title: Time interval to recurrence as a predictor of overall survival in salvage liver transplantation for patients with hepatocellular carcinoma associated with hepatitis B virus.
abstract: BACKGROUND
  Salvage liver transplantation (SLT) has been proposed for recurrent hepatocellular carcinoma (HCC) after hepatectomy; however, it is unclear how the time interval to tumor recurrence from previous hepatectomy affects prognosis.
  
  
  METHODS
  We analyzed retrospectively the outcomes of 62 patients who underwent SLT in the Liver Transplantation Center of the First Affiliated Hospital of Zhejiang University between 2001 and 2012. SLT recipients were divided into 2 groups based on whether the time interval to recurrence was >1 year (L group) or <1 year (S group).
  
  
  RESULTS
  Baseline characteristics were similar between the 2 groups. The 1-, 3-, and 5-year overall survival rates were 81%, 45%, and 45% in the L group, which were better than in the S group, with 47%, 21%, and 21%, respectively (P = .005). The corresponding tumor-free survival rates were similar (P = .60) between 2 groups, with 71%, 51%, and 41% in the L group versus 55%, 55%, and 55% in the S group. Macrovascular invasion (hazard ratio [HR], 3.30), greatest tumor diameter (HR, 3.92), and time interval to tumor recurrence from previous hepatectomy (HR, 0.29) were independent predictors for overall survival. Furthermore, the diameter of the largest tumor was the only independent predictor of tumor-free survival (HR, 25.64).
  
  
  CONCLUSIONS
  The time interval to HCC recurrence from a previous hepatectomy is an important factor associated with survival after SLT. This finding should be helpful in guiding patient selection criteria for SLT in patients with previous hepatectomy.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang Province, China; Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China.
authors.forename: Zhenhua
authors.initials: Z
authors.lastname: Hu
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang Province, China; Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang Province, China; Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Li
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang Province, China; Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Xiang
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang Province, China; Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China.
authors.forename: Ze
authors.initials: Z
authors.lastname: Qian
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang Province, China; Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wu
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang Province, China; Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang Province, China; Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China. Electronic address: shusenzheng@zju.edu.cn.
authors.forename: Shusen
authors.initials: S
authors.lastname: Zheng
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D013997:Time Factors