METHODS: All consecutive cirrhotic patients with HCC enlisted for OLT (2011-2020) at a single center were analyzed. Patients were divided into three LRT modality groups: PEI, TACE, and PEI+TACE. The primary study outcome was waitlist dropout due to tumor progression beyond Milan criteria. A comparison of post-transplant outcomes of patients as stratified by LRT modality also was performed.
RESULTS: One hundred twenty-nine patients were included (PEI=56, TACE=43, PEI+TACE=30). The dropout rate due to tumor progression was not different among the three groups: PEI=8.9%, TACE=14%, PEI+TACE=16.7% (p=0.54). Thirteen (76.4%) patients underwent OLT after successful downstaging (3 [75%] in the PEI group, 5 [83.3%] in the TACE group, and 5 [71.4%] in the PEI+TACE group). For the 96 patients undergoing OLT, 5-year post-transplant recurrence-free survival was PEI=55.6% vs. TACE=55.1% vs. PEI+TACE=71.4% (p=0.42). Complete/near-complete pathological response rate was similar among groups (p=0.82).
CONCLUSIONS: Dropout rates and post-transplant recurrence-free survivals related to PEI were comparable to those of TACE. This study supports the use of PEI alone or in combination with TACE for HCC patients awaiting OLT whenever RFA is not an option.
方法:分析了在单个中心进行OLT(2011-2020)的所有连续肝硬化HCC患者。患者分为三个LRT模式组:PEI,TACE,PEI+TACE。主要研究结果是由于肿瘤进展超过米兰标准而退出候补名单。还比较了按LRT模式分层的患者移植后结果。
结果:纳入了112例患者(PEI=56,TACE=43,PEI+TACE=30)。由于肿瘤进展导致的脱落率在三组之间没有差异:PEI=8.9%,TACE=14%,PEI+TACE=16.7%(p=0.54)。13例(76.4%)患者在成功降期后接受了OLT(PEI组3[75%],5[83.3%]在TACE组中,和5[71.4%]PEI+TACE组)。对于接受OLT的96名患者,移植后5年无复发生存率为PEI=55.6%vs.TACE=55.1%vs.PEI+TACE=71.4%(p=0.42)。各组间完全/接近完全的病理反应率相似(p=0.82)。
结论:与PEI相关的辍学率和移植后无复发生存率与TACE相当。这项研究支持使用PEI单独或与TACE联合用于等待OLT的HCC患者,只要RFA不是一种选择。