Optimizing staging for hepatocellular carcinoma before liver transplantation: A retrospective analysis of the UNOS/OPTN database

被引:129
作者
Freeman, Richard B.
Mithoefer, Abigail
Ruthazer, Robin
Nguyen, Khanh
Schore, Anthony
Harper, Ann
Edwards, Erick
机构
[1] Tufts New England Med Ctr, Dept Surg, Div Transplantat, Boston, MA 02111 USA
[2] Massachusetts Gen Hosp, Dept Med, Div Hepatol, Boston, MA 02114 USA
[3] Tufts New England Med Ctr, Inst Clin Res & Hlth Policy Studies, Boston, MA 02111 USA
[4] United Network Organ Sharing, Res Dept, Richmond, VA USA
关键词
D O I
10.1002/lt.20847
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Assignment of liver allocation priority for hepatocellular carcinoma is predicated on accurate imaging staging. We analyzed radiographically defined stage (radiologic stage (RS]) at listing and most recent extension and pathologic stage (PS) data from 789 liver transplant recipients for whom no pretransplant ablative treatment was given. There were no predetermined imaging or pathological protocols in this retrospective analysis of wait list data. Seventy-two (9.1%), 690 (87.5%), and 27 (3.4%) were listed as stage 1, 2 and >2, respectively. Computed tomography (CT) scan alone (46.4%), magnetic resonance image scan alone (37.1%), ultrasound alone (1.3%), and multiple imaging studies (15.2%) were used with no difference in time to transplant for listing or most recent scan among the recipient groups. Overall accuracy (RS = PS) was 44.1% and was not different if original listing RS or most recent RS was used for comparison with PS. No one type of imaging technique had superior accuracy (P = 0.13); however, CT scan used alone or in combination compared to not being used at all, had higher odds of being accurate (odds ratio [OR] 1.38 [1.03-1.84], P = 0.031). In addition, imaging done less than 90 days before transplant had higher odds of being accurate (OR 1.49 [1.06-2.08], P = 0.019) as did RS = 2 or 3 (OR 5.56 [2.70-11.11], P < 0.0001). We observed considerable variation in RS accuracy among the United Network for Organ Sharing and Organ Procurement and Transplantation Network regions that is unexplained. In conclusion, current imaging requirements for IRS prior to liver transplantation are unacceptably inaccurate. Future policy should require more accurate modalities or combinations of techniques.
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页码:1504 / 1511
页数:8
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