Analysis of treatment benefits and prognostic factors for posttransplant HCC recurrence in a large Euro-American-Asian cohort.

Autor:	Li Z; HBP & Multi-Organ Transplant Program, Department of Surgery, University Health Network, Toronto, Ontario, Canada., Chen IC; Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan., Centonze L; Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy., Magyar CTJ; HBP & Multi-Organ Transplant Program, Department of Surgery, University Health Network, Toronto, Ontario, Canada.; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Choi WJ; HBP & Multi-Organ Transplant Program, Department of Surgery, University Health Network, Toronto, Ontario, Canada., Shah S; Department of Medicine, Division of Gastroenterology, University of California San Francisco, San Francisco, California, USA., O'Kane GM; Department of Medical Oncology, St. Vincent's University Hospital and School of Medicine University College Dublin, Dublin, Republic of Ireland.; Wallace McCain Centre for Pancreatic Cancer, Division of Medical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada., Vogel A; Division of Gastroenterology and Hepatology, University Health Network, Toronto, Ontario, Canada.; Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany., De Carlis L; Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.; School of Medicine and Surgery, Department of Surgery, University of Milan-Bicocca, Milan, Italy., Lerut J; Institut de Recherche Expérimentale et Clinique, Department of Surgery, Université catholique de Louvain, Brussels, Belgium., Lai Q; General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy., Mehta N; Department of Medicine, Division of Gastroenterology, University of California San Francisco, San Francisco, California, USA., Chen CL; Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan., Sapisochin G; HBP & Multi-Organ Transplant Program, Department of Surgery, University Health Network, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2024 Oct 03. Date of Electronic Publication: 2024 Oct 03.
DOI:	10.1097/LVT.0000000000000501
Abstrakt:	Posttransplant HCC recurrence significantly impacts survival, yet its management is challenging due to limited evidence. With recent advancements in HCC treatment, updated data on managing recurrent diseases are needed. In this retrospective study across 6 centers (2000-2022), we employed Cox proportional-hazards regression and log-rank tests to assess survival differences. A prognostic score model was developed to categorize patient survival. The efficacy of tyrosine kinase inhibitors was evaluated through propensity score matching. In our study, 431 of 3349 (14%) patients with HCC who underwent transplantation developed recurrence within a median interval of 18 (IQR: 9-32) months. One hundred forty-seven (34%) underwent curative-intent treatments, 207 (48%) received palliative treatments, and 77 (18%) were given best-supportive care. Patients undergoing curative-intent treatments had better survival from the time of recurrence with a median survival of 45 (95% CI: 36-63) months and 1/3/5-year survival of 90%/56%/43% compared to those receiving noncurative treatments (median: 11 [95% CI: 10-13] mo, 1/3/5-y survival of 46%/10%/7%, log-rank p < 0.001). Patients with recurrence diagnosed in the era 2018-2022 showed improved survival over the previous era (HR 0.64 [95% CI: 0.47-0.86]). Multivariable analysis identified 5 prognostic factors: ineligibility for curative-intent treatment (HR: 3.5 [95% CI: 2.7-4.6]), recurrence within 1 year (HR: 1.7 [95% CI: 1.3-2.1]), poor tumor differentiation (HR: 1.5 [95% CI: 1.1-1.9]), RETREAT score ≥3 (HR: 1.4 [95% CI: 1.1-1.8]), and alpha-fetoprotein at recurrence ≥400 ng/mL (HR: 1.4 [95% CI: 1.1-1.9]). These factors contributed to a prognostic scoring system (0-9) that stratified patients into 3 prognosis groups. Both propensity score-matched analysis and multivariable regression indicated that lenvatinib was not statistically superior to sorafenib in terms of efficacy. Curative-intent treatments should be advocated for patients with posttransplant recurrence whenever possible. Prognostic factors linked to aggressive tumor biology significantly influence survival. Advancements in HCC management have improved survival outcomes over the past 5 years. (Copyright © 2024 American Association for the Study of Liver Diseases.)
Databáze:	MEDLINE
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