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Radiological response and inflammation scores predict tumour recurrence in patients treated with transarterial chemoembolization before liver transplantation

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World Journal of Gastroenterology 2017年第20期23卷 3690-3701页

作者： Daniele Nicolini Andrea Agostini roberto Montalti Federico Mocchegiani Cinzia Mincarelli Alessandra Mandolesi Nicola L Robertson roberto candelari Andrea Giovagnoni Marco Vivarelli Division of Hepatobiliary and Transplant Surgery Department of Experimental and Clinical MedicinePolytechnic University of Marche Division of General and Pediatric Radiology Department of Radiological SciencesPolytechnic University of Marche Division of Interventional Radiology Department of Radiological SciencesPolytechnic University of Marche Division of Pathology Department of PathologyPolytechnic University of Marche Division of Radiology Department of RadiologyMemorial Sloan Kettering Cancer Center

To investigate the prognostic value of the radiological response after transarterial chemoembolization (TACE) and inflammatory markers in patients affected by hepatocellular carcinoma (HCC) awaiting liver transplantation (LT).METHODSWe retrospectively evaluated the preoperative predictors of HCC recurrence in 70 patients treated with conventional (n = 16) or doxorubicin-eluting bead TACE (n = 54) before LT. The patient and tumour characteristics, including the static and dynamic alpha-fetoprotein, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (PLR) measurements, were recorded. Treatment response was classified according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST) and the European Association for the Study of the Liver (EASL) criteria as complete response (CR), partial response (PR), stable disease or progressive disease. After examination of the explanted livers, histological necrosis was classified as complete (100% of the cumulative tumour area), partial (50%-99%) or minimal (< 50%) and was correlated with the preoperative radiological *** to the pre-TACE radiological evaluation, 22/70 (31.4%) and 12/70 (17.1%) patients were beyond Milan and University of San Francisco (UCSF) criteria, respectively. After TACE procedures, the objective response (CR + PR) rates were 71.4% and 70.0% according to mRECIST and EASL criteria, respectively. The agreement between the two guidelines in defining the radiological response was rated as very good both for the overall and target lesion response (weighted k-value: 0.98 and 0.93, respectively). Complete and partial histological necrosis were achieved in 14/70 (20.0%) and 28/70 (40.0%) patients, respectively. Using histopathology as the reference standard, mRECIST criteria correctly classified necrosis in 72.9% (51/70) of patients and EASL criteria in 68.6% (48/70) of cases. The mRECIST non-response to TACE [Exp(b) = 9.2, p = 0.012], exceeding UCSF criteria before

关键词： Liver transplantation Recurrence-free survival Hepatocellular carcinoma Radiological response Locoregional therapies Inflammatory markers Selection criteria

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Doxorubicin-eluting bead vs conventional transcatheter arterial chemoembolization for hepatocellular carcinoma before liver transplantation

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World Journal of Gastroenterology 2013年第34期19卷 5622-5632页

作者： Daniele Nicolini Gianluca Svegliati-Baroni roberto candelari Cinzia Mincarelli Alessandra Mandolesi Italo Bearzi Federico Mocchegiani Andrea Vecchi roberto Montalti Antonio Benedetti Andrea Risaliti Marco Vivarelli Division of Hepatobiliary and Transplant Surgery Department of Gastroenterology and TransplantationPolytechnic University of Marche Division of Gastroenterology Department of Gastroenterology and TransplantationPolytechnic University of Marche Division of Interventional Radiology Department of Radiological SciencesPolytechnic University of Marche Division of Pathology Department of PathologyPolytechnic University of Marche Division of Hepatobiliary and Transplant Surgery Department of Medical and Biological SciencesUniversityof Udine

AIM:To assess the possible effect of two different types of preoperative transcatheter arterial chemoembolization(TACE)on recurrence-free survival after liver transplantation(LT)in patients with hepatocellular carcinoma(HCC)and to analyze the effects of TACE on tumor ***:We retrospectively analyzed the histological features of 130 HCC nodules in 63 native livers removed at *** who received any other type of treatment such as radiofrequency tumor ablation,percutaneous ethanol ablation or who were not treated at all were *** patients in the present study were within the Milan Criteria at the last imaging findings before *** bead TACE(DEB-TACE)was performed in 22patients(38 nodules),and conventional TACE(c-TACE)in 16(25 nodules).Patients’and tumors’characteristics were retrospectively *** performed a pernodule analysis of the explanted livers to establish the mean percentage of necrosis of any nodule treated by TACE(conventional or DEB)and a per-patient analysis to establish the percentage of necrosis in the cumulative tumor area,including 21 nodules not reached by *** and fibrotic changes in the tissue surrounding the tumor nodule were analyzed and categorized as poor/absent,moderate and enhanced ***-and multivariate analysis of risk factors for HCC-recurrence were ***:The number and diameter of the nodules,the time spent on the waiting list and the number of treatments were similar in the two groups.A trend towards higher appropriate response rates(necrosis≥90%)was observed in the DEB-TACE group(44.7%vs32.0%,P=0.2834).The mean percentage of necrosis in the cumulative tumor area was 58.8%±36.6%in the DEB-TACE group and 50.2%±38.1%in the c-TACE group(P=0.4856).Fibrotic and inflammatory reactions surrounding the tumor nodule were markedly more common in the DEB-TACE group(P<0.0001,for both the parameters).The three-year recurrence-free survival was hig

关键词： Liver transplantation Hepatocellular carcinoma Transcatheter arterial chemoembolization Doxorubicin-eluting bead Tumor histology Recurrence-free survival Locoregional therapies

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