title: Survival of patients treated with sorafenib for hepatocellular carcinoma recurrence after liver transplantation: a systematic review and meta-analysis.
abstract: BACKGROUND
  Data on survival and safety of sorafenib for hepatocellular carcinoma recurrence after liver transplant are still equivocal.
  
  
  OBJECTIVE
  We performed a meta-analysis of published studies, with the aim of estimating the 1-year rates of survival, analysing the variability in survival rates and, finally, identifying the factors associated with a longer survival.
  
  
  METHODS
  Data from 8 of the 17 selected studies were pooled, while the other 9 were excluded because survival rates were missing. All included studies were retrospective.
  
  
  RESULTS
  Overall, the 1-year survival ranged from 18% to 90%. Tumour progression was the main cause of death. The second cause was bleeding, reported only in patients undergoing m-Tor inhibitor therapy. The pooled estimate of 1-year survival was 63%. There was a significant heterogeneity among studies (P < 0.0001). Among the 34 variables assessed by univariate meta-regression, 5 were associated with an increase in the 1-year survival rate: (1) male gender (P = 0.001); (2) Time to progression (P = 0.038); and adverse drug events, divided in (3) gastrointestinal (P = 0.038), (4) cardiovascular (P = 0.029), and (5) dermatological (P = 0.014).
  
  
  CONCLUSIONS
  Additional data from multicentre prospective studies are required to clearly determine if sorafenib is a safe and acceptable treatment in hepatocellular carcinoma recurrence after liver transplant. Nevertheless, its association with m-Tor inhibitors should be discouraged.
authors: Hepatology and Gastroenterology Department, Ospedale Niguarda Ca' Granda, Milano, Italy; Internal Medicine Department, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico - Di Cristina - Benfratelli, Palermo, Italy.
authors: Andrea
authors: A
authors: Mancuso
authors: Gastroenterology Unit, Internal Medicine Department, University of Palermo, Palermo, Italy.
authors: Alessandra
authors: A
authors: Mazzola
authors: Gastroenterology Unit, Internal Medicine Department, University of Palermo, Palermo, Italy.
authors: Giuseppe
authors: G
authors: Cabibbo
authors: Hepatology and Gastroenterology Department, Ospedale Niguarda Ca' Granda, Milano, Italy.
authors: Giovanni
authors: G
authors: Perricone
authors: "S Vianelli" Department, University of Palermo, Italy.
authors: Marco
authors: M
authors: Enea
authors: Oncology Department, University of Palermo, Italy.
authors: Antonio
authors: A
authors: Galvano
authors: Hepatology and Gastroenterology Department, Ospedale Niguarda Ca' Granda, Milano, Italy.
authors: Claudio
authors: C
authors: Zavaglia
authors: Hepatology and Gastroenterology Department, Ospedale Niguarda Ca' Granda, Milano, Italy.
authors: Luca
authors: L
authors: Belli
authors: Gastroenterology Unit, Internal Medicine Department, University of Palermo, Palermo, Italy. Electronic address: calogero.camma@unipa.it.
authors: Calogero
authors: C
authors: Cammà
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D011184:Postoperative Period; D040262:Receptors, Vascular Endothelial Growth Factor; D000077157:Sorafenib; D015996:Survival Rate / Q000639:trends
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib; D040262:Receptors, Vascular Endothelial Growth Factor
keywords: Hepatocellular carcinoma; Liver transplant; Recurrence; Sorafenib