points of novelty: Direct comparison of TACE and RFA in a multimodality setting, analysis according to mRECIST.

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为肝移植前的桥接型 HCC 患者提供多模式局部治疗策略。

背景：目前的做法是，如果肝细胞癌（HCC）患者等待移植的时间超过6个月，即使没有前瞻性随机数据，也应接受局部治疗。本研究的目的是比较单一与多模式局部治疗策略对肝移植术后疗效的影响：这是一项回顾性分析，研究对象是2004年至2011年间在本中心接受肝移植手术的150名HCC患者。根据改良的实体瘤反应评估标准（mRECIST）分析了肝移植后的意向治疗和总生存率：该队列中共有92名患者（63%）接受了移植。意向治疗后1年、3年和5年的候选生存率分别为80%、59%和50%。在基于RFA（射频消融）和TACE（经动脉化疗栓塞）的治疗方案中，移植患者的比例相当（69%对58%，P = ns）。比较基于TACE和RFA的方案，肝移植后的总生存率没有差异。接受多模式局部治疗的患者移植后总生存率较低（P = 0.05）：结论：基于TACE和RFA的方案在移植率、肿瘤反应和移植后生存率方面显示出相同的结果。需要接受一种以上治疗方式的患者可能是移植后生存率较低的人群。新颖之处：在多模式下直接比较TACE和RFA，根据mRECIST进行分析。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Surgery-Acta Chirurgica Austriaca 医学-外科

CiteScore

1.10

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The journal European Surgery – Acta Chirurgica Austriaca focuses on general surgery, endocrine surgery, thoracic surgery, heart and vascular surgery. Special features include new surgical and endoscopic techniques such as minimally invasive surgery, robot surgery, and advances in surgery-related biotechnology and surgical oncology. The journal especially addresses benign and malignant esophageal diseases, i.e. achalasia, gastroesophageal reflux disease, Barrett’s esophagus, and esophageal adenocarcinoma. In keeping with modern healthcare requirements, the journal’s scope includes inter- and multidisciplinary disease management (diagnosis, therapy and surveillance).