Background: The use of neoadjuvant therapies in patients with hepatocellular carcinoma prior to liver transplantation has gained increasing popularity in recent years. To date, there are only limited data investigating the impact of neoadjuvant therapy on post-transplant survival. Methods: In this retrospective study, we evaluated patients with hepatocellular carcinoma who underwent deceased donor or living donor liver transplantation at Jena University Hospital between 2019 and 2023. Comprehensive clinical and pathological variables were systematically analyzed, including correlations between neoadjuvant therapy use, tumor burden and overall survival. Survival outcomes were estimated using the Kaplan–Meier method. Results: A total of 107 patients were included in the analysis, of whom 90 received neoadjuvant therapy prior to transplantation. Treatment modalities comprised SIRT, TACE, liver resection and combined SIRT and TACE. The 1-, 3-, and 5-year OS rates following transplantation were 93.5%, 82.2%, and 79.4%, respectively. Recurrence-free survival at 1, 3, and 5 years was 91.6%, 85.0%, and 83.2%, respectively. Among the various neoadjuvant strategies, SIRT and TACE yielded the highest OS rates. Patients listed outside the transplantation criteria (Milan, UCSF, up-to-seven) at the time of initial diagnosis who underwent SIRT had significantly better OS than those outside the criteria who underwent TACE. In contrast, among patients within the Milan, UCSF and up-to-seven criteria, TACE was associated with superior OS compared with SIRT. Conclusion: The use of neoadjuvant therapies confers a significant survival benefit following liver transplantation in patients with HCC. TACE appears to be most suitable for patients listed within established transplantation criteria, who consequently have a lower tumor burden. In contrast, SIRT is more beneficial for patients with a higher tumor burden and those beyond standard transplantation criteria. A limitation of our study, however, is that the included SIRT cohort comprised only 24 patients, and TACE was preferentially performed in patients with a lower tumor burden, which means that a selection bias cannot be fully excluded. Overall, further studies are required to define the optimal bridging strategies.
背景：近年来，肝细胞癌患者在肝移植前接受新辅助治疗的应用日益普遍。迄今为止，关于新辅助治疗对移植后生存影响的研究数据仍较为有限。方法：本回顾性研究评估了2019年至2023年间在耶拿大学医院接受死亡供体或活体供体肝移植的肝细胞癌患者。系统分析了全面的临床和病理学变量，包括新辅助治疗应用、肿瘤负荷与总生存期之间的相关性。生存结局采用Kaplan-Meier法进行评估。结果：研究共纳入107例患者，其中90例在移植前接受了新辅助治疗。治疗方式包括选择性内放射治疗、经动脉化疗栓塞、肝切除术以及联合选择性内放射治疗与经动脉化疗栓塞。移植后1年、3年和5年总生存率分别为93.5%、82.2%和79.4%；1年、3年和5年无复发生存率分别为91.6%、85.0%和83.2%。在各种新辅助治疗策略中，选择性内放射治疗和经动脉化疗栓塞获得了最高的总生存率。在初诊时超出移植标准（米兰标准、加州大学旧金山分校标准、up-to-seven标准）的患者中，接受选择性内放射治疗者的总生存率显著优于接受经动脉化疗栓塞者。相反，在符合米兰标准、加州大学旧金山分校标准和up-to-seven标准的患者中，经动脉化疗栓塞相较于选择性内放射治疗显示出更优的总生存率。结论：新辅助治疗的应用为肝细胞癌患者肝移植后带来了显著的生存获益。对于符合既定移植标准且肿瘤负荷较低的患者，经动脉化疗栓塞似乎最为适宜；而对于肿瘤负荷较高或超出标准移植标准的患者，选择性内放射治疗更具优势。然而，本研究的局限性在于纳入的选择性内放射治疗队列仅包含24例患者，且经动脉化疗栓塞更倾向于在肿瘤负荷较低的患者中实施，这意味着无法完全排除选择偏倚。总体而言，仍需进一步研究以明确最佳的桥接治疗策略。
肿瘤(癌症)患者之家