FATORES PREDITORES DA RESPOSTA RADIOLÓGICA DA QUIMIOEMBOLIZAÇÃO TRANSARTERIAL HEPÁTICA COM MICROESFERAS CARREADORAS NO TRATAMENTO NEOADJUVANTE DO CARCINOMA HEPATOCELULAR

• Ano de defesa: 2019
• Autor(a) principal: Francisco Leonardo Galastri
• Orientador(a): Nelson Wolosker
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Faculdade Israelita de Ciências da Saúde Albert Einstein
• Programa de Pós-Graduação: Acadêmico em Ciências da Saúde
• País: Brasil
• Palavras-chave em Português: Carcinoma hepatocelular; Quimioembolização hepática; Terapia neoadjuvante; Transplante de fígado; Resposta radiológica; Quimioembolização terapêutica
• Palavras-chave em Inglês: Hepatocellular carcinoma; Hepatic chemoembolization; Neoadjuvant therapy; Liver transplantation; Radiological response; Chemoembolization; therapeutic
• Link de acesso: https://repositorio.einstein.br/publicacao/171721

Purpose: To identify pre and intraoperative clinical and radiological predictors of the radiological response of drug-eluting bead chemoembolization in the neoadjuvant treatment of hepatocellular carcinoma, evaluated by the objective response, using mRECIST criteria and the percentage of necrosis tumor. Methods: Prospective, cohort study, performed in a single transplant center, from 2011 to 2014. Consecutive patients with hepatocellular carcinoma were studied in the 0, A or B stages of Barcelona Clinic Liver Cancer who underwent the first session using drug-eluting bead chemoembolization for downstaging or bridging purposes. Pre and post-chemoembolization imaging studies were performed by computed tomography or magnetic resonance. The radiological response of hepatocellular carcinoma was evaluated by the percentage of necrosis and the objective response through mRECIST, being classified into two categories: responder, when there was complete or partial response, and no response when there was a stable disease or disease progression. Results: Two hundred patients with 380 hepatocellular carcinomas were studied. Among the clinical and laboratory characteristics, indirect bilirubin (mg/dL) was related to the objective response - radiological response of the target lesion (p=0.05). The analysis of the objective response - individual response of treated hepatocellular carcinoma - through multivariate logistic regression, showed that hepatocellular carcinomas with pseudocapsule had a 2.01 times greater chance of being responders to drug-eluting bead chemoembolization than those without pseudocapsules (95% CI: 1.18 to 3.42, p=0.01), and addition of every 1mg of chemoembolic agent increased 4 percent the chance of hepatocellular carcinoma being responder (95% CI 1.02 to 1, 06, p<0.001). The analysis of the percentage of necrosis through multiple linear regression showed that the addition of each 1mg of the chemoembolic agent caused an average increase of 0.65% (p<0.001) of necrosis in the treated lesion, whereas the hepatocellular carcinoma with pseudocapsule presented 18.27% (p<0.001) plus necrosis than those without pseudocapsule. Conclusion: The presence of pseudocapsule and the addition of the amount of chemoembolic agent (mg) increase the chance of hepatocellular carcinoma responding according to the objective response, as well as increasing the percentage of tumor necrosis following drug-eluting bead chemoembolization in the treatment neoadjuvant to liver transplantation.