Repeated loco-regional therapies for hepatocellular carcinoma is associated with inferior outcome after living donor liver transplantation in cirrhotic patients

Abstract

Background: Liver transplantation is the definitive treatment for defined stage hepatocellular carcinoma (HCC) in cirrhotic patients. Loco-regional therapy (LRT) may be considered before transplantation to prevent the disease progression and the patient from dropping out of the waiting list. This study aims to evaluate the impact of repeated pretransplant LRTs on the long-term outcomes in HCC liver transplant recipients. Methods: Between 2004 and 2019, living donor liver transplantation (LDLT) recipients with viable HCC on the explant livers were enrolled. Uni- and multivariate analysis was performed with the Cox regression model to stratify the risk factors associated with HCC recurrence and patent survival after LDLT. Results: A total of 124 patients were enrolled, in which 65.3% (n = 81) were Barcelona Clinic Liver Cancer classification stage B or D and 89% (n = 110) had advanced fibrosis or cirrhosis on the explanted livers. After a median follow-up of 41 months (IQR: 24–86.5), there were 18 cases (13.7%) of HCC recurrence. Univariate analysis showed that the model of end-stage liver disease and Child-Turcotte-Pugh score, pretransplant alpha-fetoprotein value (>500 ng/ml), repeated pretransplant LRTs (N > 4), increased tumor numbers and maximal size, presence of microvascular invasion, and the histological grading of the tumors are risk factors of inferior outcomes. In multivariate analysis, only repeated pretransplant LRTs (N > 4) had a significant impact on both the overall- and recurrence-free survival. The impact of pretransplant LRT was consistently significant among subgroups based on their LRT episodes (N = 0, 1–4, >4 respectively). Conclusion: Repeated LRT for HCC can be associated with the risk of tumor recurrence and inferior patient survival after LDLT in cirrhotic patients. Early referral of those eligible for transplantation may improve the treatment outcomes in these patients.

Winners of the 2022 honor awards for excellence at the annual meeting of the Chinese Medical Association-Taipei: Part I

“…Tsou et al tried to respond to this question. 1 The results showed a significantly better overall survival (OS) and disease-free survival (DFS) in the group of LDLT without previous LRT (5-year OS 87.5% vs 61.7%, p = 0.012; 5-year DFS 100.0% vs 70.7%, p = 0.001). 1 Moreover, LRT > 4 times was a critical redline, because OS and DFS were dramatically shortened with 5-year OS 51.1% and 5-year RFS 56.7%, respectively.…”

“…1 The results showed a significantly better overall survival (OS) and disease-free survival (DFS) in the group of LDLT without previous LRT (5-year OS 87.5% vs 61.7%, p = 0.012; 5-year DFS 100.0% vs 70.7%, p = 0.001). 1 Moreover, LRT > 4 times was a critical redline, because OS and DFS were dramatically shortened with 5-year OS 51.1% and 5-year RFS 56.7%, respectively. 1 This critical point by >4 times of LRT was further confirmed by the multivariate analysis, because it was the only determined factor for worsening both DFS (hazard ratio [HR] 5.75, 95% confidence interval [CI] 1.45-22.80) and OS (HR 2.75, 95% CI 1.37-5.54), respectively.…”

“…The present editorial is a "Part I," including three excellent works. [1][2][3] We are honored to present three winners and summary their impressive, scientific and useful findings, which bring a great impact on global health promotion and offer a better care reference for the profession in the management of various kinds of patients with similar clinical situation in the future.…”

“…1 Among 124 patients with hepatocellular carcinoma (HCC) treated by living donor liver transplantation (LDLT) procedure, 18 patients had recurrence and 32 patients died during a median follow-up period of 41 months. 1 Traditionally, the therapy of HCC patients is based the Barcelona Clinic Liver Cancer (BCLC) stage system. [4][5][6] Noncirrhotic HCC patients with BCLC stage 0-A could be treated with resection surgery or local ablation.…”

“…The publication entitled “Repeated loco-regional therapies for hepatocellular carcinoma is associated with inferior outcome after living donor liver transplantation in cirrhotic patients” was conducted by Dr Tsou and his colleagues. 1 Among 124 patients with hepatocellular carcinoma (HCC) treated by living donor liver transplantation (LDLT) procedure, 18 patients had recurrence and 32 patients died during a median follow-up period of 41 months. 1 Traditionally, the therapy of HCC patients is based the Barcelona Clinic Liver Cancer (BCLC) stage system.…”