title: Can sorafenib increase survival for recurrent hepatocellular carcinoma after liver transplantation? A pilot study.
abstract: Recurrence of hepatocellular carcinoma (HCC) remains a main detriment to long-term survival in liver transplants (LTx) for HCC. The study aims to review the use of sorafenib in recurrent HCC LTx in the Model End Stage Liver Disease era. Two hundred forty-seven patients with HCC LTx from 2002 to 2013 were included. Survival was calculated by the Kaplan-Meier (KM) method and Cox multivariate model. Twenty-two patients recurred (11%). By KM, overall survival was 27 months (standard deviation [SD], 3.2 months; median, 28.4 months). Mean time to recurrence was 16.9 months (SD, 2.8 months; median, 12 months). Nine patients were treated with sorafenib after recurrence. Median survival for sorafenib-treated patients was 42 months compared with a median of 16.2 months without sorafenib (-2 log likelihood ratio, P = 0.0582). By Cox, only sorafenib (P = 0.0233; hazard ratio, 8.528) and pathologic stage had a significant impact on survival. The recurrence rates of HCC LTx remain acceptable considering understaging and expansion of beyond Stage A. This pilot study of sorafenib in recurrent HCC demonstrates improved survival over historic controls. Many other factors affecting improved survival are explained. However, treatment remains palliative. Quality-of-life years and cost analysis need to be performed in this population.
authors.forename: Angel E
authors.initials: AE
authors.lastname: Alsina
authors.forename: Alexia
authors.initials: A
authors.lastname: Makris
authors.forename: Vasilios
authors.initials: V
authors.lastname: Nenos
authors.forename: Eduardo
authors.initials: E
authors.lastname: Sucre
authors.forename: Jade
authors.initials: J
authors.lastname: Arrobas
authors.forename: Edson
authors.initials: E
authors.lastname: Franco
authors.forename: Nyingi
authors.initials: N
authors.lastname: Kemmer
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010166:Palliative Care / Q000379:methods*; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D010865:Pilot Projects; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000077157:Sorafenib; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib