Department of Gastroenterology.
São Paulo Clinicas Liver Cancer Group.
Eur J Gastroenterol Hepatol. 2019 Sep;31(9):1148-1156. doi: 10.1097/MEG.0000000000001448.
Liver transplantation (LT) is the treatment of choice for patients with unresectable early hepatocellular carcinoma (HCC). Post-LT HCC recurrence rates range from 8 to 20% and still impact on overall survival (OS). The aim of our study was to evaluate the impact of HCC recurrence on post-LT survival and analyze prognostic factors among those patients with recurrence.
We carried out a national, multicenter, retrospective cohort study in Brazil. Medical records of 1119 LT recipients with HCC were collected. Data from patients with post-LT HCC recurrence were analyzed and correlated with post-relapse survival.
OS of the 1119 patients included in the study was 63% over 5 years. Post-LT HCC recurrence occurred in 86 (8%) patients. The mean time to recurrence was 12 months. Sites of recurrence were extrahepatic in 55%, hepatic in 27%, and both hepatic and extrahepatic in 18%. Recurrence treatment was performed in 50 (64%) cases, mostly with sorafenib. Post-relapse survival rates were 34% at 1 year and 13% at 5 years. Univariable analysis identified α-fetoprotein more than 1000 ng/ml at relapse, recurrence treatment, extrahepatic location, and time to recurrence more than 2 years as prognostic factors. In multivariable analysis, recurrence treatment, extrahepatic location, and time to recurrence more than 2 years were independent predictors of better survival.
In a large Brazilian cohort of LT recipients with HCC, post-LT HCC recurrence occurred in 8% and impacted significantly on the OS. Patients with early recurrence presented a worse prognosis. However, treatment of recurrence improved outcomes, highlighting the importance of early diagnosis.
肝移植（LT）是治疗不可切除的早期肝细胞癌（HCC）的首选方法。LT 后 HCC 复发率为 8%至 20%，仍影响总体生存率（OS）。我们的研究旨在评估 HCC 复发对 LT 后生存的影响，并分析复发患者的预后因素。
我们在巴西进行了一项全国性的多中心回顾性队列研究。收集了 1119 例 HCC 接受 LT 的患者的病历。分析了 LT 后 HCC 复发患者的数据，并与复发后生存相关。
纳入研究的 1119 例患者的 OS 为 5 年 63%。86 例（8%）患者发生 LT 后 HCC 复发。复发的平均时间为 12 个月。复发部位为肝外 55%，肝内 27%，肝内外均有 18%。50 例（64%）患者进行了复发治疗，主要使用索拉非尼。复发后 1 年生存率为 34%，5 年生存率为 13%。单变量分析发现复发时甲胎蛋白大于 1000ng/ml、复发治疗、肝外位置和复发时间大于 2 年是预后因素。多变量分析显示，复发治疗、肝外位置和复发时间大于 2 年是生存的独立预测因素。
在一个大型的巴西 HCC 接受 LT 的患者队列中，LT 后 HCC 复发率为 8%，对 OS 有显著影响。早期复发的患者预后较差。然而，对复发的治疗改善了预后，强调了早期诊断的重要性。
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