Korean J Transplant.  2022 Nov;36(Supple 1):S74. 10.4285/ATW2022.F-1899.

Impact of tumor biology on outcomes of radical therapy for hepatocellular carcinoma oligo-recurrence after liver transplantation

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

• KMID: 2535590
• DOI: http://doi.org/10.4285/ATW2022.F-1899

Abstract

Background
It is uncertain whether tumour biology affects radical treatment for posttransplant hepatocellular carcinoma (HCC) oligo-recurrence, i.e., recurrence limited in numbers and locations amendable to radical therapy.
Methods
We conducted a retrospective study on 144 patients with posttransplant HCC recurrence.
Results
Early recurrence within 1 year after transplant (hazard ratio [HR], 2.53; 95% confidence interval [CI], 1.65–3.88; P<0.001), liver recurrence (HR, 1.74; 95% CI, 1.12–2.68; P=0.01) and AFP >200 ng/mL upon recurrence (HR, 1.62; 95% CI, 1.04–2.52; P=0.03) predicted mortality following recurrence. In patients with early recurrence and liver recurrence, radical treatment was associated with improved post-recurrence survival (early recurrence: median 18.2±1.5 vs. 9.2±1.5 months, P<0.001; liver recurrence: median 28.0±4.5 vs. 11.6±2.0, P<0.001). In patients with AFP >200 ng/mL, improvement in survival did not reach statistical significance (median, 18.2±6.5 vs. 8.8±2.2 months; P=0.13). Survival benefits associated with radical therapy were reduced in early recurrence (13.6 vs. 9.0 months) and recurrence with high AFP (15.4 vs. 9.3 months) but were similar among patients with and without liver recurrence (16.9 vs. 16.4 months). They were also diminished in patients with multiple biological risk factors (0 risk factor: 29.0 months; 1 risk factor: 19.7 months; 23 risk factors: 3.4 months).
Conclusions
The survival benefit following radical therapy was superior in patients with favorable biological recurrence but was also observed in patients with poor tumor biology. Treatment decisions should be individualized considering the oncological ben-efits, quality of life gain and procedural morbidity.