radiological response and inflammation scores predict tumour recurrence in patients treated with transarterial chemoembolization before liver transplantation
to investigate the prognostic value of the radiological response after transarterial chemoembolization (tace) and inflammatory markers in patients affected by hepatocellular carcinoma (hcc) awaiting liver transplantation (lt).
we retrospectively evaluated the preoperative predictors of hcc recurrence in 70 patients treated with conventional (n = 16) or doxorubicin-eluting bead tace (n = 54) before lt. the patient and tumour characteristics, including the static and dynamic alpha-fetoprotein, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (plr) measurements, were recorded. treatment response was classified according to the modified response evaluation criteria in solid tumours (mrecist) and the european association for the study of the liver (easl) criteria as complete response (cr), partial response (pr), stable disease or progressive disease. after examination of the explanted livers, histological necrosis was classified as complete (100% of the cumulative tumour area), partial (50%-99%) or minimal (< 50%) and was correlated with the preoperative radiological findings.
according to the pre-tace radiological evaluation, 22/70 (31.4%) and 12/70 (17.1%) patients were beyond milan and university of san francisco (ucsf) criteria, respectively. after tace procedures, the objective response (cr pr) rates were 71.4% and 70.0% acccording to mrecist and easl criteria, respectively. the agreement between the two guidelines in defining the radiological response was rated as very good both for the overall and target lesion response (weighted k-value: 0.98 and 0.93, respectively). complete and partial histological necrosis were achieved in 14/70 (20.0%) and 28/70 (40.0%) patients, respectively. using histopathology as the reference standard, mrecist criteria correctly classified necrosis in 72.9%(51/70) of patients and easl criteria in 68.6% (48/70) of cases. the mrecist non-response to tace [exp(b) = 9.2, p = 0.012], exceeding ucsf criteria before tace [exp(b) = 4.7, p = 0.033] and a preoperative plr > 150 [exp(b) = 5.9, p= 0.046] were independent predictors of tumour recurrence.
根据tace术前影像学评估，分别有31.4%（22/70）及17.1% （12/70）的患者超出米兰标准及ucsf标准。tace术后，客观反应率（cr pr）为71.4%（mrecist标准）和70.0%（easl标准）。两项指南对于评价总体及靶病灶疗效的一致性非常好（加权k值分别为0.98和0.93）。完全和部分组织学坏死分别达到20.0%（14/70）和40.0%（28/70）。以组织学坏死为参考标准，则mrecist标准和easl标准的评价准确率分别为72.9%（51/70）和68.6%（48/70）。根据mrecist标准评价为tace无响应[exp(b)= 9.2, p = 0.012]、tace术前超出ucsf标准[exp(b) = 4.7, p = 0.033]、外科手术前plr > 150[exp(b) = 5.9, p = 0.046]，均为肿瘤复发的独立预测因素。
the radiological response and inflammatory markers are predictive of tumour recurrence and allow the proper selection of tace-treated candidates for lt.