Liver transplantation for hepatocellular carcinoma after successful treatment of macrovascular invasion - a multi-center retrospective cohort study

被引:57
作者
Assalino, Michela [1 ]
Terraz, Sylvain [2 ]
Grat, Michal [3 ]
Lai, Quirino [4 ]
Vachharajani, Neeta [5 ]
Gringeri, Enrico [6 ]
Bongini, Marco Angelo [7 ]
Kulik, Laura [8 ]
Tabrizian, Parissa [9 ]
Agopian, Vatche [10 ]
Mehta, Neil [11 ]
Brustia, Raffaele [12 ]
Vitali, Giulio Cesare [1 ]
Andres, Axel [1 ,13 ]
Berney, Thierry [1 ,13 ]
Mazzaferro, Vincenzo [7 ]
Compagnon, Philippe [1 ,13 ]
Majno, Pietro [14 ]
Cillo, Umberto [6 ]
Chapman, William [5 ]
Zieniewicz, Krzysztof [3 ]
Scatton, Olivier [12 ]
Toso, Christian [1 ,13 ]
机构
[1] Geneva Univ Hosp, Dept Surg, Div Transplantat, Geneva, Switzerland
[2] Geneva Univ Hosp, Dept Radiol, Geneva, Switzerland
[3] Med Univ Warsaw, Dept Gen Transplant & Liver Surg, Warsaw, Poland
[4] Sapienza Univ Hosp Rome, Dept Gen Surg & Organ Transplantat, Rome, Italy
[5] Washington Univ, Dept Gen Surg, Sect Abdominal Organ Transplant, St Louis, MO 63110 USA
[6] Padua Univ Hosp, Dept Surg, Hepatobiliary Surg & Liver Transplantat, Padua, Italy
[7] Univ Milan, Fdn IRCCS Ist Nazl Tumori, Natl Canc Inst, Div Surg & Hepatol, Milan, Italy
[8] Northwestern Mem Hosp, Dept Med, Div Gastroenterol & Hepatol, Chicago, IL 60611 USA
[9] Icahn Sch Med Mt Sinai, Dept Surg, Recanati Miller Transplantat Inst, New York, NY 10029 USA
[10] Univ Calif Los Angeles, David Geffen Sch Med, Dept Surg, Div Liver & Pancreas Transplantat, Los Angeles, CA 90095 USA
[11] Univ Calif San Francisco, Dept Med, Div Gastroenterol, San Francisco, CA 94143 USA
[12] Sorbonne Univ, Pitie Salpetriere Univ Hosp, AP HP, Dept Hepatobiliary & Liver Transplantat Surg, Paris, France
[13] Geneva Univ Hosp, Hepatopancreatobiliary Ctr, Dept Surg, Div Abdominal Surg, Geneva, Switzerland
[14] Reg Hosp Lugano, Dept Surg, Div Gen Surg, Lugano, Switzerland
关键词
downstaging; hepatocellular carcinoma; liver transplantation; locoregional therapy; macrovascular invasion; tumor recurrence; PORTAL-VEIN THROMBOSIS; VASCULAR INVASION; ALPHA-FETOPROTEIN; RESECTION; CHEMOEMBOLIZATION; METAANALYSIS; HEPATECTOMY; MANAGEMENT; SORAFENIB; SURVIVAL;
D O I
10.1111/tri.13586
中图分类号
R61 [外科手术学];
学科分类号
摘要
Macrovascular invasion is considered a contraindication to liver transplantation for hepatocellular carcinoma (HCC) due to a high risk of recurrence. The aim of the present multicenter study was to explore the outcome of HCC patients transplanted after a complete radiological regression of the vascular invasion by locoregional therapies and define sub-groups with better outcomes. Medical records of 45 patients were retrospectively reviewed, and imaging was centrally assessed by an expert liver radiologist. In the 30 patients with validated diagnosis of macrovascular invasion, overall survival was 60% at 5 years. Pretransplant alpha-fetoprotein (AFP) value was significantly different between patients with and without recurrence (P = 0.019), and the optimal AFP cutoff was 10ng/ml (area under curve = 0.78). Recurrence rate was 11% in patients with pretransplant AFP < 10ng/ml. The number of viable nodules (P = 0.008), the presence of residual HCC (P = 0.036), and satellite nodules (P = 0.001) on the explant were also significantly different between patients with and without recurrence. Selected HCC patients with radiological signs of vascular invasion could be considered for transplantation, provided that they previously underwent successful treatment of the macrovascular invasion resulting in a pretransplant AFP < 10 ng/ml. Their expected risk of post-transplant HCC recurrence is 11%, and further prospective validation is needed.
引用
收藏
页码:567 / 575
页数:9
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