Clinical usefulness of transarterial chemoembolization response prior to liver transplantation as predictor of optimal timing for living donor liver transplantation
Annals of Surgical Treatment and Research
;
: 111-120, 2018.
Article
Dans Anglais
| WPRIM
| ID: wpr-716293
ABSTRACT
PURPOSE:
Response to preoperative transarterial chemoembolization (TACE) has been recommended as a biological selection criterion for liver transplantation (LT). The aim of our study was to identify optimal timing of living donor liver transplantation (LDLT) after TACE based on the TACE response.METHODS:
We performed a retrospective study to assess recurrence in 128 hepatocellular carcinoma (HCC) patients who underwent LDLT following sequential TACE from January 2002 to March 2015 at a single institute. Cox proportional hazard models and Kaplan-Meier analysis were utilized to estimate HCC recurrence and find optimal timing for LDLT.RESULTS:
Seventy-three and 61 patients were divided as the responder and nonresponder, respectively. Multivariate analysis showed independent pre-liver transplantation (pre-LT) predictors of recurrence were larger sized tumor (>3 cm, P = 0.024), nonresponse to TACE (P = 0.031), vascular invasion (P = 0.002), and extrahepatic nodal involvement (P = 0.001). In the 3-month time difference between last pre-LT TACE and LDLT subgroup, TACE responders showed significantly higher adjusted hazard ratio (aHR) of recurrence free survival (aHR, 6.284; P = 0.007), cancer specific survival (aHR, 7.033; P = 0.016), and overall survival (aHR, 7.055; P = 0.005). Moreover, for overall patients and responder groups, the significant time difference between last pre-LT TACE and LDLT was 2 months in the minimum P-value approach.CONCLUSION:
In selected patients who showed good response to pre-LT TACE, a shorter time interval between TACE and LDLT may be associated with higher recurrence free survival, cancer specific survival, and overall survival.
Texte intégral:
Disponible
Indice:
WPRIM (Pacifique occidental)
Sujet Principal:
Récidive
/
Modèles des risques proportionnels
/
Analyse multifactorielle
/
Études rétrospectives
/
Transplantation hépatique
/
Carcinome hépatocellulaire
/
Donneur vivant
/
Estimation de Kaplan-Meier
/
Foie
Type d'étude:
Étude observationnelle
/
Étude pronostique
/
Facteurs de risque
Limites du sujet:
Humains
langue:
Anglais
Texte intégral:
Annals of Surgical Treatment and Research
Année:
2018
Type:
Article
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