局部治疗在肝细胞癌活体肝移植术后存活中的作用——来自一个大容量中心的经验。

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Clinical and Experimental Hepatology Pub Date : 2024-12-19 DOI:10.1016/j.jceh.2024.102490

Vibha Varma, Phani K. Nekarakanti, Shaleen Agarwal, Rajesh Dey, Subash Gupta

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引用次数: 0

摘要

背景：肝移植（LT）前肝细胞癌（HCC）患者的局部治疗（LRT）除了降低分期和桥接外，在改善肿瘤生物学和LT后生存结局方面具有重要作用。我们回顾性分析了肝癌成人活体供肝移植（LDLT）数据库，比较了第一组（前期肝移植，米兰/UCSF/AFP1000 ng/ml内的HCC）的生存结果。我们还探讨了随访中复发的危险因素。方法：对2006年7月至2022年12月期间行LDLT治疗的HCC患者（n = 506, 1-348, 2 = 158）进行研究，排除偶发性HCC （n = 42）、其他组织学患者（n = 13）和住院死亡率（n = 43）。研究队列（n = 341）在倾向评分匹配后，分析第一组（n = 156）和第二组（n = 158）之间的生存结局（总生存期、OS和无病生存期、DFS）和复发危险因素。结果：与1组相比，2组表现出更好的平均OS和DFS （OS-133 vs. 107个月，P = NS, DFS-118 vs. 102个月，P = NS）。在米兰和UCSF标准组，长期OS（10年）优于组2，P = NS。与部分缓解和病情稳定的患者相比，LRT后完全病理缓解（cPR）（46.8%）， OS和DFS显著改善；152月vs. 94月vs. 49月，P = 0.001； 147月vs. 75月vs. 41月，P = 0.006。受体年龄、肿瘤大小和lt前血清甲胎蛋白（AFP）是心肺复苏术的独立预测因子。复发的独立危险因素包括lt前AFP、UCSF以外的肿瘤、神经周围浸润和高级别肿瘤。结论：HCC局部治疗在病理反应完全的患者中提供了明显更好的OS和DFS。肝移植后复发的危险因素是甲胎蛋白水平，超过UCSF肿瘤，组织学上有PNI的高级别HCC。

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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Role of Locoregional Therapy on Survival After Living Donor Liver Transplantation for Hepatocellular Carcinoma--Experience from a High-volume Center

Background

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.

Methods

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).

Results

Group-2 exhibited a trend towards better mean OS and DFS compared to Group-1 (OS-133 vs. 107-months, P = NS, DFS-118 vs. 102-months, P = NS). Long-term OS (10-year) for those within Milan and UCSF criteria was superior in Group-2, P = 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, P = 0.001, and 147 vs. 75 vs. 41 months, P = 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.

Conclusion

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.

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