肝細胞癌肝移植候選者的局部治療結果

StephenW

肝細胞癌肝移植候選者的局部治療結果

臨床胃腸病學和肝病學

帶回家的信息

    這項研究著眼於美國肝移植 (LT) 等候名單上的肝細胞癌 (HCC) 患者的局部區域治療 (LRT) 的趨勢和結果。分析了 2003 年至 2018 年間接受 HCC MELD 例外的 LT 候選人的數據。在研究期間，接受至少一次 LRT 的患者百分比從 42.3% 增加到 92.4%，化療栓塞是最常見的治療方法。

    接受 LRT 與 HCC 患者退出等候名單的風險較低有關。

– Natasha von Roenn，醫學博士

背景與目標

美國的政策變化延長了肝細胞癌 (HCC) 患者的總體等待時間。我們調查了美國肝移植 (LT) 候選者中使用局部區域治療 (LRT) 和相關候補名單結果的時間趨勢。
方法

從器官採購和移植網絡數據庫中提取了 2003 年至 2018 年列出的接受 HCC 例外的主要成人 LT 候選人的數據。檢查外植體組織學，並使用多變量競爭風險分析來評估 LRT 類型與候補名單退出之間的關聯。
結果

在 24,145 名 LT 候選人中，有 31,609 名符合條件的患者至少有 1 名獲批的 HCC 例外，以及 34,610 次治療。記錄到至少 1 次 LRT 的比例從 2003 年的 42.3% 增加到 2018 年的 92.4%。化學栓塞仍然是最常見的類型，其次是熱消融，放射栓塞從 2013 年的 3% 顯著增加到 2018 年的 19%。在腫瘤負荷超過米蘭標準、甲胎蛋白水平較高和代償性肝病較多的患者中，觀察到 LRT 發生率增加。接受任何類型的輕軌與較低的候補名單退出風險相關；輕軌數量沒有顯著差異。在治療加權調整的逆概率分析中，與化療栓塞相比，作為第一個 LRT 的放射栓塞或消融與降低候補名單退出風險相關。
結論

在全國范圍內患有 HCC 的 LT 候選者的大型隊列中，LRT，尤其是放射栓塞，越來越多地用於過渡到 LT。腫瘤負荷較大的患者和代償性肝病較多的患者在等待 LT 期間接受了更多治療。搭橋輕軌與候補名單退出的風險較低有關。

StephenW

Outcomes of Locoregional Therapy Among Liver Transplant Candidates With Hepatocellular Carcinoma

Clinical Gastroenterology and Hepatology

TAKE-HOME MESSAGE

    This study looked at the trends and outcomes of locoregional therapy (LRT) in patients with hepatocellular carcinoma (HCC) on the liver transplant (LT) waiting list in the US. Data from candidates for LT who received a HCC MELD exception between 2003 and 2018 were analyzed. The percentage of patients receiving at least one LRT increased from 42.3% to 92.4% over the study period, with chemoembolization being the most commonly ordered treatment.

    Receipt of LRT was associated with a lower risk of patients with HCC dropping out of the waiting list.

–  Natasha von Roenn, MD

BACKGROUND & AIMS

Policy changes in the United States have lengthened overall waiting times for patients with hepatocellular carcinoma (HCC). We investigated temporal trends in utilization of locoregional therapy (LRT) and associated waitlist outcomes among liver transplant (LT) candidates in the United States.
METHODS

Data for primary adult LT candidates listed from 2003 to 2018 who received HCC exception were extracted from the Organ Procurement and Transplantation Network database. Explant histology was examined, and multivariable competing risk analysis was used to evaluate the association between LRT type and waitlist dropout.
RESULTS

There were 31,609 eligible patients with at least 1 approved HCC exception, and 34,610 treatments among 24,145 LT candidates. The proportion with at least 1 LRT recorded increased from 42.3% in 2003 to 92.4% in 2018. Chemoembolization remains the most frequent type, followed by thermal ablation, with a notable increase in radioembolization from 3% in 2013 to 19% in 2018. An increased incidence of LRT was observed among patients with tumor burden beyond Milan criteria, higher α-fetoprotein level, and more compensated liver disease. Receipt of any type of LRT was associated with a lower risk of waitlist dropout; there was no significant difference by number of LRTs. In inverse probability of treatment weighting-adjusted analysis, radioembolization or ablation as the first LRT was associated with a reduced risk of waitlist dropout compared with chemoembolization.
CONCLUSIONS

In a large nationwide cohort of LT candidates with HCC, LRT, and in particular radioembolization, increasingly was used to bridge to LT. Patients with greater tumor burden and those with more compensated liver disease received more treatments while awaiting LT. Bridging LRT was associated with a lower risk of waitlist dropout.

StephenW

https://www.cghjournal.org/article/S1542-3565(21)00830-2/fulltext