Premium
Recurrence of hepatocellular carcinoma after liver transplantation: Prognostic and predictive factors of survival in a Latin American cohort
Author(s) -
Maccali Claudia,
Chagas Aline L.,
Boin Ilka,
Quiñonez Emilio,
Marciano Sebastián,
Vilatobá Mario,
Varón Adriana,
Anders Margarita,
Hoyos Duque Sergio,
Lima Agnaldo S.,
Menendez Josemaría,
PadillaMachaca Martín,
Poniachik Jaime,
Zapata Rodrigo,
Maraschio Martín,
Chong Menéndez Ricardo,
Muñoz Linda,
Arufe Diego,
Figueroa Rodrigo,
Soza Alejandro,
Fauda Martín,
Perales Simone R.,
Vergara Sandoval Rodrigo,
Bermudez Carla,
Beltran Oscar,
Arenas Hoyos Isabel,
McCormack Lucas,
Mattera Francisco Juan,
Gadano Adrián,
Parente García Jose H.,
Tani Claudia Megumi,
Augusto Carneiro D’Albuquerque Luiz,
Carrilho Flair J.,
Silva Marcelo,
Piñero Federico
Publication year - 2021
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.14736
Subject(s) - medicine , hepatocellular carcinoma , propensity score matching , sorafenib , liver transplantation , proportional hazards model , retrospective cohort study , cumulative incidence , milan criteria , cohort , gastroenterology , transplantation , surgery , oncology
Background & Aim Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) has a poor prognosis, and the adjusted effect of different treatments on post‐recurrence survival (PRS) has not been well defined. This study aims to evaluate prognostic and predictive variables associated with PRS. Methods This Latin American multicenter retrospective cohort study included HCC patients who underwent LT between the years 2005‐2018. We evaluated the effect of baseline characteristics at time of HCC recurrence diagnosis and PRS (Cox regression analysis). Early recurrences were those occurring within 12 months of LT. To evaluate the adjusted treatment effect for HCC recurrence, a propensity score matching analysis was performed to assess the probability of having received any specific treatment for recurrence. Results From a total of 1085 transplanted HCC patients, the cumulative incidence of recurrence was 16.6% (CI 13.5‐20.3), with median time to recurrence of 13.0 months (IQR 6.0‐26.0). Factors independently associated with PRS were early recurrence (47.6%), treatment with sorafenib and surgery/trans‐arterial chemoembolization (TACE). Patients who underwent any treatment presented “early recurrences” less frequently, and more extrahepatic metastasis. This unbalanced distribution was included in the propensity score matching, with correct calibration and discrimination (receiving operator curve of 0.81 [CI 0.72;0.88]). After matching, the adjusted effect on PRS for any treatment was HR of 0.2 (0.10;0.33); P < .0001, for sorafenib therapy HR of 0.4 (0.27;0.77); P = .003, and for surgery/TACE HR of 0.4 (0.18;0.78); P = .009. Conclusion Although early recurrence was associated with worse outcome, even in this population, systemic or locoregional treatments were associated with better PRS.