TY - JOUR
T1 - Survival After Treatable Hepatocellular Carcinoma Recurrence in Liver Recipients
T2 - A Nationwide Cohort Analysis
AU - Ho, Cheng Maw
AU - Lee, Chih Hsin
AU - Lee, Ming Chia
AU - Zhang, Jun Fu
AU - Chen, Chin Hua
AU - Wang, Jann Yuan
AU - Hu, Rey Heng
AU - Lee, Po Huang
N1 - Funding Information:
We thank the Department of Statistics, Ministry of Health and Welfare, and National Taiwan University Health Data Research Center for providing administrative support. We thank Ms. Ching-Wen Tsai for technical assistance.
Funding Information:
This study was funded by the Ministry of Health and Welfare (MOHW109-CDC-C-114-000108). The funder played no role in the study design, data analysis, or manuscript drafting.
Publisher Copyright:
© Copyright © 2021 Ho, Lee, Lee, Zhang, Chen, Wang, Hu and Lee.
PY - 2021/1/28
Y1 - 2021/1/28
N2 - Background: Survival after post-transplant recurrence of HCC is dismal, and almost all treatments for recurrent HCC are off-labeled, without an extensive large-scale analysis. We aimed to delineate their post-recurrence courses and define benchmarks for comparing future treatment effectiveness. Methods: Three national databases, including health insurance, catastrophic illness, and the cause of death, were linked for cohort establishment and data collection during the period from 2005 to 2016. Patients with HCC recurrence ≥6 months after transplant surgery and under treatment were recruited for survival analysis. Selection of treatment strategies for HCC recurrence after liver transplant was based on the same criteria for those without liver transplant. Results: Of 2,123 liver transplant recipients, 349 developed HCC recurrence ≥6 months after liver transplant, and the median recurrence time was 17.8 months post-transplant. Within 2 years of treatment, 61% patients showed recurrence (early recurrence group), and survival in these patients was poorer than in the late recurrence group. According to a multivariable analysis, the transplant era before 2008 and radiofrequency ablation were associated with good prognosis, whereas receiving sorafenib and radiotherapy was associated with poor prognosis. The effect of transplant era became insignificant after stratification by recently receiving pretransplant transarterial chemoembolization. Conclusion: Timing of recurrence and interventions used were associated with the outcomes of patients with post-transplant HCC recurrence. These data provide the benchmark and indicate the critical period and high-risk factors for further therapeutic trial consideration.
AB - Background: Survival after post-transplant recurrence of HCC is dismal, and almost all treatments for recurrent HCC are off-labeled, without an extensive large-scale analysis. We aimed to delineate their post-recurrence courses and define benchmarks for comparing future treatment effectiveness. Methods: Three national databases, including health insurance, catastrophic illness, and the cause of death, were linked for cohort establishment and data collection during the period from 2005 to 2016. Patients with HCC recurrence ≥6 months after transplant surgery and under treatment were recruited for survival analysis. Selection of treatment strategies for HCC recurrence after liver transplant was based on the same criteria for those without liver transplant. Results: Of 2,123 liver transplant recipients, 349 developed HCC recurrence ≥6 months after liver transplant, and the median recurrence time was 17.8 months post-transplant. Within 2 years of treatment, 61% patients showed recurrence (early recurrence group), and survival in these patients was poorer than in the late recurrence group. According to a multivariable analysis, the transplant era before 2008 and radiofrequency ablation were associated with good prognosis, whereas receiving sorafenib and radiotherapy was associated with poor prognosis. The effect of transplant era became insignificant after stratification by recently receiving pretransplant transarterial chemoembolization. Conclusion: Timing of recurrence and interventions used were associated with the outcomes of patients with post-transplant HCC recurrence. These data provide the benchmark and indicate the critical period and high-risk factors for further therapeutic trial consideration.
KW - hepatocellular carcinoma
KW - liver transplantation
KW - radiofrequency ablation
KW - recurrence
KW - survival
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U2 - 10.3389/fonc.2020.616094
DO - 10.3389/fonc.2020.616094
M3 - Article
AN - SCOPUS:85100904466
SN - 2234-943X
VL - 10
JO - Frontiers in Oncology
JF - Frontiers in Oncology
M1 - 616094
ER -