Background: Current guidelines do not indicate any comprehensive management of hepatic hypervascular incidentalomas (HVIs) discovered in hepatocellular carcinoma (HCC) patients during intra-arterial therapies (IATs). This study aims to evaluate the prognostic value of HVIs detected on per-interventional cone beam computed tomography (CBCT) during IAT for HCC in patients waiting for liver transplantation (LT). Material and methods: In this retrospective single-institutional study, all liver-transplanted HCC patients between January 2014 and December 2018 who received transarterial chemoembolization (TACE) or radioembolization (TARE) before LT were included. The number of ≥10 mm HCCs diagnosed on contrast-enhanced pre-interventional imaging (PII) was compared with that detected on per-interventional CBCT with a nonparametric Wilcoxon test. The correlation between the presence of an HVI and histopathological criteria associated with poor prognosis (HPP) on liver explants was investigated using the chi-square test. Tumor recurrence (TR) and TR-related mortality were investigated using the chi-square test. Recurrence-free survival (RFS), TR-related survival (TRRS), and overall survival (OS) were assessed according to the presence of HVI using Kaplan–Meier analysis. Results: Among 63 included patients (average age: 59 ± 7 years, H/F = 50/13), 36 presented HVIs on per-interventional CBCT. The overall nodule detection rate of per-interventional CBCT was superior to that of PII (median at 3 [Q1:2, Q3:5] vs. 2 [Q1:1, Q3:3], respectively,p< 0.001). No significant correlation was shown between the presence of HVI and HPP (p= 0.34), TR (p= 0.095), and TR-related mortality (0.22). Kaplan–Meier analysis did not show a significant impact of the presence of HVI on RFS (p= 0.07), TRRS (0.48), or OS (p= 0.14). Conclusions: These results may indicate that the treatment plan during IAT should not be impacted or modified in response to HVI detection.
背景：目前指南未对肝细胞癌（HCC）患者经动脉介入治疗（IAT）期间发现的肝富血供偶发瘤（HVI）提出系统管理方案。本研究旨在评估等待肝移植（LT）的HCC患者接受IAT期间，介入术中锥形束计算机断层扫描（CBCT）检测到的HVI对预后的预测价值。材料与方法：本回顾性单中心研究纳入2014年1月至2018年12月期间接受肝移植的所有HCC患者，这些患者在移植前均接受过经动脉化疗栓塞（TACE）或放射栓塞（TARE）治疗。通过非参数Wilcoxon检验，比较增强介入前影像（PII）与介入术中CBCT检测到的≥10 mm HCC病灶数量。采用卡方检验分析HVI存在与移植肝标本中不良预后相关组织病理学标准（HPP）之间的相关性。肿瘤复发（TR）及TR相关死亡率同样采用卡方检验分析。根据HVI存在情况，使用Kaplan-Meier法评估无复发生存期（RFS）、TR相关生存期（TRRS）和总生存期（OS）。结果：在纳入的63例患者中（平均年龄59±7岁，男/女=50/13），36例在介入术中CBCT发现HVI。介入术中CBCT总体结节检出率显著优于PII（中位数3[Q1:2, Q3:5] vs. 2[Q1:1, Q3:3]，p<0.001）。HVI存在与HPP（p=0.34）、TR（p=0.095）及TR相关死亡率（p=0.22）均无显著相关性。Kaplan-Meier分析显示HVI存在对RFS（p=0.07）、TRRS（p=0.48）或OS（p=0.14）均无显著影响。结论：这些结果表明，IAT期间的治疗方案可能无需因HVI的检测而调整或改变。
肿瘤(癌症)患者之家