Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
J Korean Med Sci. 2018 Oct 12;33(45):e283. doi: 10.3346/jkms.2018.33.e283. eCollection 2018 Nov 5.
The role of sorafenib in patients with hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) has been rarely studied. The aim of this study was to evaluate the efficacy of sorafenib in post-LT era.
Consecutive patients with post-transplant HCC recurrence not eligible to resection or locoregional therapy were included. Patients receiving best supportive care (BSC) until 2007 were compared with those treated by sorafenib thereafter.
Of a total of 65 patients, 20 patients received BSC and 45 received sorafenib. Clinical characteristics were similar between two groups except that sorafenib group received tacrolimus and mammalian target-of-rapamycin inhibitors more frequently than BSC group. Treatment with sorafenib conferred a survival advantage as compared with BSC for survival after recurrence (median, 14.2 vs. 6.8 months; = 0.01). In multivariate analyses, high serum α-fetoprotein level, synchronous intrahepatic recurrence and distant metastasis at the time of recurrence, and BSC were independently associated with poorer survival after recurrence. Sorafenib treatment was associated with better survival after recurrence as compared with BSC (hazard ratio, 0.25; 95% confidence interval, 0.10-0.62; = 0.002). In addition, sorafenib group showed tolerable toxicity in the post-transplant setting.
Sorafenib may be beneficial in patients with post-transplant HCC recurrence.
索拉非尼在肝癌（HCC）肝移植（LT）后复发患者中的作用鲜有研究。本研究旨在评估索拉非尼在 LT 后时代的疗效。
连续纳入不符合肝切除或局部区域治疗条件的 LT 后 HCC 复发患者。2007 年前接受最佳支持治疗（BSC）的患者与此后接受索拉非尼治疗的患者进行比较。
共 65 例患者，20 例接受 BSC，45 例接受索拉非尼。两组患者的临床特征相似，除了索拉非尼组比 BSC 组更常接受他克莫司和哺乳动物雷帕霉素靶蛋白抑制剂外。与 BSC 相比，索拉非尼治疗可提高复发后的生存率（中位生存时间，14.2 个月 vs. 6.8 个月；P = 0.01）。多因素分析显示，复发时血清甲胎蛋白水平高、肝内同步复发和远处转移以及 BSC 与复发后生存较差独立相关。与 BSC 相比，索拉非尼治疗与复发后生存改善相关（风险比，0.25；95%置信区间，0.10-0.62；P = 0.002）。此外，索拉非尼组在 LT 后显示出可耐受的毒性。
索拉非尼可能对 LT 后 HCC 复发患者有益。
