Трансартериальная химиоэмболизация в комбинированном лечении больных с прогрессированием гепатоцеллюлярного рака в аллотрансплантате печени: клинический случай

Резекция и ортотопическая трансплантация печени считаются радикальными методами лечения больных с гепатоцеллюлярным раком. Однако у 6–20 % пациентов, перенесших трансплантацию печени по поводу гепатоцеллюлярного рака, наблюдается прогрессирование. При этом примерно в 20 % случаев отмечается изолированное поражение аллотрансплантата, а сочетание внутри- и внепеченочного метастазирования наблюдается не менее чем у 30 % больных. На момент выявления прогрессирования ГЦР в аллотрансплантате большинство больных уже не подлежат радикальному лечению из-за наличия мультифокального билобарного поражения печени или внепеченочного метастазирования. Поэтому у них трансартериальная химиоэмболизация (ТАХЭ) может являться эффективным методам лечения, обеспечивая длительный локальный контроль опухолевого процесса в аллотрансплантате печени. 

1. EASL Clinical Practice Guidelines. Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236, doi: 10.1016/j.jhep.2018.03.019.

2. Tang A, Hallouch O, Chernyak V. et al. Epidemiology of hepatocellular carcinoma: target population for surveillance and diagnosis. In: Abdominal Radiology. Vol. 43, Springer New York LLC. 2018:13-25. doi: 10.1007/s00261-017-1209.

3. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology (Baltimore, MD). 2003;37(2):429–42, doi: 10.1053/jhep.2003.50047.

4. Maluccio M, Covey A. Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma. CA cancer j clin. 2012;62(6):394–9, doi: 10.3322/caac.21161.

5. Welling TH., Eddinger K , Carrier K. et al. Multicenter Study of Staging and Therapeutic Predictors of Hepatocellular Carcinoma Recurrence following Transplantation Liver Transpl. 2018 September; 24(9): 1233–1242. doi:10.1002/lt.25194.

6. Alshahrani AA, Ha SM, Hwang S. et al. Clinical Features and Surveillance of Very Late Hepatocellular Carcinoma Recurrence After Liver Transplantation. Ann Transplant. 2018 Sep 21;23:659-665. doi: 10.12659/AOT.910598.

7. Samuel D and Coilly A, Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation, BMC Medicine (2018) 16:113, doi: 10.1186/s12916-018-1110-y.

8. Au KP, Chok KSH. Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: A proposed management algorithm, World J Gastroenterol 2018 December 7; 24(45): 5081-5094, doi: 10.3748/wjg.v24.i45.5081.

9. Foerster F, Hoppe-Lotichius M, Vollmar J, Long-term observation of hepatocellular carcinoma recurrence after liver transplantation at a European transplantation centre, United European Gastroenterology Journal 2019, Vol. 7(6) 838–849, doi: 10.1177/205064061984022119.

10. Sapisochin G, Bruix J. Liver transplantation for hepatocellular carcinoma: outcomes and novel surgical approaches. Nat Rev Gastroenterol Hepatol. 2017 Apr;14(4):203-217. doi: 10.1038/nrgastro.2016.193.

11. Maccali C, Chagas AL, Boin I. Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Prognostic and predictive factors of survival in a Latin American cohort, Liver Int. 2021 Apr;41(4):851-862. doi: 10.1111/liv.14736

12. Karakaya E, Akdur A, Soy EA. et al. Treatment of Posttransplant Hepatocellular Carcinoma Recurrence, Experimental and Clinical Transplantation (2022) 1:59-61 DOı: 10.6002/ect.2021.0450.

13. Davis E, Wiesner R, Valdecasas J. et al: Treatment of recurrent hepatocellular carcinoma after liver transplantation. Liver Transpl, 2011; 17(Suppl. 2): S162–66, doi: 10.1002/lt.22361.

14. de’Angelis N, Landi F, Carra MC, Azoulay D. Managements of recurrent hepatocellular carcinoma after liver transplantation: a systematic review. World J Gastroenterol. 2015;21(39):11185-98, doi: 10.3748/wjg.v21.i39.11185.

15. Pomfret EA, Washburn K, Wald C. et al. Report of a national conference on liver allocation in patients with hepatocellular carcinoma in the United States. Liver Transpl. 2010;16(3):262-78, doi: 10.1002/lt.21999.

16. Yao FY, Mehta N, Flemming J. et al. Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria. Hepatology. 2015;61(6):1968-77, doi: 10.1002/hep.27752

17. Levi DM, Tzakis AG, Martin P, et al. Liver transplantation for hepatocellular carcinoma in the model for end-stage liver disease era. J Am Coll Surg. 2010;210(5):727-34, doi: 10.1016/j.jamcollsurg.2010.01.007.

18. Zheng J, Cai J, Tao L. et al. Comparison on the efficacy and prognosis of different strategies for intrahepatic recurrent hepatocellular carcinoma: A systematic review and Bayesian network meta-analysis, International Journal of Surgery 83 (2020) 196–204, doi: 10.1016/j.ijsu.2020.09.031.

19. Jeon MY, Kim HS, Lim TS. et al. Refractoriness to transarterial chemoembolization in patients with recurrent hepatocellular carcinoma after curative resection. PloS one. 2019;14(4):e0214613, doi: 10.1371/journal.pone.0214613.

20. Koh PS, Chan AC, Cheung TT. et al. Efficacy of radiofrequency ablation compared with transarterial chemoembolization for the treatment of recurrent hepatocellular carcinoma: a comparative survival analysis. HPB (Oxford). 2016;18(1):72–8, doi: 10.1016/j.hpb.2015.07.005.

21. Liu Y, Ren Y, Ge S. et al. Transarterial Chemoembolization in Treatment-Naïve and Recurrent Hepatocellular Carcinoma: A Propensity-Matched Outcome and Risk Signature Analysis. Frontiers in oncology. 2021;11:662408, doi: 10.3389/fonc.2021.662408.

22. Ko HK, Ko GY, Yoon HK, Sung KB. Tumor response to carcinoma after living donor liver transplantation. Korean J Radiol 2007; 8: 320-327, doi: 10.3348/kjr.2007.8.4.320.

23. Zhou B, Shan H, Zhu KS. et al. Chemoembolization with lobaplatin mixed with iodized oil for unresectable recurrent hepatocellular carcinoma after orthotopic liver transplantation. J Vasc Interv Radiol 2010; 21: 333-338, doi: 10.1016/j.jvir.2009.11.006

24. Llovet JM, Real MI, Montana X. et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002; 359(9319):1734–9, doi: 10.1016/S0140-6736(02)08649-X.

25. Bruix J, Reig M, Sherman M. Evidence-Based Diagnosis, Staging, and Treatment of Patients With Hepatocellular Carcinoma. Gastroenterology. 2016 Apr;150(4):835-53. doi: 10.1053/j.gastro.2015.12.041.

26. Bruix J, Takayama T, Mazzaferro V. et al. Adjuvant sorafenib for hepatocellular carcinoma after resection or ablation (STORM): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2015; 16(13):1344–54, doi: 10.1016/S1470-2045(15)00198-9.

27. Huang J, Yan L, Cheng Z. et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Annals of surgery. 2010; 252(6):903–12, doi: 10.1097/SLA.0b013e3181efc656.

28. Shim JH, Kim KM. et al. Complete necrosis after transarterial chemoembolization could predict prolonged survival in patients with recurrent intrahepatic hepatocellular carcinoma after curative resection. Ann Surg Oncol. 2010;17(3):869–77, doi: 10.1245/s10434-009-0788-7.

29. Kim DS, Lim TS, Jeon MY. et al. Transarterial Chemoembolization in Treatment-Naïve and Recurrent Hepatocellular Carcinoma: A Propensity-Matched Outcome Analysis. Dig Dis Sci.2019;64(12):3660–8, doi: 10.1007/s10620-019-05701-8.

30. Sapisochin G, Goldaracena N, Astete S. et al. Benefit of treating hepatocellular carcinoma recurrence after liver transplantation and analysis of prognostic factors for survival in a large Euro-American Series. Ann Surg Oncol. 2015;22(7):2286-2294, doi: 10.1245/s10434-014-4273-6.