Defining Optimal Surgical Treatment for Recurrent Hepatocellular Carcinoma: A Propensity Score Matched Analysis.

Abstract

Salvage liver transplantation (sLT) and repeated resection (RR) are effective treatments for recurrent hepatocellular carcinoma (HCC), and comparisons of the oncological outcomes between these 2 modalities were scarce. Consecutive patients admitted for either sLT or RR for recurrent HCC were recruited. All patients in the present series received either prior hepatectomy, ablative therapy, or both before RR or sLT. Patient demographic, perioperative, and outcome data were analyzed. A survival analysis was performed after propensity score matching. There were 277 eligible patients recruited, and 67 and 210 of them underwent sLT and RR, respectively. Significant differences in preoperative hemoglobin, albumin, Model of End-Stage Liver Disease (MELD) score, and tumor number were found between the sLT and RR groups. After 1:3 propensity score matching, there were 36 sLT and 108 RR patients for comparison. The median age, MELD, alpha fetoprotein, and tumor size and number of the matched population were 57 years, 7.5, 16 ng/mL, 2.5 cm, and 1, respectively. There was no difference in the hospital mortality and complication rate (Clavien IIIa or above) between the groups. The recurrence rate after RR was significantly higher than for the patients who received sLT (72.2% versus 27.8%; P < 0.001). Following RR, 3 patients received liver transplantation for further recurrence, and 54.6% of the patients developed nontransplantable recurrence. The 5-year disease-free survival (DFS) and overall survival (OS) were both superior in the sLT group (DFS, 71.6% versus 32.8%, P < 0.001; OS, 72.8% versus 48.3%, P = 0.007). In conclusion, sLT is superior to RR for treatment of recurrent HCC in terms of DFS and OS. The high rate of nontransplantable recurrence after reresection underscores the importance of timely sLT.

• Authors: Ka Wing Ma, Kenneth Siu Ho Chok, Wong Hoi She, Albert Chi Yan Chan, Tan To Cheung, Wing Chiu Dai, James Yan Yue Fung, Chung Mau Lo
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 24 Issue 8 Pg. 1062-1069 (08 2018) ISSN: 1527-6473 [Electronic] United States
• PMID: 29451360 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2018 The Authors. Liver Transplantation published by Wiley Periodicals, Inc. on behalf of American Association for the Study of Liver Diseases.

Topics

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Hepatocellular (mortality, surgery)
• Disease-Free Survival
• Female
• Follow-Up Studies
• Hepatectomy (adverse effects, methods)
• Hong Kong (epidemiology)
• Humans
• Liver Neoplasms (mortality, surgery)
• Liver Transplantation (adverse effects, methods)
• Male
• Middle Aged
• Neoplasm Recurrence, Local (mortality, surgery)
• Propensity Score
• Prospective Studies
• Reoperation (adverse effects, methods)
• Retrospective Studies
• Salvage Therapy (adverse effects, methods)
• Survival Analysis
• Time Factors
• Young Adult