CAJ | 학술논문

BACKGROUND:?Locoregional?therapies?(LRTs)?are?treatments?to?achieve?local?control?of?hepatocellular?carcinoma?(HCC).?Correlation?between?radiologic?response?to?LRT?and?degree?of?induced?tumor?necrosis?is?not?well?understood.?The?aim?of?this?study?was?to?evaluate?different?levels?of?radiologic?response?after?pre-liver?transplant?(LT)?LRT?and?its?correlation?with?percentage?of?tumor?necrosis?on?explanted?histopathology. <br> METHODS:??Institutional?Review?Board?approved?LT?database?was?queried?for?treated?HCC?in?patients?undergoing?LT.?Radiologic?response?was?evaluated?to?predict?tumor?necrosis?in?the?explanted?liver.?Tumor?response?was?evaluated?1?to?3?months?after?LRT?with?computed?tomography?or?MRI?via?Response?Evaluation?Criteria?in?Solid?Tumors?(RECIST),?and?European?Association?for?the?Study?of?the?Liver?(EASL)?guidelines.?LRT?was?repeated?as?needed?until?time?of?LT.?Histological?tumor?necrosis?was?graded?as?complete?(100%),?partial?(50%-99%),?or?poor?(<50%). <br> RESULTS:?Between?2002?and?2011,?128?patients?(97?men?and?31?women)?received?pre-LT?LRT?including?transarterial?therapy?(93),?radiofrequency?ablation?(20),?or?combination?of?both?(15).?The?mean?age?of?the?patients?was?58±9?years.?Their?mean?follow-up?was?35±27?months.?The?median?waitlist?time?was?55?days.?One?hundred?(78%)?patients?had?HCC?within?the?Milan?criteria?at?the?initial?radiologic?diagnosis.?Nineteen?(15%)?of?the?patients?had?complete?tumor?necrosis?on?histopathology?analysis.?Fifty?(39%)?of?the?patients?exhibited?partial?necrosis,?52?(41%)?showed?poor?or?no?necrosis?and?7?(5%)?showed?progressive?disease.?The?overall?pre-LT?radiologic?staging?was?correlated?with?explant?pathology?in?73?(57%)?of?the?patients.?Underestimated?tumor?stage?was?noted?in?49?(38%)?patients,?and?overestimated?tumor?stage?in?6?(5%)?patients.?The?post-LT?3-year?overall?survival?and?disease?free?survival?were?82%?and?80%,?and?the?rates?for?complete?and?partial?tumor?necrosis?were?100%?vs?78%?(P=0.02)?and?100%?vs?75%?(P=0.03),?respectively. <br> CONCLUSIONS:?In?the?current?era,?interpretation?of?radiologic?response?after?LRT?for?HCC?does?not?correlate?accurately?with?histologic?tumor?necrosis.?Total?tumor?necrosis?is?the?goal?of?LRT;?therefore,?evolution?in?its?performance?is?needed.?Similarly,?ways?to?predict?therapy?induced?tumor?necrosis?via?radiological?investigation?need?to?be?improved.