Outcomes of loco-regional therapy for down-staging of hepatocellular carcinoma prior to liver transplantation

被引:0
作者
Xian-Jie Shi
机构
关键词
hepatocellular carcinoma; tumor down-staging; loco-regional therapy; liver transplantation;
D O I
暂无
中图分类号
R735.7 [肝肿瘤];
学科分类号
100214 ;
摘要
BACKGROUND: The number of loco-regional therapies (LRTs) for hepatocellular carcinoma (HCC) has increased dramatically during the past decade. Many patients with HCC who were beyond the Milan criteria were allowed to receive a liver transplantation (LT) once the HCC was successfully down-staged. This retrospective study aimed to analyze the outcomes of LRTs prior to LT in patients with HCC beyond the Milan criteria. METHODS: We analyzed 56 patients treated from June 2006 to March 2010: 22 met the Milan criteria (T1+T2, 39.3%), 16 had T3 tumors (28.6%), and 11 had T4a tumors (19.6%), while 7 were suspected of tumor vascular invasion (T4b, 12.5%). All patients underwent preoperative LRTs, including transcatheter arterial chemoembolization, radiofrequency ablation, percutaneous ethanol injection, liver resection, and/or microwave coagulation therapy. The number of the patients who were successfully down-staged before LT, the types of LRTs used before LT, and their outcomes after LT were recorded. RESULTS: Eleven patients had necrotic tumors (pT0, 19.6%); 6 had pT1 tumors (10.7%), 22 had pT2 tumors (39.3%), 6 had pT3 tumors (10.7%), 5 had pT4a tumors (8.9%), and 6 had pT4b tumors (10.7%). The histopathologic tumors of 39 patients (69.6%) were down-staged and met the established Milan criteria (pT0-2). Imaging-proven under-staging was present in 5 HCC patients (8.9%) who had tumors involving the intrahepatic venous system. Twenty-three patients (41.1%) had stable HCC and 10 (17.9%) died. The 1-, 3- and 4-year survival rates were 96%, 73% and 61%, respectively, with a mean survival time of 22.29±1.63 months. Six patients died of tumorrecurrence. The 1-, 3- and 4-year recurrence-free survival (RFS) rates were 88%, 75% and 66%, respectively. The 3-year RFS of patients with pT0-2 tumors was 82%, which was markedly greater than that of patients with pT3 tumors (63%, P=0.018) or pT4 tumors (17%, P=0.000). Although the 3-year RFS of patients with pT3 tumors was greater than that of patients with pT4 tumors, the difference was not significant. CONCLUSIONS: Successful down-staging of HCCs can be achieved in the majority of carefully selected patients by LRTs. Importantly, patients who are successfully down-staged and undergo LT may have a higher RFS rate.
引用
收藏
页码:143 / 150
页数:8
相关论文
共 50 条
[31]   Stereotactic ablative radiation therapy prior to liver transplantation in hepatocellular carcinoma [J].
Guarneri, Alessia ;
Franco, Pierfrancesco ;
Romagnoli, Renato ;
Trino, Elisabetta ;
Mirabella, Stefano ;
Molinaro, Luca ;
Rizza, Giorgia ;
Filippi, Andrea Riccardo ;
Carucci, Patrizia ;
Salizzoni, Mauro ;
Ricardi, Umberto .
RADIOLOGIA MEDICA, 2016, 121 (11) :873-881
[32]   Stereotactic ablative radiation therapy prior to liver transplantation in hepatocellular carcinoma [J].
Alessia Guarneri ;
Pierfrancesco Franco ;
Renato Romagnoli ;
Elisabetta Trino ;
Stefano Mirabella ;
Luca Molinaro ;
Giorgia Rizza ;
Andrea Riccardo Filippi ;
Patrizia Carucci ;
Mauro Salizzoni ;
Umberto Ricardi .
La radiologia medica, 2016, 121 :873-881
[33]   Changes in Staging for Hepatocellular Carcinoma after Radiofrequency Ablation Prior to Liver Transplantation as Found in the Explanted Liver [J].
Schroeder, Tobias ;
Sotiropoulos, Georgios C. ;
Molmenti, Ernesto P. ;
Kuehl, Hilmar ;
Cicinnati, Vito R. ;
Schmitz, Klaus J. ;
Kobori, Laszlo ;
Paul, Andreas ;
Mathe, Zoltan .
HEPATO-GASTROENTEROLOGY, 2011, 58 (112) :2029-2031
[34]   Improving prognostication in patients with hepatocellular carcinoma undergoing loco-regional therapy using pre- and post-locoregional therapy scores [J].
Ragesh B. Thandassery ;
Charles A. Lavender ;
Abhilash Perisetti ;
Michael Beheshti .
Abdominal Radiology, 2024, 49 :631-641
[35]   Survival Differences between Milan Criteria after Down-staging and De novo Milan in Living Donor Liver Transplantation for Hepatocellular Carcinoma [J].
Ahn, Chul-Soo ;
Moon, Deok-Bog ;
Lee, Sung-Gyu ;
Hwang, Shin ;
Kim, Ki-Hun ;
Ha, Tae-Yong ;
Song, Gi-Won ;
Jung, Dong-Hwan ;
Park, Gil-Chun ;
Park, Yo-Han ;
Park, Hyung-Woo ;
Jung, Bo-Hyun ;
Kang, Sung-Hwa .
HEPATO-GASTROENTEROLOGY, 2014, 61 (129) :187-191
[36]   Improving prognostication in patients with hepatocellular carcinoma undergoing loco-regional therapy using pre- and post-locoregional therapy scores [J].
Thandassery, Ragesh B. ;
Lavender, Charles A. ;
Perisetti, Abhilash ;
Beheshti, Michael .
ABDOMINAL RADIOLOGY, 2024, 49 (02) :631-641
[37]   Hypoxia and tumor angiogenesis in the era of hepatocellular carcinoma transarterial loco-regional treatments [J].
Petrillo, Mario ;
Patella, Francesca ;
Pesapane, Filippo ;
Suter, Matteo B. ;
Ierardi, Anna M. ;
Angileri, Salvatore A. ;
Floridi, Chiara ;
de Filippo, Massimo ;
Carrafiello, Gianpaolo .
FUTURE ONCOLOGY, 2018, 14 (28) :2957-2967
[38]   Reasons for Dropout from Transcatheter Arterial Chemoembolization (TACE) when Served as a Down-Staging Therapy for Advanced Hepatocellular Carcinoma [J].
Jie, Li ;
Lei Jianyong ;
Wang Wentao ;
Lin Longying ;
Wang Jiaxing ;
Liang, Ma ;
Lunan, Yan .
HEPATO-GASTROENTEROLOGY, 2014, 61 (131) :717-721
[39]   Loco-regional treatment of hepatocellular carcinoma: Role of contrast-enhanced ultrasonography [J].
Inzerillo, Agostino ;
Meloni, Maria Franca ;
Taibbi, Adele ;
Bartolotta, Tommaso Vincenzo .
WORLD JOURNAL OF HEPATOLOGY, 2022, 14 (05) :911-922
[40]   Magnetic Resonance Imaging of the Liver After Loco-Regional and Systemic Therapy [J].
Corona-Villalobos, Celia Pamela ;
Zhang, Yan ;
Zhang, Wei-Dong ;
Kamel, Ihab R. .
MAGNETIC RESONANCE IMAGING CLINICS OF NORTH AMERICA, 2014, 22 (03) :353-+