The outcome of liver transplantation (LT) for hepatocarcinoma (HCC) is strongly influenced by HCC staging, which is based on radiological examinations in a pre-LT setting; concordance between pre-LT radiological and definitive pathological staging remains controversial. To address this issue, we retrospectively analyzed our LT series to assess concordance between radiology and pathology and to explore the factors associated with poor concordance and outcomes. We included all LTs with an HCC diagnosis performed between 2013 and 2018. Concordance (Co group) was defined as a comparable tumor burden in preoperative imaging and post-transplant pathology; otherwise, non-concordance was diagnosed (nCo group). Concordance between radiology and pathology was observed in 32/134 patients (Co group, 24%). The number and diameter of the nodules were higher when nCo was diagnosed, as was the number of pre-LT treatments. Although concordance did not affect survival, more than three pre-LT treatments led to a lower disease-free survival. Patients who met the Milan Criteria (Milan-in patients) were more likely to receive ≥three prior treatments, leading to a lower survival in multi-treated Milan-in patients than in other Milan-in patients. In conclusion, the concordance rate between the pre-LT imaging and histopathological results was low in patients with a high number of nodules. Multiple bridging therapies reduce the accuracy of pre-LT imaging in predicting HCC stages and negatively affect outcomes after LT.
肝细胞癌（HCC）肝移植（LT）的预后在很大程度上受HCC分期的影响，而分期主要基于移植前的影像学检查；然而，移植前影像学分期与最终病理分期之间的一致性仍存在争议。为解决这一问题，我们回顾性分析了本中心的肝移植病例系列，以评估影像学与病理学之间的一致性，并探讨与一致性差及预后相关的因素。我们纳入了2013年至2018年间所有诊断为HCC的肝移植病例。一致性（Co组）定义为术前影像学与移植后病理学显示的肿瘤负荷相当；否则诊断为非一致性（nCo组）。在134例患者中，有32例（24%）观察到影像学与病理学结果一致（Co组）。当诊断为非一致性时，结节的数量和直径均较高，移植前治疗次数也更多。尽管一致性本身不影响生存率，但移植前接受超过三次治疗会导致无病生存率降低。符合米兰标准（Milan-in）的患者更可能接受≥三次的移植前治疗，导致这些接受多次治疗的Milan-in患者比其他Milan-in患者的生存率更低。总之，在结节数量较多的患者中，移植前影像学与组织病理学结果的一致性较低。多次桥接治疗降低了移植前影像学预测HCC分期的准确性，并对肝移植后的预后产生负面影响。
肿瘤(癌症)患者之家