基于肝脏外植体评估不可逆电穿孔治疗肝细胞癌的疗效

Introduction: Hepatocellular carcinoma (HCC) commonly develops in the context of cirrhosis. In these patients, liver transplantation remains the therapeutic approach with the highest likelihood of achieving cure. Local treatments such as ablation may be used to control HCC in patients awaiting a suitable organ. Irreversible electroporation (IRE) is a nonthermal ablation modality often considered for tumors in locations not amenable to thermal ablation, such as those near bile ducts, bowel, and other vulnerable structures. Previous studies investigating IRE have assessed efficacy primarily based on surveillance imaging. To these authors' knowledge, this is the largest study to examine HCC response to IRE in liver explants. Methods: This single-institution retrospective study includes 18 patients who received IRE for HCC between 2018 and 2025 and subsequently underwent liver transplantation. Among liver transplantation candidates with HCC requiring a bridging locoregional therapy, IRE was selected as the treatment modality for tumors less than 3 cm located within 1 cm of heat-vulnerable structures. IRE treatments were performed in a single session. Procedural complications were recorded and classified according to the Society of International Radiology (SIR) grading system. Surveillance imaging (CT or MRI) was obtained at one month post-IRE, and every three months subsequently. A board-certified radiologist specialized in abdominal imaging interpreted all surveillance imaging according to LI-RADS treatment response criteria, with binary categorization of the treated lesion as viable or nonviable. One of several board-certified pathologists evaluated each liver explant with respect to viability of the IRE-treated lesion. Results: Mean patient age was 62 (SD: 54-70). 72% were male. Their race/ethnicity were 61% white, 27% hispanic, 5% asian, 5% black. The etiology of their cirrhosis was either hepatitis C (61%), hepatitis B (11%), or alcohol use disorder (27%). Barcelona Clinic Liver Cancer (BCLC) classification was either A (78%) or B (22%). Child-Pugh classification was either A (78%) or B (22%). The average pre-ablative alpha-fetoprotein (AFP) was 33 (SD: 0-100). Mean size of treated lesions was 2.3 cm (SD: 1.3-3.3). Mean time between IRE and liver transplantation was 540 days (SD: 300-780). Two patients had IRE procedural complications, one classified as SIR 1 and the other as SIR 2. 16 of the 18 patients (89%) had complete tumor necrosis of the treated lesion on pathological review of the explanted liver. There was 100% correlation between viability assessment on surveillance imaging and that on explant histopathology. Conclusions: IRE is a safe and effective method for treating HCC in the pre-transplant setting. Surveillance imaging has high accuracy in assessing HCC response after IRE relative to histopathologic assessment.