Efficacy and prognosis of DEB-TACE as neoadjuvant therapy before liver transplantation in patients with hepatocellular carcinoma beyond Milan criteria with microvascular invasion
Efficacy and prognosis of DEB-TACE as neoadjuvant therapy before liver transplantation in patients with hepatocellular carcinoma beyond Milan criteria with microvascular invasion
Objective To investigate the efficacy and safety of drug-eluting bead transarterial chemoembolization(DEB-TACE)as neoadjuvant therapy before liver transplantation(LT)in patients with hepatocellular carcinoma(HCC)beyond Milan criteria with microvascular invasion(MVI)and its impact on the prognosis after LT.Methods From May 2016 to December 2022,141 patients with HCC beyond Milan criteria underwent LT.A total of 55 patients with MVI were enrolled in the study and were divided into DEB-TACE before LT group(n=26)and control group(n=29)that did not receive any treatment before LT.The Kaplan-Meier method was utilized to estimate the overall survival(OS)rate and recurrence-free survival(RFS)rate after LT after potential prognostic factors for RFS and OS were identified.Results The objective response rate after DEB-TACE was 88%,and the main adverse event was embolization syndrome.The 1-,2-and 3-year RFS rates in DEB-TACE group(88.5%,79.2%and 73.9%)were higher than control group(69%,50%and 44.4%).The 3-year RFS rate was significantly different between the two groups(χ2=4.428,P=0.035).The 1-,2-and 3-year OS rates in DEB-TACE group(100%,91.7%and 82.6%)were not significantly(χ2=3.224,P=0.073)higher than control group(96.6%,82.1%and 59.3%).Conclusion Preoperative DEB-TACE neoadjuvant therapy can improve the prognosis of LT in patients with HCC beyond Milan criteria with MVI.
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