Bridging and downstaging treatments for hepatocellular carcinoma in patients on the waiting list for liver transplantation

被引:87
作者
Pompili, Maurizio [1 ]
Francica, Giampiero [4 ]
Ponziani, Francesca Romana [1 ]
Iezzi, Roberto [2 ]
Avolio, Alfonso Wolfango [3 ]
机构
[1] Univ Cattolica Sacro Cuore, Dept Internal Med, I-00168 Rome, Italy
[2] Univ Cattolica Sacro Cuore, Dept Bioimaging & Radiol Sci, I-00168 Rome, Italy
[3] Univ Cattolica Sacro Cuore, Transplant Ctr, I-00168 Rome, Italy
[4] Pinetagrande Hosp, Intervent Ultrasound Unit, I-81030 Castelvolturno, Italy
关键词
Hepatocellular carcinoma; Bridging treatment; Downstaging; Liver cirrhosis; Liver transplantation; Liver resection; Waiting list; Waiting time; Dropout rate; RADIOFREQUENCY THERMAL ABLATION; TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION; PERCUTANEOUS ETHANOL INJECTION; TRANSARTERIAL CHEMOEMBOLIZATION; ALPHA-FETOPROTEIN; SURVIVAL BENEFIT; MILAN CRITERIA; SALVAGE TRANSPLANTATION; PATHOLOGICAL CORRELATION; MULTIMODALITY TREATMENT;
D O I
10.3748/wjg.v19.i43.7515
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Several therapeutic procedures have been proposed as bridging treatments for patients with hepatocellular carcinoma (HCC) awaiting liver transplantation (LT). The most used treatments include transarterial chemoembolization and radiofrequency ablation. Surgical resection has also been successfully used as a bridging procedure, and LT should be considered a rescue treatment in patients with previous HCC resection who experience tumor recurrence or post-treatment severe decompensation of liver function. The aims of bridging treatments include decreasing the waiting list dropout rate before transplantation, reducing HCC recurrence after transplantation, and improving post-transplant overall survival. To date, no data from prospective randomized studies are available; however, for HCC patients listed for LT within the Milan criteria, prolonging the waiting time over 6-12 mo is a risk factor for tumor spread. Bridging treatments are useful in containing tumor progression and decreasing dropout. Furthermore, the response to pre-LT treatments may represent a surrogate marker of tumor biological aggressiveness and could therefore be evaluated to prioritize HCC candidates for LT. Lastly, although a definitive conclusion can not be reached, the experiences reported to date suggest a positive impact of these treatments on both tumor recurrence and post-transplant patient survival. Advanced HCC may be downstaged to achieve and maintain the current conventional criteria for inclusion in the waiting list for LT. Recent studies have demonstrated that successfully downstaged patients can achieve a 5-year survival rate comparable to that of patients meeting the conventional criteria without requiring downstaging. (C) 2013 Baishideng Publishing Group Co., Limited. All rights reserved.
引用
收藏
页码:7515 / 7530
页数:16
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