Options for the treatment of intrahepatic recurrent hepatocellular carcinoma: Salvage liver transplantation or rehepatectomy?

Abstract

Objective: To explore prognostic factors by comparing the efficacy of salvage liver transplantation (sLT) and rehepatectomy (RH) for the treatment of recurrent hepatocellular carcinoma after hepatectomy. Methods:Clinical data were collected for 124 patients treated at our center from January 2012 to August 2018. The median follow-up time for the patients was 39 months. By analyzing the clinical data between the sLT group (46 cases) and RH group (78 cases), the factors affecting the prognosis of patients were compared. Results:The proportion of alpha-fetoprotein (AFP) ≥ 100 µg/L in the recurrence group was significantly higher than that in the recurrence-free group (70.0% vs 22.2%, P = .014). The postoperative overall survival (OS) and recurrence-free survival (RFS) were better in the sLT group than in the RH group (81.2% vs 36.9%, P < .01; 77.1% vs 55.6%, P = .019). In the sLT group, the OS and RFS in the AFP < 100 µg/L group were superior to those in the AFP ≥ 100 µg/L group (P = .046 and P = .002). Conclusion:The sLT group had achieved better efficacy than RH group, but when AFP ≥ 100 µg/L, sLT did not achieve better efficacy than RH. K E Y W O R D Srecurrent hepatocellular carcinoma, rehepatectomy, salvage liver transplantation

Effectiveness of radiofrequency ablation versus transarterial chemoembolization for recurrent hepatocellular carcinoma: A meta-analysis

“…Most patients with RHCC cannot undergo liver resection or salvage liver transplantation to achieve a cure because they commonly have low liver function due to cirrhosis and there is a worldwide shortage of livers available for transplantation. [19][20][21] Currently, RFA and TACE are widely used in patients with unresectable recurrent liver lesions. RFA was first used for recurrent liver cancer in 1999, and therefore, patients with RHCC have more therapy options in addition to rehepatectomy.…”

Surgical Strategies for Recurrent Hepatocellular Carcinoma after Resection: A Review of Current Evidence

“…However, the advantage of SLT over RH was not confirmed when only patients with higher AFP at recurrence (>100 ng/mL) were considered, indicating that the selection process for RH versus SLT is complex. Furthermore, Fang et al [139] reported longer operation time, increased blood loss and blood replacement, prolonged in-hospital stays and postoperative morbidity in the case of SLT; in addition, perioperative mortality was not reported for the groups.…”

“…Several studies have reported a comparison between SLT and RH in the case of rHCC (Table 2) [119,[137][138][139][140]. Clearly, there are many factors to be considered, not least the experience of a given centre in performing both liver resection and transplantation.…”

“…RH = Redo-Hepatectomy, SLT = Salvage Liver Transplantation, RFS = Recurrence-Free Survival, DFS = disease-free survival, OS = Overall Survival; data are given as percentage (%) or median (range) unless otherwise noted. α Population after propensity score matching; Calculated median value and range of all reported values with the exception of "survivals" of Fang (2020) [139].…”

Combining local regional therapy and systemic therapy: Expected changes in the treatment landscape of recurrent hepatocellular carcinoma

“…SLT is considered an effective and curative treatment approach that can simultaneously resolve liver tumors, potential liver dysfunction and the original underlying diseases. For recurrent HCC, as long as patients meet the criteria, the prognosis is relatively high[ 11 , 82 , 83 ]; the 5-year survival rate is 42%-73%[ 84 ]. A systematic retrospective analysis of the prognosis of SLT and RR in the treatment of recurrent HCC showed that patients in the SLT group generally had larger liver lesions but better relapse-free survival (RFS) than those in the RR group and that the OS of the two groups was similar[ 85 ].…”