Abstract：
OBJECTIVE: Locoregional therapies (LRT) are employed for bridging patients with hepatocellular carcinoma (HCC) awaiting orthotopic liver transplantation (OLT). Although the main LRT options include transarterial chemoembolization (TACE) and radiofrequency ablation (RFA), percutaneous ethanol injection (PEI) is an alternative with considerably lower costs. This study is a pioneering evaluation of the natural history of PEI bridging to OLT as compared to TACE.
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.
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.
摘要：
目的：局部区域疗法（LRT）用于桥接等待原位肝移植（OLT）的肝细胞癌（HCC）患者。尽管主要的LRT选择包括经动脉化疗栓塞（TACE）和射频消融（RFA），经皮乙醇注射(PEI)是一种成本相当低的替代方法.与TACE相比，这项研究是对PEI与OLT桥接的自然史的开创性评估。
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。
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。
