Recurrence of Hepatocellular Carcinoma after Liver Transplantation: Clinical Patterns and Hierarchy of Salvage Treatments.

IF 1.8 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Digestive Surgery Pub Date : 2024-01-01 Epub Date: 2024-09-05 DOI:10.1159/000539460

Tommaso Giuliani, Eva Montalvá, Javier Maupoey, Andrea Boscá, Ana Hernando, David Calatayud, Vicente Navarro, Angel Rubín, Carmen Vinaixa, Rafael López-Andújar

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Abstract

Introduction: The multiparametric nature of recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) still leads to uncertainty with its practical management. This study aims to characterize the main posttransplant recurrence patterns of HCC and to explore the therapeutic modalities targeting recurrence.

Methods: Consecutive patients who underwent LT for HCC at a single tertiary center were analyzed. The time from first recurrence to death was investigated for each site of presentation. The impact of each recurrence-targeted treatment on survival was studied.

Results: Of 660 patients with HCC, any recurrence occurred in 96 (15.4%) patients with a median time to recurrence of 20.0 months (95% CI: 15.6-23.8). Patients recurred across different patters including solitary distant locations (30.8%, n = 28), liver only (24.2%, n = 22), lung (18.7%, n = 17), multi-organ disease (17.6%, n = 16), and bone (8.8%, n = 8). Multi-organ and bone recurrences had the poorest survival, while solitary distant lesions and pulmonary recurrences had the best outcomes. Each treatment modality carried a distinctive survival.

Conclusions: Patients recurred across 3 patterns with different prognostic implications. The benefit of each treatment option on distinct recurrence patterns appears to be influenced by the biological behavior inherent in the recurrence pattern itself.

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肝移植后肝细胞癌复发：临床模式和挽救治疗的分级。

结构式摘要引言：肝移植（LT）后肝细胞癌（HCC）复发的多参数特性仍导致其实际治疗的不确定性。本研究旨在描述 HCC 移植后的主要复发模式，并探讨针对复发的治疗方法：方法：分析了在一家三级中心接受LT治疗的HCC连续患者。对每个发病部位从首次复发到死亡的时间进行了调查。研究了每种针对复发的治疗方法对生存率的影响：在660名HCC患者中，96名（15.4%）患者出现复发，中位复发时间为20.0个月（95% CI 15.6-23.8）。患者的复发模式各不相同，包括单发远处复发（30.8%，n=28）、仅肝脏复发（24.2%，n=22）、肺复发（18.7%，n=17）、多器官疾病复发（17.6%，n=16）和骨复发（8.8%，n=8）。多器官和骨复发的生存率最差，而单发远处病灶和肺复发的生存率最好。每种治疗方式都有不同的生存率：患者的复发有三种模式，对预后的影响各不相同。每种治疗方案对不同复发模式的益处似乎受到复发模式本身固有的生物学行为的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Surgery 医学-外科

CiteScore

4.90

自引率

3.70%

发文量

审稿时长

3 months

期刊介绍： ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.