Radiological response and inflammation scores predict tumour recurrence in patients treated with transarterial chemoembolization before liver transplantation
| Autor: | Alessandra Mandolesi, Roberto Montalti, Andrea Giovagnoni, Andrea Agostini, Nicola L Robertson, Roberto Candelari, Cinzia Mincarelli, Marco Vivarelli, Daniele Nicolini, Federico Mocchegiani |
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| Přispěvatelé: | Nicolini, Daniele, Agostini, Andrea, Montalti, Roberto, Mocchegiani, Federico, Mincarelli, Cinzia, Mandolesi, Alessandra, Robertson, Nicola L, Candelari, Roberto, Giovagnoni, Andrea, Vivarelli, Marco |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Neutrophils Hepatocellular carcinoma medicine.medical_treatment Inflammatory markers 030230 surgery Liver transplantation Locoregional therapies 0302 clinical medicine Retrospective Studie Lymphocytes Multivariate Analysi Neoadjuvant therapy Observer Variation medicine.diagnostic_test Liver Neoplasms Neutrophil Gastroenterology Radiological response Arteries General Medicine Middle Aged Necrosi Magnetic Resonance Imaging Neoadjuvant Therapy Locoregional therapie Treatment Outcome Liver Neoplasm Radiological weapon 030211 gastroenterology & hepatology Female Lymphocyte alpha-Fetoproteins Radiology medicine.symptom Human Blood Platelets medicine.medical_specialty Arterie Carcinoma Hepatocellular Inflammation Disease-Free Survival Necrosis 03 medical and health sciences medicine Humans Retrospective Cohort Study In patient Selection criteria alpha-Fetoprotein Chemoembolization Therapeutic Retrospective Studies Probability business.industry Magnetic resonance imaging Retrospective cohort study medicine.disease Recurrence-free survival Multivariate Analysis Blood Platelet Inflammatory marker Neoplasm Recurrence Local business Tomography X-Ray Computed |
| Zdroj: | World Journal of Gastroenterology |
| Popis: | AIM 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). METHODS 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. RESULTS 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% according 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. CONCLUSION The radiological response and inflammatory markers are predictive of tumour recurrence and allow the proper selection of TACE-treated candidates for LT. |
| Databáze: | OpenAIRE |
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