오늘 하루동안 보지 않기
잠시만 기다려 주세요. 로딩중입니다.

Clinical usefulness of transarterial chemoembolization response prior to liver transplantation as predictor of optimal timing for living donor liver transplantation

Annals of Surgical Treatment and Research 2018년 95권 2호 p.111 ~ 120
KMID : 0371420180950020111
 ( Cho Chan-Woo ) - Yeungnam University College of Medicine Department of Surgery

 ( Choi Gyu-Seong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
 ( Kim Jong-Man ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
 ( Kwon Choon-Hyuck David ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
 ( Kim Doo-Jin ) - Gachon University College of Medicine Gachon University Gil Medical Center Department of Surgery
 ( Joh Jae-Won ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery

Abstract

Purpose: Response to preoperative transarterial chemoembolization (TACE) has been recommended as a biological selection criterion for liver transplantation (LT). The aim of our study was to identify optimal timing of living donor liver transplantation (LDLT) after TACE based on the TACE response.

Methods: We performed a retrospective study to assess recurrence in 128 hepatocellular carcinoma (HCC) patients who underwent LDLT following sequential TACE from January 2002 to March 2015 at a single institute. Cox proportional hazard models and Kaplan-Meier analysis were utilized to estimate HCC recurrence and find optimal timing for LDLT.

Results: Seventy-three and 61 patients were divided as the responder and nonresponder, respectively. Multivariate analysis showed independent pre-liver transplantation (pre-LT) predictors of recurrence were larger sized tumor (>3 cm, P = 0.024), nonresponse to TACE (P = 0.031), vascular invasion (P = 0.002), and extrahepatic nodal involvement (P = 0.001). In the 3-month time difference between last pre-LT TACE and LDLT subgroup, TACE responders showed significantly higher adjusted hazard ratio (aHR) of recurrence free survival (aHR, 6.284; P = 0.007), cancer specific survival (aHR, 7.033; P = 0.016), and overall survival (aHR, 7.055; P = 0.005). Moreover, for overall patients and responder groups, the significant time difference between last pre-LT TACE and LDLT was 2 months in the minimum P-value approach.

Conclusion: In selected patients who showed good response to pre-LT TACE, a shorter time interval between TACE and LDLT may be associated with higher recurrence free survival, cancer specific survival, and overall survival.
KeyWords

Chemoembolization, Liver transplantation, Hepatocellular carcinoma
원문 및 링크아웃 정보
 
등재저널 정보
SCI(E) 학술진흥재단(KCI) KoreaMed 대한의학회 회원