Comparison of survival analysis of the bridging or downstaging and direct transplantation strategies after liver transplantation in hepatocellular carcinoma

Year 2019, Volume: 44 Issue: 4, 1405 - 1411, 29.12.2019

Tuğsan Ballı , Abdullah Ülkü

https://doi.org/10.17826/cumj.552485

Abstract

Purpose: The aim of this study was to investigate the effects of downstaging and bridging treatments on post-transplant survival time in patients with underwent cadaveric liver transplantation hepatocellular carcinoma.

Materials and Methods: 33 patients with hepatocellular carcinoma were included in our study. These patients were divided into three groups as downstagning, bridging and control. While trans-arterial chemo-embolization, trans-arterial radio-embolization, radiofrequency ablation or microwave ablation treatments were applied to the bridging and downstaging groups before transplantation, no treatment was applied to the control group. Kaplan-Meier life analysis was used to calculate survival time after transplantation. 

Results: The mean follow-up time was 37.5 ± 32.1 months. The overall survival rate was 48.5%. The highest survival rates were in the bridging group (54.5%), then in the control group (50.0%) and the lowest survival rate  was in the downstaging group (41.7%). Although there were differences between the groups, statistically significant results could not be obtained.

Conclusion: In this study, it has been concluded that bridging and downstaging methods are effective strategies to keep the patients who will be transplanted with in the Milan Criteria, and survival time in some patients with downstaging group is higher than the average.

Keywords

Bridging treatment, downstaging treatment

Hepatosellüler karsinomada bridging veya downstaging sonrası karaciğer transplantasyonu ile direkt transplantasyon stratejilerinin sağkalım üzerine etkilerinin karşılaştırılması

Abstract

Amaç: Bu çalışmanın amacı kadaverik karaciğer transplantasyonu yapılmış hepatosellüler karsinomalı hastalarda downstaging ve bridging tedavilerinin transplantasyon sonrası sağ kalım süreleri üzerine etkilerini araştırmaktır.

Gereç ve Yöntem: Çalışmamıza hepatosellüler karsinoma tanısı almış ve kadaverik karaciğer transplantasyonu yapılmış 33 hasta dahil edilmiştir. Bu hastalar downstaging, bridging ve kontrol olmak üzere 3 gruba ayrılmıştır. Bridging ve downstaging gruplarına transplantasyon öncesi transarteriyal kemo-embolizasyon, transarteriyal radyo-embolizasyon, radyofrekans ablasyon veya mikrodalga ablasyon tedavileri uygulanırken kontrol grubuna herhangi bir tedavi uygulanmadı. Transplantasyon sonrası sağ kalım süreleri hesaplanırken  Kaplan-Meier yaşam analizi kullanıldı.

Bulgular: Ortalama takip süresi 37,5±32,1 ay olarak hesaplandı. Genel sağ kalım oranı %48,5 idi. En yüksek sağ kalım oranı bridging grubunda (%54,5), daha sonra kontrol grubunda (%50,0) ve en düşük olarak (%41,7) downstaging grubunda olduğu tespit edildi. Her ne kadar gruplar arasında farklılıklar olsa da istatistiksel olarak anlamlı sonuçlar elde edilemedi.

Sonuç: Bu çalışma ile bridging ve downstaging yöntemlerinin transplantasyon yapılacak hepatosellüler karsinomalı hastaları Milan Kriterleri içinde tutmaya yarayan etkili staratejiler olduğu, downstaging yöntemi uygulanan bazı hastalarda sağ kalım sürelerinin ortalamanın üstüne çıktığı sonucu elde edilmiştir. 

Keywords

Bridging tedavi, downstaging tedavi, hepatosesüler karsinoma, transplantasyon

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