Department of Hepatobiliary and Pancreatic Surgery, Department of Liver Transplantation, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, 848 Dongxin Road, Hangzhou 310022, China.
Division of Hepatobiliary Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, China.
Hepatobiliary Pancreat Dis Int. 2020 Aug;19(4):365-370. doi: 10.1016/j.hbpd.2020.06.002. Epub 2020 Jun 7.
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.
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.
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.
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.
肝移植（LT）后肝细胞癌（HCC）复发仍发生在约 20%的患者中，并严重影响其生存。本研究旨在评估中国人群 LT 后 HCC 复发的各种治疗方法的疗效。
共纳入 64 例 LT 后 HCC 复发患者。进行单因素和多因素分析，以确定影响复发后生存的因素。
在 64 例 LT 后 HCC 复发患者中，接受根治性切除术后联合非手术治疗的患者 HCC 复发后中位总生存期（OS）为 20.9 个月，明显优于仅接受非手术治疗（9.4 个月）或最佳支持治疗（2.4 个月）的患者。接受根治性切除术后联合非手术治疗的患者复发后 1 年和 2 年 OS 良好（93.8%，52.6%），仅接受非手术治疗的患者较差（30.8%，10.8%），最佳支持治疗的患者最差（0%，0%；总体 P < 0.001）。索拉非尼耐受患者接受仑伐替尼治疗的中位 OS 为 19.5 个月，明显长于索拉非尼耐药后停止索拉非尼或接受regorafenib 治疗的患者（12 个月，P < 0.001）。与基于他克莫司的免疫抑制治疗相比，HCC 复发后 1 年和 2 年时，基于西罗莫司的治疗显著增加了 OS（P = 0.035）。多因素分析显示，根治性切除联合非手术治疗复发性 HCC 和索拉非尼-仑伐替尼序贯治疗是复发后生存的独立有利因素。
在选择合适的患者中积极的手术干预显著提高了复发后的 OS。对于不可切除的复发性 HCC 患者，需要多学科治疗方法来减缓疾病进展。
