Li Bryan Cho Wing, Chiu Joanne, Shing Kit, Kwok Gerry Gin Wai, Tang Vikki, Leung Roland, Ma Ka Wing, She Wong Hoi, Tsang Josephine, Chan Albert, Cheung Tan To, Lo Chung Mau, Yau Thomas
Department of Medicine, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Adv Ther. 2021 Jul;38(7):3900-3910. doi: 10.1007/s12325-021-01800-z. Epub 2021 Jun 1.
Treatment of hepatocellular carcinoma (HCC) recurrences following liver transplant (LT) is challenging. Most clinical trials of systemic therapies for advanced HCC excluded patients with any history of organ transplant. We aimed to assess the outcomes in using various systemic therapies in patients with post-LT recurrence.
Consecutive patients with HCC and recurrences following LT at a large tertiary centre from 2005 to 2018 were reviewed. Overall survival (OS), response rates and adverse events (AEs) were analysed.
Forty-three consecutive patients with a recurrence of HCC following LT were identified from 2005 to 2018. Median OS from diagnosis of recurrence was 17 months (CI 11.3, 22.7). Early recurrence within 12 months of transplant was associated with a significantly worse median survival of 10 months (CI 8.5, 11.4) compared to 26 months (CI 18.8, 33.2) when recurrences occurred after 12 months from transplant (p < 0.001) with a hazard ratio of 0.104 (log-rank test, p < 0.001). A total of 41 patients had received systemic therapies and 79.1% of them were on sorafenib as the first-line treatment. Among these patients treated with sorafenib, median OS from recurrence was 14 months (CI 7.3, 20.7). Hand-foot syndrome (34.7%) was most common among AEs followed by diarrhoea (26.7%). Overall, AEs led to dose interruptions in 8.8% of patients. Notably, 47.1% of patients received subsequent lines of systemic therapies after sorafenib.
Early recurrence within 1 year from transplant was the most significant risk factor. Treatment efficacy and adverse events and tolerability of sorafenib were comparable with those in the setting of advanced HCC without transplant.
肝移植（LT）后肝细胞癌（HCC）复发的治疗具有挑战性。大多数晚期HCC全身治疗的临床试验都排除了有任何器官移植史的患者。我们旨在评估肝移植后复发患者使用各种全身治疗的结果。
回顾了2005年至2018年在一家大型三级中心连续收治的LT后HCC复发患者。分析了总生存期（OS）、缓解率和不良事件（AE）。
2005年至2018年共确定了43例LT后HCC复发的连续患者。复发诊断后的中位OS为17个月（CI 11.3，22.7）。移植后12个月内的早期复发与中位生存期显著较差相关，为10个月（CI 8.5，11.4），而移植后12个月后复发时为26个月（CI 18.8，33.2）（p＜0.001），风险比为0.104（对数秩检验，p＜0.001）。共有41例患者接受了全身治疗，其中79.1%的患者以索拉非尼作为一线治疗。在这些接受索拉非尼治疗的患者中，复发后的中位OS为14个月（CI 7.3，20.）。手足综合征（34.7%）是最常见的AE，其次是腹泻（26.7%）。总体而言，AE导致8.8%的患者剂量中断。值得注意的是，47.1%的患者在索拉非尼治疗后接受了后续的全身治疗。
移植后1年内的早期复发是最显著的危险因素。索拉非尼的治疗疗效、不良事件和耐受性与无移植的晚期HCC情况相当。
