title: Adjuvant chemotherapy for transplanted hepatocellular carcinoma patients: impact on survival or HCV recurrence timing.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide. In the Western world the current epidemic of cirrhosis due to the hepatitis C virus (HCV) is increasing the number of new cases. Liver transplantation (OLTx) represents a radical treatment for HCC and the underlying cirrhosis. Whether adjuvant chemotherapy is indicated in the postoperative period to prevent recurrence is controversial.
  
  
  METHODS
  Forty-eight HCC patients underwent liver transplantation during 11 years, including 21 who were chemo-treated (CT) patients. Thirty-one patients (65%) had post-necrotic virus-C cirrhosis (PNC-C). Twenty-one cases (44%) were p-TNM stages III-IV, and 15 cases (31%) incidental HCC detected in the explanted liver. Seven HCV patients (15%) received chemotherapy (before 1998).
  
  
  RESULTS
  One-, 3-, and 5-year overall survival rates were 100%, 85%, 79% (CT group), and 89%, 71%, 71% (no CT group), respectively. The HCV recurrence-free survival rates at 3, 6, and 12 months were 29%, 14%, 0% for the CT group, versus 76%, 38%, 25% for the no CT group (P =.005).
  
  
  CONCLUSIONS
  Discontinuation of HCV-HCC patients by chemotherapeutic adjuvant protocols after transplantation appears rational due to the early hepatitis C recurrence confirmed in our series. Moreover, few studies have demonstrated that CT prolongs survival of HCC transplanted patients. New pharmacological approaches are necessary to solve these questions.
authors.affiliation: Clinica Chirurgica 1 and Liver Transplantation Unit, Department of Surgical and Gastroenterological Sciences, Padua University, P.G. Cevese University Hospital, Via Giustiniani 2, Padua 35128, Italy. bassanellomarco@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Bassanello
authors.forename: A
authors.initials: A
authors.lastname: Vitale
authors.forename: F A
authors.initials: FA
authors.lastname: Ciarleglio
authors.forename: A
authors.initials: A
authors.lastname: Brolese
authors.forename: G
authors.initials: G
authors.lastname: Zanus
authors.forename: F
authors.initials: F
authors.lastname: D'Amico
authors.forename: A
authors.initials: A
authors.lastname: Carraro
authors.forename: G
authors.initials: G
authors.lastname: Cappuzzo
authors.forename: A
authors.initials: A
authors.lastname: Bridda
authors.forename: M
authors.initials: M
authors.lastname: Senzolo
authors.forename: P
authors.initials: P
authors.lastname: Burra
authors.forename: S
authors.initials: S
authors.lastname: Pevere
authors.forename: D
authors.initials: D
authors.lastname: D'Amico
authors.forename: U
authors.initials: U
authors.lastname: Cillo
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000601:surgery* / Q000821:virology; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors