■在更晚期肝细胞癌(HCC)中成功降级至米兰标准后,肝移植(LT)的良好结果已被报道。我们的目的是根据米兰标准和加利福尼亚大学旧金山分校降期(UCSF-DS)方案和“所有人”,比较接受局部区域治疗(LRT)之前接受LT的患者的LT后结局。
■这项多中心队列研究包括来自欧洲和拉丁美洲(2000-2018)的在LT之前接受任何LRT的患者。我们排除了甲胎蛋白(AFP)高于1,000ng/ml的患者。进行了HCC复发的竞争风险回归分析,估计子分布危险比(SHR)和相应的95%CIs。
■来自2,441例LT患者,70.1%在LT之前接受LRT(n=1,711)。其中,80.6%在米兰,在UCSF-DS内12.0%,和7.4%的全体成员。UCSF-DS组和所有患者的45.2%(CI34.8-55.8)和38.2%(CI25.4-52.3)成功降期,分别。所有患者的复发风险较高(SHR6.01[p<0.0001]),而UCSF-DS组的复发风险并不明显较高(SHR1.60[p=0.32]),与留在米兰的患者相比。所有的人都表现出更频繁的侵袭性HCC特征和外植体更高的肿瘤负担。在UCSF-DS组中,上市时AFP值≤20ng/ml与较低的复发率(SHR2.01[p=0.006])和较高的生存率相关.然而,无论AFP≤20ng/ml,所有患者的复发率仍然显著较高.
■上市时UCSF-DS方案的患者与米兰成功降级后的患者相比,移植后结果相似。同时,无论对LRT的反应如何,所有患者的复发率较高,生存率较低。此外,在UCSF-DS组中,≤20ng/ml的ALP可能是优化LT候选人选择的新工具。
■本研究已注册为公开公共注册的一部分(NCT03775863)。
■与从上市到移植的米兰标准中保留的组相比,成功降低到传统米兰标准的更多扩展HCC(在UCSF-DS方案中)的患者在LT后的复发率并不高。此外,在UCSF-DS患者组中,在列表中ALP值等于或低于20ng/ml可能是进一步优化LT候选物选择的新工具。
UNASSIGNED: Good outcomes after liver transplantation (LT) have been reported after successfully downstaging to Milan criteria in more advanced hepatocellular carcinoma (HCC). We aimed to compare post-LT outcomes in patients receiving locoregional therapies (LRT) before LT according to Milan criteria and University of California San Francisco downstaging (UCSF-DS) protocol and \'all-comers\'.
UNASSIGNED: This multicentre cohort
study included patients who received any LRT before LT from Europe and Latin America (2000-2018). We excluded patients with alpha-foetoprotein (AFP) above 1,000 ng/ml. Competing risk regression analysis for HCC recurrence was conducted, estimating subdistribution hazard ratios (SHRs) and corresponding 95% CIs.
UNASSIGNED: From 2,441 LT patients, 70.1% received LRT before LT (n = 1,711). Of these, 80.6% were within Milan, 12.0% within UCSF-DS, and 7.4% all-comers. Successful downstaging was achieved in 45.2% (CI 34.8-55.8) and 38.2% (CI 25.4-52.3) of the UCSF-DS group and all-comers, respectively. The risk of recurrence was higher for all-comers (SHR 6.01 [p <0.0001]) and not significantly higher for the UCSF-DS group (SHR 1.60 [p = 0.32]), compared with patients remaining within Milan. The all-comers presented more frequent features of aggressive HCC and higher tumour burden at explant. Among the UCSF-DS group, an AFP value of ≤20 ng/ml at listing was associated with lower recurrence (SHR 2.01 [p = 0.006]) and better survival. However, recurrence was still significantly high irrespective of AFP ≤20 ng/ml in all-comers.
UNASSIGNED: Patients within the UCSF-DS protocol at listing have similar post-transplant outcomes compared with those within Milan when successfully downstaged. Meanwhile, all-comers have a higher recurrence and inferior survival irrespective of response to LRT. Additionally, in the UCSF-DS group, an ALP of ≤20 ng/ml might be a novel tool to optimise selection of candidates for LT.
UNASSIGNED: This
study was registered as part of an open public registry (NCT03775863).
UNASSIGNED: Patients with more extended HCC (within the UCSF-DS protocol) successfully downstaged to the conventional Milan criteria do not have a higher recurrence rate after LT compared with the group remaining in the Milan criteria from listing to transplantation. Moreover, in the UCSF-DS patient group, an ALP value equal to or below 20 ng/ml at listing might be a novel tool to further optimise selection of candidates for LT.