Abstract
BackgroundSurvival 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.MethodsThree 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.ResultsOf 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.ConclusionTiming 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.
Highlights
Patients with HCC have high recurrence rates after cancer treatment [1]
Entire original data were from the following three linked national databases covering the beneficiaries of the whole population of Taiwan from 2005 to 2016: Taiwan’s National Health Insurance Research Database (NHIRD), Registry for Catastrophic Illness Patient Database (RCIPD), and Cause of Death Database
Regarding HCC, the histologic confirmation or typical imaging presentation is required for registering patients in the RCIPD
Summary
Patients with HCC have high recurrence rates after cancer treatment [1]. Primary HCC can be cured through liver transplant under stringent criteria [2], the current trend of accommodating transplant patients through relaxing criteria and salvaging those who had recurrent HCC with multiple previous loco-regional treatments can potentially increase the pool of post-transplant recurrence tremendously in the near future [1, 3]. Guidelines for the management of HCC recurrence after liver transplantation are still lacking [3]. The management strategy of primary HCC and nontransplant setting is used for post-transplant HCC recurrence [3, 4]. Almost all transplant patients with HCC recurrence were neglected and received off-labeled cancer treatments. 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
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