Long-term survival after recurrent hepatocellular carcinoma in liver transplant patients: Clinical patterns and outcome variables

• Published in: European journal of surgical oncology Vol. 36; no. 3; pp. 275 - 280
• Main Authors: Kornberg, A, Küpper, B, Tannapfel, A, Katenkamp, K, Thrum, K, Habrecht, O, Wilberg, J
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2010; WB Saunders
• Subjects: Biopsy; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - surgery; Female; Follow-Up Studies; Germany - epidemiology; Hematology, Oncology and Palliative Medicine; Hepatocellular carcinoma; Humans; Liver Neoplasms - diagnosis; Liver Neoplasms - mortality; Liver Neoplasms - surgery; Liver Transplantation; Magnetic Resonance Imaging; Male; Microvascular invasion; Middle Aged; Milan criteria; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - mortality; Retrospective Studies; Surgery; Survival Rate - trends; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Tumor biology; Germany; Tumor biology; Milan criteria; Hepatocellular carcinoma; Microvascular invasion; Liver transplantation; tumor biology; liver transplantation; hepatocellular carcinoma; microvascular invasion
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2009.10.001

Abstract Background The objective of this trial was to analyze the clinical patterns and outcome variables of recurrent hepatocellular carcinoma (HCC) in liver transplant patients. Patients and methods Sixty patients after liver transplantation (LT) for HCC were analyzed. All of them received initially a calcineurin-inhibitor based immunosuppressive regimen. Recurrent HCC was treated by surgical intervention, if eligible, or adjuvant therapies. Furthermore, patients were converted to a Sirolimus (SRL)-based immunosuppressive regimen after tumor relapse. The impact of clinical and histopathological variables on post-recurrence survival was analyzed in uni- and multivariate analysis. Results Sixteen liver recipients developed HCC recurrence between 4 and 58 months (median: 23 months) post-LT. Sites of first tumor recurrence were lung ( n = 5), liver ( n = 4), bone ( n = 4), cerebrum ( n = 1), adrenal gland ( n = 1) and peritoneum ( n = 1). Seven patients were amenable for surgical resection, while 9 patients were only suitable for adjuvant treatment ( n = 4) or general medical support ( n = 5). Median survival rate post-recurrence was 65 months (range: 12–136 months) in patients amenable for surgical therapy, and 5 months (range: 1–52 months) in patients unsuitable for surgical intervention ( P = 0.01). Multivariate analysis identified late (>24 months) posttransplant tumor relapse ( P = 0.039) and surgical therapy ( P = 0.014) as independent predictors of long-term survival after tumor relapse. Five patients are tumour-free alive for a median of 65 months after surgical resection of recurrent HCC and conversion to SRL. Conclusion Liver transplant patients with HCC recurrence should be treated surgically, if eligible, since this is an independent predictor of long-term survival.