Comparison of comprehensive therapy and local therapy of recurrence after liver transplantation in patients with hepatocellular carcinoma beyond Milan criteria

Abstract

Abstract: Objective: To compare the efficacy of different treatments of recurrence after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) beyond Milan criteria (MC). Methods: The clinical data of 57 patients with HCC beyond MC who underwent LT for the first time and had tumor recurrence after operation in Tianjin First Central Hospital from March, 2016 to August, 2019 were analyzed retrospectively. According to the different treatment methods after recurrence, the patients were divided into comprehensive treatment group and local treatment group. Local treatment includes surgical resection, transarterial chemoembolization, radioactive ¹³¹I seed implantation, arterial infusion chemotherapy, radiofrequency ablation and radiotherapy. The comprehensive treatment is the addition of sorafenib or lenvatinib on the basis of local treatment. The differences of tumor remission and survival between comprehensive treatment group and local treatment group were compared and analyzed. Results: In the local treatment group, 1 patient (4.35%) and 8 patients (34.78%) achieved partial remission (PR) and stable disease (SD) respectively, and 14 patients (60.87%) happened progressive disease (PD) after treatment. In the comprehensive treatment group, 7 patients (20.59%) achieved PR, 17 patients (50%) achieved SD, and 10 patients (29.41%) had PD after treatment, which was better than that of local treatment group (P < 0.05). The median survival timeafterrecurrencein the comprehensive treatment group was 12 months, which was higher than that in the local treatment group (7 months) (P < 0.01). In the comprehensive treatment group, 3 patients (15.79%), 9 patients (47.37%) and 7 patients (36.84%) achieved PR, SD and PD in lenvatinib respectively. In sorafenib group, 4 patients (26.67%), 8 patients (53.33%) and 3 patients (20.00%) achieved PR, SD and PD, respectively. There was no significant difference in tumor remission between the two groups (P=0.548). However, the median survival time after recurrence in the lenvatinib group (13 months) was higher than that in the sorafenib group (10 months) (P=0.047). Conclusion: Patients with tumor recurrence after LT for HCC beyond MC are more likely to benefit from the comprehensive treatment, in which lenvatinib may be sorafenib to sorafinib in the long-term survival of such patients.

Key words: Liver transplantation for liver cancer, Beyond Milan criteria, Postoperative recurrence, Comprehensive treatment

Xie Yan, Zhang Weiqi, Sun Jisan, Jiang Wentao. Comparison of comprehensive therapy and local therapy of recurrence after liver transplantation in patients with hepatocellular carcinoma beyond Milan criteria[J]. Electronic Journal of Liver Tumor, 2021, 8(3): 12-16.

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