Survival analysis of patients with transplantable recurrent hepatocellular carcinoma: implications for salvage liver transplant.
OBJECTIVE
There is no difference in the survival benefit between salvage liver transplant and nontransplant therapies for recurrent hepatocellular carcinoma (HCC).


METHODS
Retrospective study.


METHODS
Tertiary referral center.


METHODS
Sixty patients developed transplantable intrahepatic recurrent HCC after curative resection. Twelve patients received salvage liver transplant, whereas 48 received nontransplant therapies, including a second surgical resection, radiofrequency ablation, transarterial chemoembolization, and percutaneous ethanol injection.


METHODS
The overall survival rates were compared between the 2 groups. Clinicopathologic variables were evaluated by univariate and multivariate analyses for their influence on overall survival.


RESULTS
There was no significant difference in overall survival rates between the salvage transplant and nontransplant groups. In the nontransplant group, pTNM (pathologic TNM) staging at primary resection and the time from primary resection to tumor recurrence were identified as independent prognostic factors affecting overall survival. These 2 factors carried no prognostic value in the salvage transplant group. Patients in the salvage transplant group with stage II tumors before the primary resection or intrahepatic recurrence within 12 months of the primary resection had significantly better overall survival than did the nontransplant group with corresponding poor prognostic factors.


CONCLUSIONS
Patients with transplantable intrahepatic recurrence can be treated effectively by salvage transplant or nontransplant therapies. Salvage transplant may be more beneficial to patients with stage II tumors before the primary resection and those with early intrahepatic recurrence.
Ng
Kelvin K
KK
FRCS(Glasg), FRCS(Edin), FACS, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong.
Lo
Chung Mau
CM
Liu
Chi Leung
CL
Poon
Ronnie T P
RT
Chan
See Ching
SC
Fan
Sheung Tat
ST
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy; D016019:Survival Analysis