经动脉放射栓塞（TARE）是控制肿瘤生长和提高肝细胞癌（HCC）生存率的有效治疗方法。 TARE 在肝移植 (LT) 患者降期中的作用尚不清楚。本研究的目的是探讨 TARE 对中晚期 HCC 的降期疗效。采用多状态模型进行意向治疗分析。患者经历了 5 种健康状态：(1) 从 TARE 到列表，(2) 从 TARE 到死亡但没有列表，(3) 从列表到 LT，(4) 从列表到死亡但没有 LT，以及 (5) 从移植到死亡死亡。考虑影响 TARE 后死亡机会的因素对结果进行分层。214 名患者接受了 TARE。其中，43.9%有放射学反应，29.9%被列出，22.8%被移植。 TARE 后 1 年无 LT 存活概率为 40.5%，5 年存活概率为 11.5%。 1 年上市几率为 9.4%，5 年上市几率为 0.9%。没有 LT 的 TARE 后死亡概率在 1 年时为 38%，在 5 年时为 73%。接受 LT 的患者移植后 5 年的总生存率为 61%。肿瘤超过七项标准、甲胎蛋白>400ng/mL和白蛋白-胆红素≥2与死亡相关。三个风险组与不同的反应、被列入名单的机会和接受 LT 相关。低风险患者的中位生存期为 3 年，中风险患者为 1.9 年，高风险患者为 9 个月 (P < 0.001)。在中度和晚期 HCC 中，TARE 允许 44% 的缓解机会，30% 的降期机会，以及 23% 的概率允许 LT。患者和肿瘤的特征允许进行风险分层并通过 TARE 预测生存率。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

Transarterial radioembolization (TARE) is an effective treatment to control tumor growth and improve survival in hepatocellular carcinoma (HCC). The role of TARE in downstaging patients to liver transplantation (LT) is unclear. The aim of this study was to investigate the downstaging efficacy of TARE for intermediate and advanced HCC.Intention-to-treat analysis with multistate modeling was performed. Patients moved through 5 health states: (1) from TARE to listing, (2) from TARE to death without listing, (3) from listing to LT, (4) from listing to death without LT, and (5) from transplant to death. Factors affecting the chance of death after TARE were considered to stratify outcomes.Two hundred fourteen patients underwent TARE. Of those, 43.9% had radiological response, 29.9% were listed, and 22.8% were transplanted. The probability of being alive without LT was 40.5% 1 y after TARE and 11.5% at 5 y. The chance of being listed was 9.4% at 1 y and 0.9% at 5 y. The probability of dying after TARE without LT was 38% at 1 y and 73% at 5 y. The overall survival of patients receiving LT was 61% at 5 y after transplant. Tumor beyond up-to-seven criteria, alfafetoprotein >400 ng/mL, and albumin-bilirubin ≥2 were associated with death. Three risk groups were associated with different response, chances of being listed, and receiving LT. Median survival was 3 y for low-risk, 1.9 y for intermediate-risk, and 9 mo for high-risk patients (P < 0.001).In intermediate and advanced HCC, TARE allows for a 44% chance of response, 30% downstaging, and 23% probability of permitting LT. Patient's and tumor's characteristics allow for risk stratification and predict survival from TARE.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.