Annals of surgery · 2026
Liver Transplantation for Hepatocellular Carcinoma: Prognostic Impact of Complete Pathologic Response and Influence of Treatment Modality-A US National Database Study.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Tran Benjamin, Marino Rebecca, Aziz Justine, DiNorcia Joseph, Torabi Julia, Badran Nadin, Schwartz Myron, Florman Sander, Garcia-Reyes Kirema, Patel Rahul, Kim Edward, Tabrizian Parissa
Аннотация
OBJECTIVE: To establish the significance of complete pathologic response (cPR) on survival and locoregional treatment outcomes in a large US cohort.
BACKGROUND: cPR in hepatocellular carcinoma (HCC) is associated with improved post-liver transplant (LT) outcomes. cPR rates, modality-specific differences, and predictors remain undefined.
MATERIALS AND METHODS: Patients were identified from the United Network for Organ Sharing (UNOS) database (2012-2024). cPR was defined as the absence of a viable tumor on explant pathology. Logistic regression identified predictors of cPR, Fine-Gray models estimated the incidence of cPRand Kaplan-Meier analysis assessed survival.
RESULTS: Among 7398 LT recipients, 2167 (29.3%) achieved cPR. Imaging-pathology concordance was poor (30.5%), with imaging overestimating response in 42.6% of cases (κ=0.17, P<0.001). Longer waitlist time [>18 vs. <6 mo; odds ratio (OR): 1.94, 95% CI: 1.57-2.40], Y-90 (41.2%), and ablation (36.4%) were associated with higher cPR rates than transarterial chemoembolization (24.0%; P<0.001). On multivariable analysis, yttrium-90 (Y-90) [adjusted OR (aOR): 1.89, 95% CI: 1.46-2.05] and ablation (aOR: 1.23, 95% CI: 1.08-1.39) independently increased cPR, whereas greater tumor burden and elevated alpha-fetoprotein reduced cPR. Y-90 benefit was greatest when administered ≤6 months of waitlisting (OR: 2.40, 95% CI: 1.59-3.61) and in all-comer candidates (OR: 1.58, 95% CI: 1.17-3.26). Fine-Gray analysis confirmed the highest cumulative incidence of cPR with Y-90 across transplant eligibility criteria. cPR was associated with improved 5-year overall survival (86.6% vs. 77.4%) and recurrence-free survival (76.9% vs. 63.1%; P<0.001).
CONCLUSIONS: Nearly one-third of LT recipients with HCC achieved cPR, which was associated with improved survival. Y-90 was independently associated with higher cPR rates, particularly when administered early and among patients with higher tumor burden.
BACKGROUND: cPR in hepatocellular carcinoma (HCC) is associated with improved post-liver transplant (LT) outcomes. cPR rates, modality-specific differences, and predictors remain undefined.
MATERIALS AND METHODS: Patients were identified from the United Network for Organ Sharing (UNOS) database (2012-2024). cPR was defined as the absence of a viable tumor on explant pathology. Logistic regression identified predictors of cPR, Fine-Gray models estimated the incidence of cPRand Kaplan-Meier analysis assessed survival.
RESULTS: Among 7398 LT recipients, 2167 (29.3%) achieved cPR. Imaging-pathology concordance was poor (30.5%), with imaging overestimating response in 42.6% of cases (κ=0.17, P<0.001). Longer waitlist time [>18 vs. <6 mo; odds ratio (OR): 1.94, 95% CI: 1.57-2.40], Y-90 (41.2%), and ablation (36.4%) were associated with higher cPR rates than transarterial chemoembolization (24.0%; P<0.001). On multivariable analysis, yttrium-90 (Y-90) [adjusted OR (aOR): 1.89, 95% CI: 1.46-2.05] and ablation (aOR: 1.23, 95% CI: 1.08-1.39) independently increased cPR, whereas greater tumor burden and elevated alpha-fetoprotein reduced cPR. Y-90 benefit was greatest when administered ≤6 months of waitlisting (OR: 2.40, 95% CI: 1.59-3.61) and in all-comer candidates (OR: 1.58, 95% CI: 1.17-3.26). Fine-Gray analysis confirmed the highest cumulative incidence of cPR with Y-90 across transplant eligibility criteria. cPR was associated with improved 5-year overall survival (86.6% vs. 77.4%) and recurrence-free survival (76.9% vs. 63.1%; P<0.001).
CONCLUSIONS: Nearly one-third of LT recipients with HCC achieved cPR, which was associated with improved survival. Y-90 was independently associated with higher cPR rates, particularly when administered early and among patients with higher tumor burden.