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Abstract：
BACKGROUND: Current guidelines do not indicate any comprehensive management of hepatic hypervascular incidentalomas (HVIs) discovered in hepatocellular carcinoma (HCC) patients during intra-arterial therapies (IATs). This study aims to evaluate the prognostic value of HVIs detected on per-interventional cone beam computed tomography (CBCT) during IAT for HCC in patients waiting for liver transplantation (LT).
METHODS: In this retrospective single-institutional study, all liver-transplanted HCC patients between January 2014 and December 2018 who received transarterial chemoembolization (TACE) or radioembolization (TARE) before LT were included. The number of ≥10 mm HCCs diagnosed on contrast-enhanced pre-interventional imaging (PII) was compared with that detected on per-interventional CBCT with a nonparametric Wilcoxon test. The correlation between the presence of an HVI and histopathological criteria associated with poor prognosis (HPP) on liver explants was investigated using the chi-square test. Tumor recurrence (TR) and TR-related mortality were investigated using the chi-square test. Recurrence-free survival (RFS), TR-related survival (TRRS), and overall survival (OS) were assessed according to the presence of HVI using Kaplan-Meier analysis.
RESULTS: Among 63 included patients (average age: 59 ± 7 years, H/F = 50/13), 36 presented HVIs on per-interventional CBCT. The overall nodule detection rate of per-interventional CBCT was superior to that of PII (median at 3 [Q1:2, Q3:5] vs. 2 [Q1:1, Q3:3], respectively, p < 0.001). No significant correlation was shown between the presence of HVI and HPP (p = 0.34), TR (p = 0.095), and TR-related mortality (0.22). Kaplan-Meier analysis did not show a significant impact of the presence of HVI on RFS (p = 0.07), TRRS (0.48), or OS (p = 0.14).
CONCLUSIONS: These results may indicate that the treatment plan during IAT should not be impacted or modified in response to HVI detection.
METHODS: In this retrospective single-institutional study, all liver-transplanted HCC patients between January 2014 and December 2018 who received transarterial chemoembolization (TACE) or radioembolization (TARE) before LT were included. The number of ≥10 mm HCCs diagnosed on contrast-enhanced pre-interventional imaging (PII) was compared with that detected on per-interventional CBCT with a nonparametric Wilcoxon test. The correlation between the presence of an HVI and histopathological criteria associated with poor prognosis (HPP) on liver explants was investigated using the chi-square test. Tumor recurrence (TR) and TR-related mortality were investigated using the chi-square test. Recurrence-free survival (RFS), TR-related survival (TRRS), and overall survival (OS) were assessed according to the presence of HVI using Kaplan-Meier analysis.
RESULTS: Among 63 included patients (average age: 59 ± 7 years, H/F = 50/13), 36 presented HVIs on per-interventional CBCT. The overall nodule detection rate of per-interventional CBCT was superior to that of PII (median at 3 [Q1:2, Q3:5] vs. 2 [Q1:1, Q3:3], respectively, p < 0.001). No significant correlation was shown between the presence of HVI and HPP (p = 0.34), TR (p = 0.095), and TR-related mortality (0.22). Kaplan-Meier analysis did not show a significant impact of the presence of HVI on RFS (p = 0.07), TRRS (0.48), or OS (p = 0.14).
CONCLUSIONS: These results may indicate that the treatment plan during IAT should not be impacted or modified in response to HVI detection.
摘要：
背景：目前的指南没有指出在动脉内治疗（IAT）期间在肝细胞癌（HCC）患者中发现的肝高血管偶发瘤（HVIs）的任何综合管理。这项研究旨在评估IAT期间在等待肝移植（LT）的HCC患者中在每介入锥形束计算机断层扫描（CBCT）上检测到的HVI的预后价值。
方法：在这项回顾性单机构研究中，纳入2014年1月至2018年12月间接受肝动脉化疗栓塞(TACE)或放疗栓塞(TARE)的所有肝移植HCC患者.使用非参数Wilcoxon检验将在对比增强介入前成像（PII）中诊断出的≥10mmHCC的数量与在每次介入CBCT上检测到的数量进行比较。使用卡方检验研究了HVI的存在与肝外植体预后不良（HPP）相关的组织病理学标准之间的相关性。使用卡方检验研究肿瘤复发(TR)和TR相关死亡率。无复发生存率（RFS），TR相关生存（TRRS），根据HVI的存在,使用Kaplan-Meier分析评估总生存期(OS).
结果：在纳入的63名患者中（平均年龄：59±7岁，H/F=50/13),36个在每介入CBCT上呈现的HVI。经介入CBCT的整体结节检出率优于PII（中位数在3[Q1：2，Q3：5]vs.2[Q1:1,Q3:3],分别,p<0.001)。HVI和HPP的存在之间没有显着相关性（p=0.34），TR（p=0.095），和TR相关死亡率（0.22）。Kaplan-Meier分析未显示HVI的存在对RFS的显着影响（p=0.07），TRRS(0.48),或OS(p=0.14)。
结论：这些结果可能表明IAT期间的治疗计划不应因HVI检测而受到影响或修改。
方法：在这项回顾性单机构研究中，纳入2014年1月至2018年12月间接受肝动脉化疗栓塞(TACE)或放疗栓塞(TARE)的所有肝移植HCC患者.使用非参数Wilcoxon检验将在对比增强介入前成像（PII）中诊断出的≥10mmHCC的数量与在每次介入CBCT上检测到的数量进行比较。使用卡方检验研究了HVI的存在与肝外植体预后不良（HPP）相关的组织病理学标准之间的相关性。使用卡方检验研究肿瘤复发(TR)和TR相关死亡率。无复发生存率（RFS），TR相关生存（TRRS），根据HVI的存在,使用Kaplan-Meier分析评估总生存期(OS).
结果：在纳入的63名患者中（平均年龄：59±7岁，H/F=50/13),36个在每介入CBCT上呈现的HVI。经介入CBCT的整体结节检出率优于PII（中位数在3[Q1：2，Q3：5]vs.2[Q1:1,Q3:3],分别,p<0.001)。HVI和HPP的存在之间没有显着相关性（p=0.34），TR（p=0.095），和TR相关死亡率（0.22）。Kaplan-Meier分析未显示HVI的存在对RFS的显着影响（p=0.07），TRRS(0.48),或OS(p=0.14)。
结论：这些结果可能表明IAT期间的治疗计划不应因HVI检测而受到影响或修改。
