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Benefit of Treating Hepatocellular Carcinoma Recurrence after Liver Transplantation and Analysis of Prognostic Factors for Survival in a Large Euro-American Series

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To identify prognostic factors after hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT).

Methods

We retrospectively reviewed the combined experience at Toronto General Hospital and Hospital Vall d’Hebron managing HCC recurrence after LT (n = 121) between 2000 and 2012. We analyzed prognostic factors by uni- and multi-variate analysis. Median follow-up from LT was 29.5 (range 2–129.4) months. Median follow-up from HCC recurrence was 12.2 (range 0.1–112.5) months.

Results

At recurrence, 31.4 % were treated with curative-intent treatments (surgery or ablation), 42.1 % received palliative treatment, and 26.4 % received best supportive care. The 1-, 3-, and 5-year survivals, respectively, after HCC recurrence were 75, 60, and 31 %, vs. 60, 19, and 12 %, vs. 52, 4, and 5 % (p < 0.001). By multivariate analysis, not being amenable to a curative-intent treatment [hazard ratio (HR) 4.7, 95 % confidence interval (CI) 2.7–8.3, p < 0.001], α-fetoprotein of ≥100 ng/mL at the time of HCC recurrence (HR 2.1, 95 % CI 1.3–2.3, p = 0.002) and early recurrence (<12 months) after LT (HR 1.6, 95 % CI 1.1–2.5, p = 0.03) were found to be poor prognosis factors. A prognostic score was devised on the basis of these three independent variables. Patients were divided into three groups, as follows: good prognosis, 0 points (n = 22); moderate prognosis, 1 or 2 points (n = 84); and poor prognosis, 3 points (n = 15). The 1-, 3-, and 5-year actuarial survival for each group was 91, 50, and 50 %, vs. 52, 7, and 2 %, vs. 13, 0, and 0 %, respectively (p < 0.001).

Conclusions

Patients with HCC recurrence after transplant amenable to curative-intent treatments can experience significant long-term survival (~50 % at 5 years), so aggressive management should be offered. Poor prognosis factors after recurrence are not being amenable to a curative-intent treatment, α-fetoprotein of ≥100 ng/mL, and early (<1 year) recurrence after LT.

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada

    G. Sapisochin MD, PhD, N. Goldaracena MD, J. M. Laurence MD, PhD, D. Davidson BSc, D. R. Grant MD, A. Ghanekar MD, PhD, I. D. McGilvray MD, PhD, M. S. Cattral MD, M. Selzner MD & P. D. Greig MD

  2. Department of HPB Surgery and Transplantation, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

    G. Sapisochin MD, PhD, S. Astete MD, L. Castells MD, PhD, I. Bilbao MD, PhD, C. Dopazo MD, PhD, J. L. Lázaro MD, M. Caralt MD, PhD & R. Charco MD, PhD

  3. Department of Transplantation, Skane University Hospital, Malmö, Sweden

    E. Rafael MD, PhD

  4. University of Sydney, Sydney, Australia

    C. Sandroussi MD

  5. Department of Medicine, Toronto General Hospital and University of Toronto, Toronto, Canada

    L Lilly MD

Authors
  1. G. Sapisochin MD, PhD
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  2. N. Goldaracena MD
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  3. S. Astete MD
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  4. J. M. Laurence MD, PhD
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  5. D. Davidson BSc
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  6. E. Rafael MD, PhD
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  7. L. Castells MD, PhD
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  8. C. Sandroussi MD
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  9. I. Bilbao MD, PhD
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  10. C. Dopazo MD, PhD
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  11. D. R. Grant MD
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  12. J. L. Lázaro MD
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  13. M. Caralt MD, PhD
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  14. A. Ghanekar MD, PhD
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  15. I. D. McGilvray MD, PhD
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  16. L Lilly MD
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  17. M. S. Cattral MD
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  18. M. Selzner MD
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  19. R. Charco MD, PhD
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  20. P. D. Greig MD
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Corresponding author

Correspondence to G. Sapisochin MD, PhD.

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Sapisochin, G., Goldaracena, N., Astete, S. et al. Benefit of Treating Hepatocellular Carcinoma Recurrence after Liver Transplantation and Analysis of Prognostic Factors for Survival in a Large Euro-American Series. Ann Surg Oncol 22, 2286–2294 (2015). https://doi.org/10.1245/s10434-014-4273-6

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  • DOI: https://doi.org/10.1245/s10434-014-4273-6

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