Análise do desfecho dos pacientes com carcinoma hepatocelular na lista de espera de transplante de fígado
Arquivos
Data
2024-11-08
Autores
Benini, Bárbara Burza 
Orientadores
Gonzalez, Adriano Miziara
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Correlacionar o desfecho de pacientes portadores de carcinoma hepatocelular (CHC), inscritos para transplante de fígado, com o estadio tumoral e com o tempo de espera em lista. Métodos: Análise de coorte retrospectiva de 2.127 pacientes inscritos em lista de espera para transplante de fígado com doador falecido nas duas regionais da Central de Transplantes da Secretaria de Estado da Saúde de São Paulo (R1 e R2), com situação especial por CHC deferida no período de 1o de janeiro de 2012 a 31 de dezembro de 2020. Os pacientes foram classificados nos estadios T2A, T2B, CM-/CMB+ (além do Critério de Milão por nódulos <2cm), ou downstaging (DS), conforme o número e tamanho dos nódulos hepáticos identificados no exame de imagem submetido para concessão de situação especial. Os desfechos foram classificados em negativo (DN = saída da lista por óbito ou progressão da doença) ou positivo (DP = transplante). Resultados: A incidência acumulada de DN foi 32,5%. Estadios mais avançados do tumor apresentam maior incidência de DN (T2A = 25,7%, T2B = 31,6%, DS = 38,5%, CM-/CMB+ = 38,9%, p < 0,001). O tempo mediano de espera de fila foi significantemente maior na R1 do que na R2 (213 dias vs 149 dias; p < 0,001). A incidência de DN foi significantemente maior na R1 do que na R2 (35,9% vs 26,0%, p < 0,001). Conclusões: Em candidatos a transplante de fígado por CHC, a incidência de DN é maior em estadios mais avançados do tumor e em regiões com maior tempo de espera em lista.
Objective: To correlate the outcome of patients with hepatocellular carcinoma (HCC) registered for liver transplantation with the tumor stage and waiting time on the transplant list. Methods: The retrospective cohort analyzed 2,127 patients enrolled on the waiting list for deceased donor liver transplantation across two regions (R1 and R2) under the Transplant Center of the State Department of Health of São Paulo.Patients were granted special status for HCC from January 1, 2012, to December 31, 2020. Tumor staging was categorized 2A, T2B, CM/CMB+ (beyond the Milan Criteria for nodules <2cm), or downstaging (DS) based on the number and size of liver nodules identified in imaging used to obtain special status. Outcomes were classified as either negative (NP = removal from the list due to death or disease progression) or positive (DP = transplant). Results: The cumulative incidence of NP was 32.5%. Advanced tumor stages were associated with higher NP incidence (T2A = 25.7%, T2B = 31.6%, DS = 38.5%, CM/CMB+ = 38.9%, p < 0.001). The median waiting time was was significantly longer in R1 than in R2 (213 days vs 149 days; p < 0.001), with NP incidence significantly higher in R1 tha in R2 (35.9% vs 26.0%, p < 0.001). Conclusions: Among candidates for liver transplantation with HCC, NP is higher in cases of advanced tumor stages and in regions with longer wait times on the transplant.
Objective: To correlate the outcome of patients with hepatocellular carcinoma (HCC) registered for liver transplantation with the tumor stage and waiting time on the transplant list. Methods: The retrospective cohort analyzed 2,127 patients enrolled on the waiting list for deceased donor liver transplantation across two regions (R1 and R2) under the Transplant Center of the State Department of Health of São Paulo.Patients were granted special status for HCC from January 1, 2012, to December 31, 2020. Tumor staging was categorized 2A, T2B, CM/CMB+ (beyond the Milan Criteria for nodules <2cm), or downstaging (DS) based on the number and size of liver nodules identified in imaging used to obtain special status. Outcomes were classified as either negative (NP = removal from the list due to death or disease progression) or positive (DP = transplant). Results: The cumulative incidence of NP was 32.5%. Advanced tumor stages were associated with higher NP incidence (T2A = 25.7%, T2B = 31.6%, DS = 38.5%, CM/CMB+ = 38.9%, p < 0.001). The median waiting time was was significantly longer in R1 than in R2 (213 days vs 149 days; p < 0.001), with NP incidence significantly higher in R1 tha in R2 (35.9% vs 26.0%, p < 0.001). Conclusions: Among candidates for liver transplantation with HCC, NP is higher in cases of advanced tumor stages and in regions with longer wait times on the transplant.
Descrição
Citação
BENINI, Bárbara Burza. Análise do desfecho dos pacientes com carcinoma hepatocelular na lista de espera de transplante de fígado. 2024. 108 f. Tese (Doutorado em Ciência Cirúrgica Interdisciplinar) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2024.