title: Benefit of Treating Hepatocellular Carcinoma Recurrence after Liver Transplantation and Analysis of Prognostic Factors for Survival in a Large Euro-American Series.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada, sapisochin@me.com.
authors.forename: G
authors.initials: G
authors.lastname: Sapisochin
authors.forename: N
authors.initials: N
authors.lastname: Goldaracena
authors.forename: S
authors.initials: S
authors.lastname: Astete
authors.forename: J M
authors.initials: JM
authors.lastname: Laurence
authors.forename: D
authors.initials: D
authors.lastname: Davidson
authors.forename: E
authors.initials: E
authors.lastname: Rafael
authors.forename: L
authors.initials: L
authors.lastname: Castells
authors.forename: C
authors.initials: C
authors.lastname: Sandroussi
authors.forename: I
authors.initials: I
authors.lastname: Bilbao
authors.forename: C
authors.initials: C
authors.lastname: Dopazo
authors.forename: D R
authors.initials: DR
authors.lastname: Grant
authors.forename: J L
authors.initials: JL
authors.lastname: Lázaro
authors.forename: M
authors.initials: M
authors.lastname: Caralt
authors.forename: A
authors.initials: A
authors.lastname: Ghanekar
authors.forename: I D
authors.initials: ID
authors.lastname: McGilvray
authors.forename: L
authors.initials: L
authors.lastname: Lilly
authors.forename: M S
authors.initials: MS
authors.lastname: Cattral
authors.forename: M
authors.initials: M
authors.lastname: Selzner
authors.forename: R
authors.initials: R
authors.lastname: Charco
authors.forename: P D
authors.initials: PD
authors.lastname: Greig
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D033182:Intention; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins