肝细胞癌和移植后预后的放射学-组织学差异：博洛尼亚大学23年单中心研究

IF 3.8 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2025-09-01 DOI:10.1016/j.dld.2025.08.016

E. Prosperi , M. Serenari , L. Vinella , C. Bonatti , G. Fallani , A. Stocco , E. Prosperi , L. Braccischi , M. Taninokuchi , B. Stefanini , D. Malvi , A. D'Errico , F. Tovoli , C. Mosconi , F. Piscaglia , P. Pianta , M.C. Morelli , M. Ravaioli , M. Cescon

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引用次数: 0

摘要

肝移植前准确的肝细胞癌（HCC）放射学分期对患者的选择至关重要。本研究旨在评估放射学-组织学不一致对无复发生存期（RFS）和总生存期（OS）的影响。方法：我们进行了一项单中心回顾性研究，对2000年至2023年局部治疗后肝细胞癌患者进行了肝移植。仅包括外植体组织学上的结节数量等于或大于最后一次lt前成像的病例。患者分为三组：一致性组（相同结节数）；1-2个结节不一致；不一致≥3个结节。采用多变量Cox模型分析OS和RFS。结果499例LTs中，一致性216例（43.3%），1 ~ 2个结节不一致205例（41.1%），≥3个结节不一致78例（15.6%）。诊断时，96例患者（19.4%）未达到米兰标准（Milan- out， MO）；28.9%的MO患者表现出≥3个结节的不一致性。术后中位随访时间为7.1年（95% CI 7.0-8.2）。在RFS分析中，1-2个和≥3个结节的不一致性与复发风险增加相关（HR 2.97, 95% CI 1.53-5.77, p = 0.001,HR 6.84, 95% CI 3.41-13.57, p < 0.001）。在OS分析中，只有不一致性≥3个结节增加死亡风险（HR 1.84, 95% CI 1.16-2.93, p = 0.009）。多变量分析证实不一致性≥3个结节是OS的独立危险因素（HR 1.70, 95% CI 1.10-2.60, p = 0.015）。结论影像学-组织学不一致对肝细胞癌肝移植患者的RFS和OS均有显著影响。≥3个病变不一致是复发和死亡的独立预测因子。

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Radiological–Histological Discrepancy in Hepatocellular Carcinoma and Post-Transplant Outcomes: A 23-Year Single-Centre Study from the University of Bologna

Introduction

Accurate radiological staging of hepatocellular carcinoma (HCC) before liver transplantation (LT) is important for appropriate patient selection. This study aimed to evaluate the impact of radiological–histological discordance on recurrence-free survival (RFS) and overall survival (OS).

Methods

We performed a single-centre retrospective study of LTs for HCC performed between 2000 to 2023 after locoregional therapy. Only cases in which the number of nodules on explant histology was equal to or greater than that on the last pre-LT imaging were included. Patients were stratified into three groups: concordance (identical nodule count); discordance of 1–2 nodules; and discordance of ≥3 nodules. OS and RFS were analysed with multivariable Cox models.

Results

Among 499 LTs, 216 (43.3 %) showed concordance, 205 (41.1 %) had a discordance of 1–2 nodules, and 78 (15.6 %) had a discordance of ≥3 nodules. At diagnosis, 96 patients (19.4 %) were outside the Milan criteria (Milan-Out, MO); 28.9 % of MO patients exhibited a discordance of ≥3 nodules. Median post-LT follow-up was 7.1 years (95 % CI 7.0–8.2). At RFS analysis, discordance of 1–2 and ≥3 nodules was associated with an increased risk of recurrence (HR 2.97, 95 % CI 1.53–5.77, p = 0.001, and HR 6.84, 95 % CI 3.41–13.57, p < 0.001, respectively). In OS analysis, only discordance ≥3 nodules increased mortality risk (HR 1.84, 95 % CI 1.16–2.93, p = 0.009). Multivariable analysis confirmed discordance ≥3 nodules as an independent risk factor for OS (HR 1.70, 95 % CI 1.10–2.60, p = 0.015).

Conclusions

Radiological–histological discordance significantly impacts both RFS and OS in patients undergoing LT for HCC. A discordance of ≥3 lesions is an independent predictor of recurrence and mortality.

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.