Time interval to recurrence as a predictor of overall survival in salvage liver transplantation for patients with hepatocellular carcinoma associated with hepatitis B virus

• Published in: Surgery Vol. 157; no. 2; pp. 239 - 248
• Main Authors: Hu, Zhenhua, MD, Zhou, Jie, MD, Li, Zhiwei, MD, Xiang, Jie, MD, Qian, Ze, MD, Wu, Jian, PhD, MD, Zhang, Min, MD, Zheng, Shusen, PhD, MD, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2015
• Subjects: Adult; Carcinoma, Hepatocellular - etiology; Carcinoma, Hepatocellular - surgery; Female; Hepatectomy; Hepatitis B, Chronic - complications; Humans; Liver Neoplasms - etiology; Liver Neoplasms - surgery; Liver Transplantation; Male; Middle Aged; Neoplasm Recurrence, Local - surgery; Prognosis; Retrospective Studies; Salvage Therapy; Surgery; Survival Analysis; Time Factors
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2014.09.018

Background Salvage liver transplantation (SLT) has been proposed for recurrent hepatocellular carcinoma (HCC) after hepatectomy; however, it is unclear how the time interval to tumor recurrence from previous hepatectomy affects prognosis. Methods We analyzed retrospectively the outcomes of 62 patients who underwent SLT in the Liver Transplantation Center of the First Affiliated Hospital of Zhejiang University between 2001 and 2012. SLT recipients were divided into 2 groups based on whether the time interval to recurrence was >1 year (L group) or <1 year (S group). Results Baseline characteristics were similar between the 2 groups. The 1-, 3-, and 5-year overall survival rates were 81%, 45%, and 45% in the L group, which were better than in the S group, with 47%, 21%, and 21%, respectively ( P  = .005). The corresponding tumor-free survival rates were similar ( P  = .60) between 2 groups, with 71%, 51%, and 41% in the L group versus 55%, 55%, and 55% in the S group. Macrovascular invasion (hazard ratio [HR], 3.30), greatest tumor diameter (HR, 3.92), and time interval to tumor recurrence from previous hepatectomy (HR, 0.29) were independent predictors for overall survival. Furthermore, the diameter of the largest tumor was the only independent predictor of tumor-free survival (HR, 25.64). Conclusion The time interval to HCC recurrence from a previous hepatectomy is an important factor associated with survival after SLT. This finding should be helpful in guiding patient selection criteria for SLT in patients with previous hepatectomy.