title: Role of Sorafenib in Patients With Recurrent Hepatocellular Carcinoma After Liver Transplantation.
abstract: BACKGROUND
  The management of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) is challenging, especially if it is not treatable by surgery or embolization.
  
  
  OBJECTIVE
  The present study aims to compare the survival rates of liver transplanted patients receiving sorafenib or best supportive care (BSC) for HCC recurrence not amenable to curative intent treatments.
  
  
  METHODS
  This is a retrospective comparative study on a prospectively maintained database.
  
  
  METHODS
  Liver transplanted patients with untreatable HCC recurrence receiving BSC (n = 18) until 2007 or sorafenib (n = 15) thereafter were compared.
  
  
  RESULTS
  No group difference was observed for demographic characteristics at the time of transplantation and at the time of HCC recurrence. On the explant pathology of the native liver, 81.2% patients were classified within the Milan criteria, and 53.1% presented with microvascular invasion. Hepatocellular carcinoma recurrence was diagnosed 17.8 months (standard deviation: 14.5) after LT, with 17 (53.1%) patients presenting with early recurrence (≤12 months). The 1-year survival from untreatable progression of HCC recurrence was 23.9% for the BSC and 60% for the sorafenib group ( P = .002). The type of treatment (sorafenib vs BSC) was the sole independent predictor of survival (hazard ratio: 2.98; 95% confidence interval: 1.09-8.1; P = .033). In the sorafenib group, 8 (53.3%) patients required dose reduction, and 2 (13.3%) patients discontinued the treatment due to intolerable side effects.
  
  
  CONCLUSIONS
  Sorafenib improves survival and is superior to the BSC in cases of untreatable posttransplant hepatocellular carcinoma recurrence.
authors.affiliation: 1 Department of HPB Surgery and Liver Transplantation, Henri-Mondor Hospital, Université Paris Est-UPEC, Créteil, France.
authors.forename: Nicola
authors.initials: N
authors.lastname: de'Angelis
authors.affiliation: 1 Department of HPB Surgery and Liver Transplantation, Henri-Mondor Hospital, Université Paris Est-UPEC, Créteil, France.
authors.forename: Filippo
authors.initials: F
authors.lastname: Landi
authors.affiliation: 1 Department of HPB Surgery and Liver Transplantation, Henri-Mondor Hospital, Université Paris Est-UPEC, Créteil, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Nencioni
authors.affiliation: 1 Department of HPB Surgery and Liver Transplantation, Henri-Mondor Hospital, Université Paris Est-UPEC, Créteil, France.
authors.forename: Anais
authors.initials: A
authors.lastname: Palen
authors.affiliation: 1 Department of HPB Surgery and Liver Transplantation, Henri-Mondor Hospital, Université Paris Est-UPEC, Créteil, France.
authors.forename: Eylon
authors.initials: E
authors.lastname: Lahat
authors.affiliation: 1 Department of HPB Surgery and Liver Transplantation, Henri-Mondor Hospital, Université Paris Est-UPEC, Créteil, France.
authors.forename: Chady
authors.initials: C
authors.lastname: Salloum
authors.affiliation: 1 Department of HPB Surgery and Liver Transplantation, Henri-Mondor Hospital, Université Paris Est-UPEC, Créteil, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Compagnon
authors.affiliation: 1 Department of HPB Surgery and Liver Transplantation, Henri-Mondor Hospital, Université Paris Est-UPEC, Créteil, France.
authors.forename: Chetana
authors.initials: C
authors.lastname: Lim
authors.affiliation: 2 Department of Hepatology, Henri-Mondor Hospital, Université Paris Est-UPEC, Créteil, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Costentin
authors.affiliation: 3 Department of Pathology, Henri-Mondor Hospital, Université Paris Est-UPEC, Créteil, France.|4 INSERM Unit UMR1162, Créteil, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Calderaro
authors.affiliation: 5 Department of Radiology and Medical Imaging, Henri-Mondor Hospital, Université Paris Est-UPEC, Créteil, France.|6 INSERM Unit 955, Créteil, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Luciani
authors.affiliation: 2 Department of Hepatology, Henri-Mondor Hospital, Université Paris Est-UPEC, Créteil, France.|6 INSERM Unit 955, Créteil, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Feray
authors.affiliation: 1 Department of HPB Surgery and Liver Transplantation, Henri-Mondor Hospital, Université Paris Est-UPEC, Créteil, France.|6 INSERM Unit 955, Créteil, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy*; D016031:Liver Transplantation; D009364:Neoplasm Recurrence, Local; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077157:Sorafenib; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib
keywords: best supportive care; hepatocellular carcinoma; liver transplantation; sorafenib; tumor recurrence