Recurrence of hepatocellular carcinoma after liver transplantation: Is there a place for resection?

Abstract

Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is widely considered as a terminal condition. Therefore, the role of surgery is uncertain in this case. The purpose of this study was to identify the prognostic factors of survival after post-LT HCC recurrence and to evaluate the impact of surgery in this setting. All patients transplanted for HCC between 1991 and 2013 in a single institution and who further developed a post-LT recurrence were included in this study. Univariate and multivariate analyses were performed to identify factors affecting postrecurrence survival. Of the 493 patients transplanted for HCC, a total of 70 (14.2%) consecutive patients developed a recurrence after a median disease-free interval of 17 months. Median survival (MS) from the time of recurrence was 19 months, with a 3-year postrecurrence survival of 26%. Most recurrences were extrahepatic (lung, lymph node, and bone; n = 51; 72.9%), whereas only intrahepatic recurrences were observed in 2 (2.8%) patients. Both intrahepatic and extrahepatic locations were found in 17 (24.3%) patients. A total of 22 (31.4%) patients underwent macroscopically complete resection of the recurrence (intrahepatic [n = 2] and extrahepatic [n = 20]). The MS for resected patients after transplantation was 35 months compared with 15 months for nonresected patients (P < 0.001). In multivariate analysis, the independent unfavorable factors of postrecurrence survival were alpha-fetoprotein level > 100 ng/mL at relapse (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.1-4.1; P = 0.03), intrahepatic location (HR, 1.8; 95% CI, 1.0-3.2; P = 0.05), and multifocal recurrence (HR, 1.8; 95% CI, 1.1-3.1; P = 0.04). The management including surgery (HR, 0.4; 95% CI, 0.2-0.7; P = 0.004) was identified as an independent favorable factor. In conclusion, recurrence of HCC after LT is associated with a poor prognosis. However, resection is associated with improved survival and should therefore be considered when feasible. Liver Transplantation 23 440-447 2017 AASLD.

Liver transplantation for hepatocellular carcinoma: Management after the transplant

“…90,92,[146][147][148] In the largest single center experience, of 106 total recurrences, 25 underwent surgical resection with overall better survival with this approach. 90,92,[146][147][148] In the largest single center experience, of 106 total recurrences, 25 underwent surgical resection with overall better survival with this approach.…”

“…Surveillance may improve survival through access to earlier and perhaps curative treatment of recurrence. [90][91][92][93] To be most effective,…”

“…Early HCC recurrence defined as within the first year of LT portends the worst prognosis. 87,88,92 This could occur due to nondetected extrahepatic metastases that may be present before LT and as a consequence of circulating HCC clones engrafting and growing in a target organ after LT. The plausible explanation for late HCC recurrence (within 2-5 years of LT) could be a second unknown hit that may lead to late engrafting of HCC cells that are less in number and remained latent for a long time during the post-LT period.…”

Exportin‐T promotes tumor proliferation and invasion in hepatocellular carcinoma

“…The incidence of HCC is increasing due to the prevalence of obesity and diabetes mellitus . A high frequency of tumor recurrence and metastasis leads to poor prognosis . Although some progress has been made in the study of HCC in recent years, existing therapeutic methods have limited effects on advanced HCC patients.…”

“…2 A high frequency of tumor recurrence and metastasis leads to poor prognosis. 3,4 Although some progress has been made in the study of HCC in recent years, [5][6][7] existing therapeutic methods have limited effects on advanced HCC patients. The underlying mechanism of HCC remains unclear.…”