PDF(Pubmed)
Abstract：
The outcome of liver transplantation (LT) for hepatocarcinoma (HCC) is strongly influenced by HCC staging, which is based on radiological examinations in a pre-LT setting; concordance between pre-LT radiological and definitive pathological staging remains controversial. To address this issue, we retrospectively analyzed our LT series to assess concordance between radiology and pathology and to explore the factors associated with poor concordance and outcomes. We included all LTs with an HCC diagnosis performed between 2013 and 2018. Concordance (Co group) was defined as a comparable tumor burden in preoperative imaging and post-transplant pathology; otherwise, non-concordance was diagnosed (nCo group). Concordance between radiology and pathology was observed in 32/134 patients (Co group, 24%). The number and diameter of the nodules were higher when nCo was diagnosed, as was the number of pre-LT treatments. Although concordance did not affect survival, more than three pre-LT treatments led to a lower disease-free survival. Patients who met the Milan Criteria (Milan-in patients) were more likely to receive ≥three prior treatments, leading to a lower survival in multi-treated Milan-in patients than in other Milan-in patients. In conclusion, the concordance rate between the pre-LT imaging and histopathological results was low in patients with a high number of nodules. Multiple bridging therapies reduce the accuracy of pre-LT imaging in predicting HCC stages and negatively affect outcomes after LT.
摘要：
肝癌（HCC）的肝移植（LT）的结果受到HCC分期的强烈影响，这是基于LT前设置的放射学检查；LT前放射学和确定的病理分期之间的一致性仍然存在争议。为了解决这个问题，我们回顾性分析我们的LT系列,以评估放射学和病理学之间的一致性,并探讨一致性差和结局的相关因素.我们纳入了2013年至2018年期间进行的所有诊断为HCC的LTs。一致性（Co组）定义为术前成像和移植后病理中具有可比性的肿瘤负荷；否则，诊断为不一致（nCo组）。在32/134例患者中观察到放射学和病理学之间的一致性(Co组，24%)。诊断为nCo时，结节的数量和直径较高，LT前治疗的数量也是如此。虽然一致性并不影响生存，超过三种LT前治疗导致较低的无病生存率。符合米兰标准的患者（米兰患者）更有可能接受3次以上治疗。导致多治疗米兰患者的生存率低于其他米兰患者。总之,在结节数量较多的患者中,LT术前成像与组织病理学结果的一致率较低.多种桥接疗法降低了LT前成像预测HCC分期的准确性，并对LT后的结果产生负面影响。
