Hassanain Hala, Connor Ashton A, Brombosz Elizabeth W, Patel Khush, Elaileh Ahmed, Basra Tamneet, Kodali Sudha, Victor David W, Simon Caroline J, Cheah Yee Lee, Hobeika Mark J, Mobley Constance M, Saharia Ashish, Dhingra Sadhna, Schwartz Mary, Maqsood Anaum, Heyne Kirk, Kaseb Ahmed O, Vauthey Jean-Nicolas, Gaber A Osama, Abdelrahim Maen, Ghobrial R Mark
Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.
Department of Medicine, Houston Methodist Hospital, Houston, TX, USA.
Transplant Direct. 2025 Jan 23;11(2):e1746. doi: 10.1097/TXD.0000000000001746. eCollection 2025 Feb.
Hepatocellular carcinoma (HCC) has a rising incidence and mortality in North America. Liver transplantation (LT) with adjunctive therapies offers excellent outcomes. However, HCC recurrences are associated with high mortality. We investigate whether adjuvant systemic therapy can reduce recurrence, as shown with other malignancies.
Medical records of patients undergoing LT for HCC at a single center between January 2016 and December 2022 were retrospectively reviewed. Patients were stratified into 3 groups: (1) recipients of adjuvant sorafenib, (2) nonrecipients at high recurrence risk, and (3) nonrecipients at low risk by explant pathology features. The outcomes were overall survival (OS) and recurrence-free survival (RFS). Adjuvant sorafenib recipients were also propensity score matched 1:2 to nonadjuvant recipients based on recurrence risk features.
During the study period, 273 patients with HCC underwent LT and 16 (5.9%) received adjuvant sorafenib therapy. Adjuvant sorafenib recipients were demographically similar to nonrecipients and, on explant pathology, had greater tumor burden, lymphovascular invasion, and poorer differentiation (all < 0.001). Adverse events were observed in 12 adjuvant sorafenib recipients (75%). OS was similar among the 3 groups ( = 0.2), and adjuvant sorafenib was not associated with OS in multivariable analysis (hazard ratio, 1.31; 95% confidence interval, 0.45-3.78; = 0.62). RFS was significantly lower in sorafenib patients (hazard ratio, 6.99; 95% confidence interval, 2.12-23.05; = 0.001). Following propensity matching, adjuvant sorafenib use was not associated with either OS ( = 0.24) or RFS rates ( = 0.65).
In this single-center analysis, adjuvant sorafenib was not associated with OS. Recipients were observed to have shorter RFS, likely due to the increased prevalence of high-risk features, and sorafenib use was associated with high frequencies of adverse events.
在北美，肝细胞癌（HCC）的发病率和死亡率呈上升趋势。肝移植（LT）联合辅助治疗可带来良好的治疗效果。然而，HCC复发与高死亡率相关。我们研究辅助性全身治疗是否能像其他恶性肿瘤那样降低复发率。
回顾性分析了2016年1月至2022年12月在单一中心接受LT治疗HCC的患者的病历。患者被分为3组：（1）接受索拉非尼辅助治疗的患者；（2）复发风险高但未接受辅助治疗的患者；（3）根据切除标本病理特征复发风险低且未接受辅助治疗的患者。观察指标为总生存期（OS）和无复发生存期（RFS）。接受索拉非尼辅助治疗的患者还根据复发风险特征按1:2的倾向评分与未接受辅助治疗的患者进行匹配。
在研究期间，273例HCC患者接受了LT，其中16例（5.9%）接受了索拉非尼辅助治疗。接受索拉非尼辅助治疗的患者在人口统计学特征上与未接受辅助治疗的患者相似，且在切除标本病理检查中，其肿瘤负荷更大、存在淋巴管侵犯且分化程度更低（均P<0.001）。12例接受索拉非尼辅助治疗的患者（75%）出现了不良事件。3组患者的OS相似（P=0.2），多变量分析显示索拉非尼辅助治疗与OS无关（风险比，1.31；95%置信区间，0.45-3.78；P=0.62）。索拉非尼治疗组患者的RFS显著更低（风险比，6.99；95%置信区间，2.12-23.05；P=0.001）。倾向评分匹配后，索拉非尼辅助治疗与OS（P=0.24）或RFS率（P=0.65）均无关。
在这项单中心分析中，索拉非尼辅助治疗与OS无关。观察到接受索拉非尼辅助治疗的患者RFS较短，可能是由于高风险特征的患病率增加，且索拉非尼的使用与高频率不良事件相关。
