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

Yıl 2019, Cilt: 44 Sayı: 4, 1405 - 1411, 29.12.2019

Tuğsan Ballı , Abdullah Ülkü

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

Öz

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.

Anahtar Kelimeler

Bridging treatment, downstaging treatment

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

Öz

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. 

Anahtar Kelimeler

Bridging tedavi, downstaging tedavi, hepatosesüler karsinoma, transplantasyon

Kaynakça

• 1. Parikh N.D, Waljee A. K, and Amit G. Singal, Downstaging Hepatocellular Carcinoma:A Systematic Reviewand Pooled Analysis. LıverTransplantatıon 2015: 21:1142–1152
• 2. Mazzaferro V, Llovet J, Miceli R, Bhoori S, Schiavo M, Mariani L, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol 2009;10(1):35-43.
• 3. Sandri G.B., Rayar M, Qi X andLucatelli P. Liver transplant for patients outside Milan criteria Transl Gastroenterol Hepatol2018;3:81
• 4. Rudnick S.P andRusso M W. Liver transplantation beyond or downstaging with in the Milan criteria for hepatocellular carcinoma. Expert Review of Gastroenterology& Hepatology.2018;265-275
• 5. Pompili M, Francica G, Ponziani F R, Iezzi R andAvolio A W. Bridginganddownstagingtreatmentsforhepatocellularcarcinoma in patients on thewaitinglistforlivertransplantation.World J Gastroenterol2013; 19(43): 7515-7530
• 6. Pomfret EA, Washburn K, Wald C, Nalesnik MA, Douglas D, et al. Report of a national conference on liveral location in patients with hepatocellular carcinoma in the United States. LiverTranspl2010; 16: 262-278
• 7. Lewandowski RJ, Kulik LM, Riaz A, Senthilnathan S, Mulcahy MF et al. A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radio embolization.Am J Transplant2009; 9: 1920-1928
• 8. Mennon KV, Hakeem AR, Heaton ND. Reviewarticle: liver transplantation for hepatocellular carcinoma - a critical appraisal of the current worldwide listing criteria. Aliment PharmacolTher. 2014; 40(8):893-902.
• 9. El-Serag HB, Siegel AB, Davila JA, Shaib YH, Cayton-Woody M, McBride R, McGlynn KA. Treatment and outcomes of treating of hepatocellular carcinoma among Medicare recipients in the United States: a population based study. J Hepatol 2006;44:158-166.
• 10. Green TJ, Rochon PJ, Chang S, Ray CE Jr, Winston H et al. Downstaging disease in patients with hepatocellular carcinoma outside of Milan criteria: strategies using drug-eluting bead chemoembolization. J VascIntervRadiol 2013;24:1613-1622.
• 11. Tohme S, Sukato D, Chen HW, Amesur N, Zajko AB, Humar A, et al. Yttrium-90 radioembolization as a bridge to liver transplantation: a single-institution experience. J VascIntervRadiol 2013;24:1632-1638.
• 12. Bova V, Miraglia R, Maruzzelli L, Vizzini GB, Luca A. Predictive factors of downstaging of hepatocellular carcinoma beyond the Milan criteria treated within tra-arterialtherapies. CardiovascInterventRadiol2013; 36: 433-439
• 13. Chapman WC, MajellaDoyle MB, Stuart JE, Vachharajani N, Crippin JS et al. Outcomes of neo adjuvant trans arterial chemo embolization to down stage hepatocellular carcinoma before liver transplantation. AnnSurg2008; 248: 617-625
• 14. Alba E, Valls C, Dominguez J, Martinez L, Escalante E, Lladó L et al. Trans catheter arterial chemoembolization in patients with hepatocellular carcinoma on the waiting list for orthotopic liver transplantation. AJR Am J Roentgenol2008; 190: 1341-1348
• 15. Branco F, Brú C, Vilana R, Bianchi L, Alves de Mattos A. Percutaneouse than olinjection before liver transplantation in th ehepatocellular carcinoma. AnnHepatol2009; 8: 220-227
• 16. Brillet PY, Paradis V, Brancatelli G, Rangheard AS, Consigny Y et al. Percutaneous radio frequency ablation for hepatocellular carcinoma before liver transplantation: a prospective study with histopathologic comparison. AJR Am J Roentgenol2006; 186: S296-S305
• 17. Graziadei IW, Sandmueller H, Waldenberger P, Koenigsrainer A, Nachbaur K et al. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome. LiverTranspl2003; 9: 557-563
• 18. Hayashi PH, Ludkowski M, Forman LM, Osgood M, Johnson S, et al. Hepatic artery chemoembolization for hepatocellular carcinoma in patients listed for liver transplantation. Am J Transplant2004; 4: 782-787
• 19. Cillo U, Vitale A, Volk ML, Frigo AC, Grigoletto F et al. The survival benefit of liver transplantation in hepatocellular carcinoma patients. DigLiverDis2010; 42: 642-649
• 20. De Luna W, Sze DY, Ahmed A, Ha BY, Ayoub W et al. Trans arterial chemoinfusion for hepatocellular carcinoma as downstaging therapy and a bridge to ward liver transplantation. Am J Transplant2009; 9:1158-1168
• 21. Otto G, Herber S, Heise M, Lohse AW, Mönch C et al. Response to trans arterial chemoembolization as a biological selection criteri on for liver transplantation in hepatocellular carcinoma. LiverTranspl2006; 12: 1260-1267