Liver cancer understaging in liver transplantation in the current era of radiologic imaging and newer generation locoregional therapies  

作　　者：Hannah M.Lee Donna McClish Binu V.John Sarah Winks Ryan Clayton Somaya Albhaisi Allawy Allawy Samarth Patel Emma C.Fields Scott Matherly Brian Strife Chandra Bhati Amit Sharma Richard K.Sterling 

机构地区：[1]Division of Gastroenterology,Hepatology,and Nutrition,Department of Medicine,Virginia Commonwealth University,Richmond,VA 23298,USA [2]Department of Biostatistics,Virginia Commonwealth University,Richmond,VA 23298,USA [3]Division of Digestive Health and Liver Disease,University of Miami,and Division of Gastroenterology and Hepatology,Miami VA Health System,Miami,FL 33125,USA [4]Department of Radiology,Virginia Commonwealth University,Richmond,VA 23298,USA [5]Department of Internal Medicine,Virginia Commonwealth University,Richmond,VA 23298,USA [6]Central Virginia Veterans Health Care System,Richmond,VA 23249,USA [7]Department of Radiation Oncology,Virginia Commonwealth University,Richmond,VA 23298,USA [8]Division of Interventional Radiology,Department of Radiology,Virginia Commonwealth University,Richmond,VA 23298,USA [9]Hume-Lee Transplant Center,Virginia Commonwealth University,Richmond,VA 23298,USA

出　　处：《Hepatoma Research》2022年第1期233-247,共15页肝癌研究（英文版）

摘　　要：Background:Discordance in hepatocellular carcinoma(HCC)staging between pre-transplant imaging and explant pathology is associated with an increased risk of recurrence and death.Our aim was to evaluate variables that predicted concordance/discordance in the era of new generation locoregional therapies(LRT)and improved radiologic technology in diagnosis.Methods:A single-center retrospective study was performed on patients who received a liver transplant for HCC between 2008-2019.Pre-and post-LT variables,including type of LRT,downstaging(DS),transplant time period,and radiologic response to LRT,were analyzed for concordance/discordance.Kaplan-Meier analysis was used to assess post-LT survival.Results:Of 146 patients transplanted within Milan Criteria(MC),discordance rates(understaged)were 45%.Discordance was associated with≥3 HCC lesions at diagnosis but not newer generation LRT(transarterial radioembolization/stereotactic body radiation therapy),traditional LRT or combination.No differences in discordance were seen between transplant periods(2008-2013 vs.2014-2019),but those within MC in the earlier period had higher concordance rates.A trend was observed between DS and discordance.Conclusion:HCC stage discordance remains common and poorly predictable.Discordance was associated with three or more HCC lesions at the time of diagnosis.Patients within MC transplanted between 2008-2013 was associated with concordance,while a trend was noted between DS and discordance.No other pre-or post-LT variables predicted discordance/concordance.Discordance was associated with decreased survival.

关 键 词：Hepatocellular carcinoma understaging liver transplant RADIOEMBOLIZATION stereotactic body radiation therapy(SBRT) 

分 类 号：R73[医药卫生—肿瘤]