Abstract | BACKGROUND: Surgical stress by hepatic ischaemia-reperfusion (I/R) is supposed to promote intra- and extrahepatic tumour recurrence. Treatment with prostaglandin E1 ( PGE1) has been shown to attenuate hepatic I/R injury in liver transplant patients, but the potential anti- cancer effects have not been analysed. AIM: METHODS: A retrospective review of 106 liver transplant patients with HCC was conducted. Fifty-nine patients underwent early post- liver transplantation (LT) treatment with the stable PGE1 analogue alprostadil. Administration of alprostadil was correlated with outcome in uni- and multivariate analysis. Subgroup analysis focused on patients with HCC beyond the Milan criteria (Milan Out) on radiographic imaging. RESULTS: Three- and 5-year recurrence-free survival rates were 87.9% and 85.7% in the PGE1-group, but only 65.3% and 63.1% in the non-PGE1-population (P = 0.003). Multivariate Cox regression analysis identified absence of PGE1-treatment (HR = 11.42), along with presence of poor tumour grading (HR = 2.69) and microvascular tumour invasion (HR = 35.8) to be independently associated with early (within 12 months) HCC recurrence. In Milan Out-patients, only therapy with PGE1 (HR = 5.09) and well/moderate tumour differentiation (HR = 6.51) were independent promoters of recurrence-free survival. CONCLUSIONS: Treating hepatic ischaemia- reperfusion injury with alprostadil reduces the risk of early HCC recurrence following LT. In particular patients with HCC exceeding the Milan criteria seem to benefit from PGE1-treatment. The molecular mechanisms of the anti-tumour effects need to be further assessed.
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Authors | A Kornberg, U Witt, J Kornberg, H Friess, K Thrum |
Journal | Alimentary pharmacology & therapeutics
(Aliment Pharmacol Ther)
Vol. 42
Issue 9
Pg. 1101-10
(Nov 2015)
ISSN: 1365-2036 [Electronic] England |
PMID | 26282466
(Publication Type: Journal Article)
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Copyright | © 2015 John Wiley & Sons Ltd. |
Chemical References |
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Topics |
- Adult
- Aged
- Alprostadil
(therapeutic use)
- Carcinoma, Hepatocellular
(diagnostic imaging, surgery)
- Female
- Humans
- Liver Neoplasms
(diagnostic imaging, surgery)
- Liver Transplantation
(adverse effects)
- Male
- Middle Aged
- Neoplasm Recurrence, Local
(complications, prevention & control)
- Radiography
- Reperfusion Injury
(complications, drug therapy)
- Retrospective Studies
- Risk Factors
- Survival Rate
- Treatment Outcome
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