title: Recurrence of hepatocellular carcinoma after liver transplantation: Is there a place for resection?
abstract: Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is widely considered as a terminal condition. Therefore, the role of surgery is uncertain in this case. The purpose of this study was to identify the prognostic factors of survival after post-LT HCC recurrence and to evaluate the impact of surgery in this setting. All patients transplanted for HCC between 1991 and 2013 in a single institution and who further developed a post-LT recurrence were included in this study. Univariate and multivariate analyses were performed to identify factors affecting postrecurrence survival. Of the 493 patients transplanted for HCC, a total of 70 (14.2%) consecutive patients developed a recurrence after a median disease-free interval of 17 months. Median survival (MS) from the time of recurrence was 19 months, with a 3-year postrecurrence survival of 26%. Most recurrences were extrahepatic (lung, lymph node, and bone; n = 51; 72.9%), whereas only intrahepatic recurrences were observed in 2 (2.8%) patients. Both intrahepatic and extrahepatic locations were found in 17 (24.3%) patients. A total of 22 (31.4%) patients underwent macroscopically complete resection of the recurrence (intrahepatic [n = 2] and extrahepatic [n = 20]). The MS for resected patients after transplantation was 35 months compared with 15 months for nonresected patients (P < 0.001). In multivariate analysis, the independent unfavorable factors of postrecurrence survival were alpha-fetoprotein level > 100 ng/mL at relapse (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.1-4.1; P = 0.03), intrahepatic location (HR, 1.8; 95% CI, 1.0-3.2; P = 0.05), and multifocal recurrence (HR, 1.8; 95% CI, 1.1-3.1; P = 0.04). The management including surgery (HR, 0.4; 95% CI, 0.2-0.7; P = 0.004) was identified as an independent favorable factor. In conclusion, recurrence of HCC after LT is associated with a poor prognosis. However, resection is associated with improved survival and should therefore be considered when feasible. Liver Transplantation 23 440-447 2017 AASLD.
authors.affiliation: Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France.
authors.forename: Elena
authors.initials: E
authors.lastname: Fernandez-Sevilla
authors.affiliation: Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France.|Université Paris-Sud, Villejuif, France.|Unité 935, Institut National de la Santé et de la Recherche, Villejuif, France.
authors.forename: Marc-Antoine
authors.initials: MA
authors.lastname: Allard
authors.affiliation: Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France.
authors.forename: Jasmijn
authors.initials: J
authors.lastname: Selten
authors.affiliation: Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France.|Université Paris-Sud, Villejuif, France.|Unité 785, Institut National de la Santé et de la Recherche, Villejuif, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Golse
authors.affiliation: Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France.|Université Paris-Sud, Villejuif, France.|Unité 785, Institut National de la Santé et de la Recherche, Villejuif, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Vibert
authors.affiliation: Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France.|Université Paris-Sud, Villejuif, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sa Cunha
authors.affiliation: Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France.|Université Paris-Sud, Villejuif, France.|Unité 785, Institut National de la Santé et de la Recherche, Villejuif, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
authors.affiliation: Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France.|Université Paris-Sud, Villejuif, France.|Unité 785, Institut National de la Santé et de la Recherche, Villejuif, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.affiliation: Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France.|Université Paris-Sud, Villejuif, France.|Unité 935, Institut National de la Santé et de la Recherche, Villejuif, France.
authors.forename: René
authors.initials: R
authors.lastname: Adam
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation; D012307:Risk Factors; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins