Ossami Saidy Ramin Raul, Postel Maximilian Paul, Pflüger Michael Johannes, Schoening Wenzel, Öllinger Robert, Gül-Klein Safak, Schmelzle Moritz, Tacke Frank, Pratschke Johann, Eurich Dennis
Department of Surgery, Campus Virchow-Klinikum and Campus Charité Mitte, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, 10117 Berlin, Germany.
Cancers (Basel). 2021 Mar 31;13(7):1617. doi: 10.3390/cancers13071617.
Recurrence of hepatocellular carcinoma (rHCC) after liver transplantation (LT) is associated with limited survival. Therefore, identification of factors that prolong survival in these patients is of great interest. Surgical resection, radiotherapy, and transarterial chemoembolization (TACE) are established interventions to improve outcomes in these patients; however, the impact of immunosuppression is unknown.
All patients diagnosed with rHCC in the follow-up after LT were identified from a database of liver recipients transplanted between 1988 and 2019 at our institution (Charité Universitätsmedizin Berlin, Germany). Based on the immunosuppressive regimen following diagnosis of rHCC and the oncological treatment approach, survival analysis was performed.
Among 484 patients transplanted for HCC, 112 (23.1%) developed rHCC in the follow-up. Recurrent HCC was diagnosed at a median interval of 16.0 months (range 1.0-203.0), with the majority presenting early after transplantation (63.0%, <2 years). Median survival after rHCC diagnosis was 10.6 months (0.3-228.7). Reduction of immunosuppression was associated with improved survival, particularly in patients with palliative treatment (8.4 versus 3.0 months). In addition, greater reduction of immunosuppression seemed to be associated with greater prolongation of survival. Graft rejection after reduction was uncommon ( = 7, 6.8%) and did not result in any graft loss. Patients that underwent surgical resection showed improved survival rates (median 19.5 vs. 8.7 months).
Reduction of immunosuppressive therapy after rHCC diagnosis is associated with prolonged survival in LT patients. Therefore, reduction of immunosuppression should be an early intervention following diagnosis. In addition, surgical resection should be attempted, if technically feasible and oncologically meaningful.
肝移植（LT）后肝细胞癌复发（rHCC）与生存期有限相关。因此，确定延长这些患者生存期的因素备受关注。手术切除、放疗和经动脉化疗栓塞术（TACE）是改善这些患者预后的既定干预措施；然而，免疫抑制的影响尚不清楚。
从1988年至2019年在我们机构（德国柏林夏里特大学医学中心）接受肝移植的受者数据库中，识别出所有在LT术后随访中被诊断为rHCC的患者。基于rHCC诊断后的免疫抑制方案和肿瘤治疗方法，进行生存分析。
在484例因肝癌接受移植的患者中，112例（23.1%）在随访中出现rHCC。复发性肝癌诊断的中位间隔时间为16.0个月（范围1.0 - 203.0个月），大多数在移植后早期出现（63.0%，<2年）。rHCC诊断后的中位生存期为10.6个月（0.3 - 228.7个月）。免疫抑制的降低与生存期改善相关，特别是在接受姑息治疗的患者中（8.4个月对3.0个月）。此外，免疫抑制降低幅度越大，生存期延长似乎越明显。免疫抑制降低后发生移植物排斥并不常见（n = 7，6.8%），且未导致任何移植物丢失。接受手术切除的患者生存率有所提高（中位生存期19.5个月对8.7个月）。
rHCC诊断后降低免疫抑制治疗与LT患者生存期延长相关。因此，免疫抑制降低应作为诊断后的早期干预措施。此外，如果技术上可行且肿瘤学上有意义，应尝试进行手术切除。
