Korean J Transplant.  2022 Nov;36(Supple 1):S73. 10.4285/ATW2022.F-1892.

Verifying the benefits of radical treatment in posttransplant hepatocellular carcinoma oligo-recurrence: a propensity score analysis

• Au KP
• Yue Fung JY
• Dai WC
• Yan Chan AC
• Lo CM
• Ho Chok KS

• KMID: 2535589
• DOI: http://doi.org/10.4285/ATW2022.F-1892

Abstract

Background
It is unclear whether radical treatment for hepatocellular carcinoma (HCC) oligo-recurrence after liver transplantation conveys survival benefits.
Methods
A retrospective study of 144 patients with posttransplant HCC recurrence was performed. Propensity score matching was performed to adjust for baseline covariates between patients receiving radical and palliative treatment. The primary endpoint was post-recurrence survival.
Results
Fifty (35%) patients received radical treatment for recurrence, while 76 (53%) and 18 (13%) patients received palliative and supportive treatment, respectively. Comparing to the radical group, patients who received palliative treatment had more early recurrences (time from transplant 17 vs. 11 months, P=0.01) and more extensive disease in terms of tumor numbers (1 vs. 4, P<0.001), size of largest tumor (1.8 vs. 2.5 cm, P=0.046), numbers of involved organs (interquartile range [IQR], 1–1 vs. 1–2; P=0.02) and AFP level (7 vs. 40 ng/mL, P=0.01). Multivariate Cox-regression analysis revealed that early recurrence (time from transplant hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.01–1.03; P=0.001), larger recurrent tumor (HR, 1.12; 95% CI, 1.03–1.23; P=0.01), liver recurrence (HR, 1.84; 95% CI, 1.17–2.90; P=0.01) and log10AFP level upon recurrence (HR, 1.27; 95% CI, 1.07–1.52; P=0.01) predicted poor survival. mTOR inhibitor (HR, 0.331; 95% CI, 0.213–0.548; P<0.0001) and radical treatment (HR, 0.342; 95% CI, 0.213–0.548; P<0.0001) were associated with improved survival. After 2-to-1 propensity score matching for covariates, the 50 patients receiving curative treatment survived significantly longer than the 25 matched patients receiving palliative treatment (median survival 30.9±2.4 vs. 19.5±3.0 months, P=0.01).
Conclusions
Radical treatment conveys survival benefits to HCC oligo-recurrence after liver transplantation.