Impact of treatment modalities on patients with recurrent hepatocellular carcinoma after liver transplantation: Preliminary experience

• 作者: Cheng-Ze Chen Li Zhuang Qi-Yong Li Qin-Fen Xie Shu-Sen Zheng Shuo Wang Xin-Yao Tian Zhe Yang
• 来源期刊: 国际肝胆胰疾病杂志(英文版)
• 年，卷（期）: 2020,（4）
• 页码范围: 365-370
• 页数: 6页
• 语种: 英文

摘要

Background: Post-liver transplantation (LT) hepatocellular carcinoma (HCC) recurrence still occurs in ap- proximately 20％ of patients and drastically affects their survival. This study aimed to evaluate the efficacy of various treatments for recurrent HCC after LT in a Chinese population.Methods: A total of 64 HCC patients with tumor recurrence after LT were enrolled in this study. Univari- ate and multivariate analyses were performed to identify factors affecting post-recurrence survival. Results: Of the 64 patients with recurrent HCC after LT, those who received radical resection followed by nonsurgical therapy had a median overall survival (OS) of 20.9 months after HCC recurrence, signifi- cantly superior to patients who received only nonsurgical therapy (9.4 months) or best supportive care (2.4 months). The one- and two-year OS following recurrence was favorable for patients receiving radi- cal resection followed by nonsurgical therapy (93.8％, 52.6％), poor for patients receiving only nonsurgical therapy (30.8％, 10.8％), and dismal for patients receiving best supportive care (0％, 0％; overall P < 0.001). Median OS in sorafenib-tolerant patients treated with lenvatinib was 19.5 months, far surpassing the pa- tients that discontinued sorafenib or were treated with regorafenib after sorafenib failure (12 months, P < 0.001). Compared with tacrolimus-based immunosuppressive therapy, OS was significantly increased with sirolimus-based therapy at one and two years after HCC recurrence ( P = 0.035). Multivariate analysis showed radical resection combined with nonsurgical therapy for recurrent HCC and sorafenib-lenvatinib sequential therapy were independent favorable factors for post-recurrence survival. Conclusions: Aggressive surgical intervention in well-selected patients significantly improves OS after re- currence. A multidisciplinary treatment approach is required to slow down disease progression for pa- tients with unresectable recurrent HCC.