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Impact of treatment modalities on patients with recurrent hepatocellular carcinoma after liver transplantation: Preliminary experience.
- Source :
-
Hepatobiliary & pancreatic diseases international : HBPD INT [Hepatobiliary Pancreat Dis Int] 2020 Aug; Vol. 19 (4), pp. 365-370. Date of Electronic Publication: 2020 Jun 07. - Publication Year :
- 2020
-
Abstract
- Background: Post-liver transplantation (LT) hepatocellular carcinoma (HCC) recurrence still occurs in approximately 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.<br />Methods: A total of 64 HCC patients with tumor recurrence after LT were enrolled in this study. Univariate and multivariate analyses were performed to identify factors affecting post-recurrence survival.<br />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, significantly 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 radical 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 patients 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.<br />Conclusions: Aggressive surgical intervention in well-selected patients significantly improves OS after recurrence. A multidisciplinary treatment approach is required to slow down disease progression for patients with unresectable recurrent HCC.<br />Competing Interests: Competing interest No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.<br /> (Copyright © 2020 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Adult
Carcinoma, Hepatocellular mortality
Carcinoma, Hepatocellular secondary
Carcinoma, Hepatocellular virology
Female
Hepatitis B, Chronic complications
Humans
Liver Cirrhosis etiology
Liver Cirrhosis virology
Liver Neoplasms mortality
Liver Neoplasms pathology
Liver Neoplasms virology
Male
Middle Aged
Neoplasm Recurrence, Local drug therapy
Neoplasm Recurrence, Local mortality
Risk Factors
Survival Analysis
Treatment Outcome
Carcinoma, Hepatocellular therapy
Liver Neoplasms therapy
Liver Transplantation mortality
Neoplasm Recurrence, Local therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1499-3872
- Volume :
- 19
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Hepatobiliary & pancreatic diseases international : HBPD INT
- Publication Type :
- Academic Journal
- Accession number :
- 32553774
- Full Text :
- https://doi.org/10.1016/j.hbpd.2020.06.002