Au Kin-Pan, Fung James Yan-Yue, Dai Wing-Chiu, Chan Albert Chi-Yan, Lo Chung-Mau, Chok Kenneth Siu-Ho
Department of Surgery, The University of Hong Kong, Hong Kong, China.
Department of Medicine, The University of Hong Kong, Hong Kong, China.
J Clin Med. 2022 Jul 28;11(15):4389. doi: 10.3390/jcm11154389.
It is uncertain whether tumour biology affects radical treatment for post-transplant hepatocellular carcinoma (HCC) oligo-recurrence, i.e. recurrence limited in numbers and locations amendable to radical therapy. We conducted a retrospective study on 144 patients with post-transplant HCC recurrence. Early recurrence within one year after transplant (HR 2.53, 95% CI 1.65−3.88, p < 0.001), liver recurrence (HR 1.74, 95% CI 1.12−2.68, p = 0.01) and AFP > 200 ng/mL upon recurrence (HR 1.62, 95% CI 1.04−2.52, p = 0.03) predicted mortality following recurrence. In patients with early recurrence and liver recurrence, radical treatment was associated with improved post-recurrence survival (early recurrence: median 18.2 ± 1.5 vs. 9.2 ± 1.5 months, p < 0.001; liver recurrence: median 28.0 ± 4.5 vs. 11.6 ± 2.0, p < 0.001). In patients with AFP > 200 ng/mL, improvement in survival did not reach statistical significance (median 18.2 ± 6.5 vs. 8.8 ± 2.2 months, p = 0.13). Survival benefits associated with radical therapy were reduced in early recurrence (13.6 vs. 9.0 months) and recurrence with high AFP (15.4 vs. 9.3 months) but were similar among patients with and without liver recurrence (16.9 vs. 16.4 months). They were also diminished in patients with multiple biological risk factors (0 risk factor: 29.0 months; 1 risk factor: 19.7 months; 2−3 risk factors: 3.4 months): The survival benefit following radical therapy was superior in patients with favourable biological recurrence but was also observed in patients with poor tumour biology. Treatment decisions should be individualised considering the oncological benefits, quality of life gain and procedural morbidity.
肿瘤生物学是否会影响移植后肝细胞癌（HCC）寡复发的根治性治疗尚不确定，即复发的数量和部位有限且适合根治性治疗。我们对144例移植后HCC复发患者进行了一项回顾性研究。移植后1年内的早期复发（风险比[HR] 2.53，95%置信区间[CI] 1.65 - 3.88，p < 0.001）、肝内复发（HR 1.74，95% CI 1.12 - 2.68，p = 0.01）以及复发时甲胎蛋白（AFP）> 200 ng/mL（HR 1.62，95% CI 1.04 - 2.52，p = 0.03）可预测复发后的死亡率。在早期复发和肝内复发的患者中，根治性治疗与复发后生存期改善相关（早期复发：中位数18.2 ± 1.5个月对9.2 ± 1.5个月，p < 0.001；肝内复发：中位数28.0 ± 4.5个月对11.6 ± 2.0个月，p < 0.001）。在AFP > 200 ng/mL的患者中，生存期改善未达到统计学显著性（中位数18.2 ± 6.5个月对8.8 ± 2.2个月，p = 0.13）。根治性治疗相关的生存获益在早期复发（13.6个月对9.0个月）和AFP高值复发（15.4个月对9.3个月）时降低，但在有和无肝内复发的患者中相似（16.9个月对16.4个月）。在具有多种生物学风险因素的患者中生存获益也减少（0个风险因素：29.0个月；1个风险因素：19.7个月；2至3个风险因素：3.4个月）：根治性治疗后的生存获益在生物学复发情况良好的患者中更显著，但在肿瘤生物学情况较差的患者中也有观察到。应综合考虑肿瘤学获益、生活质量改善和手术并发症，对治疗决策进行个体化。
