Managements of recurrent hepatocellular carcinoma after liver transplantation: A systematic review

• Published in: World journal of gastroenterology : WJG Vol. 21; no. 39; pp. 11185 - 11198
• Main Authors: de'Angelis, Nicola, Landi, Filippo, Carra, Maria Clotilde, Azoulay, Daniel
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 21.10.2015
• Subjects: Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - secondary; Carcinoma, Hepatocellular - surgery; carcinoma;Liver; hepatocellular; Humans; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver Transplantation - adverse effects; Liver Transplantation - mortality; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Niacinamide - adverse effects; Niacinamide - analogs & derivatives; Niacinamide - therapeutic use; Phenylurea Compounds - adverse effects; Phenylurea Compounds - therapeutic use; Protein Kinase Inhibitors - adverse effects; Protein Kinase Inhibitors - therapeutic use; Recurrent; Reoperation; Risk Factors; Survival Analysis; Systematic Reviews; Time Factors; transplan; Treatment Outcome; Trans-arterial chemoembolization; Tumor recurrence; Sorafenib; Recurrent hepatocellular carcinoma; Surgical resection; Systematic review; Liver transplantation
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v21.i39.11185

AIM: To investigate the efficacy(survival) and safety of treatments for recurrent hepatocellular carcinoma(HCC) in liver transplantation(LT) patients.METHODS: Literature search was performed on available online databases without a time limit until January 2015. Clinical studies describing survival after HCC recurrence in LT patients were retrieved for a fulltext evaluation. A total of 61 studies were selected: 13 case reports, 41 retrospective case series, and 7 retrospective comparative studies.RESULTS: Based on all included studies, the mean HCC recurrence rate was 16% of all LTs for HCC. A total of 1021 LT patients experienced HCC recurrence. The median time from LT to HCC recurrence was 13 mo(range 2-132 mo). The majority of patients(67%) presented with HCC extra-hepatic recurrences, involving lung, bone, adrenal gland, peritoneal lymph nodes, and rarely the brain. Overall survival after HCC recurrence was 12.97 mo. Surgical resection of localized HCC recurrence and Sorafenib for controlling systemic spread of HCC recurrence were associated with the higher survival rates(42 and 18 mo, res-pectively). However, Sorafenib, especially when combined with m TOR, was frequently associated with severe side effects that required dose reduction or discontinuation CONCLUSION: Management of recurrent HCC in LT patients is challenging and associated with poor prognosis independently of the type of treatment.