Chee-Chien Yong1, Ming-Chao Tsai2,3, Chih-Che Lin4, Chih-Chi Wang1, Sheng-Nan Lu2, Chao-Hung Hung2, Tsung-Hui Hu2, Chao-Long Chen1. 1. Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung, Kao-hsiung, 833, Taiwan. 2. Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kao-hsiung, Taiwan. 3. Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan. 4. Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung, Kao-hsiung, 833, Taiwan. immunologylin@gmail.com.
Abstract
BACKGROUND AND AIMS: Salvage liver transplantation (LT) provides definite treatment for recurrent hepatocellular carcinoma (HCC) after primary liver resection. However, salvage living donor LT (SLDLT) involves more surgical difficulty, compared to local regional therapy (LRT). The optimal treatment strategy remains unclear. This study aims to compare the survival between SLDLT and LRT for patients with recurrent HCC after primary hepatic resection in a single center. METHODS: Between 2001 and 2010, 211 patients with recurrent HCC after primary liver resection and a certain Milan criteria were enrolled. Among these patients, 41 and 170 patients received SLDLT and LRT, respectively. Clinical parameters were analyzed in terms of overall survival by multivariate analysis. RESULTS: The 1-, 3-, and 5-year overall survival rates were 90.2, 80.4, and 80.4 % in the SLDLT group, and 91.6, 71.7, and 51.1 % in LRT group, respectively. A paradoxical phenomenon of survival was noticed-a poorer survival rate within the first year in the SLDLT group but a better one after that year. For patients who survived more than 1 year, the SLDLT led to significantly better survival outcomes than LRT (P < 0.001). In multivariate analysis, SLDLT and alpha-fetoprotein (AFP) level < 200 ng/ml at recurrence were associated with better survival. CONCLUSIONS: To manage recurrent HCC, SLDLT with reasonable surgical mortality provided better long-term survival. AFP is an independent risk factor for overall survival.
BACKGROUND AND AIMS: Salvage liver transplantation (LT) provides definite treatment for recurrent hepatocellular carcinoma (HCC) after primary liver resection. However, salvage living donor LT (SLDLT) involves more surgical difficulty, compared to local regional therapy (LRT). The optimal treatment strategy remains unclear. This study aims to compare the survival between SLDLT and LRT for patients with recurrent HCC after primary hepatic resection in a single center. METHODS: Between 2001 and 2010, 211 patients with recurrent HCC after primary liver resection and a certain Milan criteria were enrolled. Among these patients, 41 and 170 patients received SLDLT and LRT, respectively. Clinical parameters were analyzed in terms of overall survival by multivariate analysis. RESULTS: The 1-, 3-, and 5-year overall survival rates were 90.2, 80.4, and 80.4 % in the SLDLT group, and 91.6, 71.7, and 51.1 % in LRT group, respectively. A paradoxical phenomenon of survival was noticed-a poorer survival rate within the first year in the SLDLT group but a better one after that year. For patients who survived more than 1 year, the SLDLT led to significantly better survival outcomes than LRT (P < 0.001). In multivariate analysis, SLDLT and alpha-fetoprotein (AFP) level < 200 ng/ml at recurrence were associated with better survival. CONCLUSIONS: To manage recurrent HCC, SLDLT with reasonable surgical mortality provided better long-term survival. AFP is an independent risk factor for overall survival.
Authors: J Bruix; M Sherman; J M Llovet; M Beaugrand; R Lencioni; A K Burroughs; E Christensen; L Pagliaro; M Colombo; J Rodés Journal: J Hepatol Date: 2001-09 Impact factor: 25.083
Authors: Umberto Cillo; Alessandro Vitale; Filippo Navaglia; Daniela Basso; Umberto Montin; Marco Bassanello; Francesco D'Amico; Francesco Antonio Ciarleglio; Alberto Brolese; Giacomo Zanus; Vito De Pascale; Mario Plebani; Davide Francesco D'Amico Journal: World J Gastroenterol Date: 2005-11-28 Impact factor: 5.742
Authors: Giorgio Ercolani; Gian Luca Grazi; Matteo Ravaioli; Massimo Del Gaudio; Andrea Gardini; Matteo Cescon; Giovanni Varotti; Francesco Cetta; Antonino Cavallari Journal: Ann Surg Date: 2003-04 Impact factor: 12.969
Authors: Shaheed Merani; Pietro Majno; Norman M Kneteman; Thierry Berney; Philippe Morel; Gilles Mentha; Christian Toso Journal: J Hepatol Date: 2011-02-18 Impact factor: 25.083
Authors: Stephen L Chan; Frankie K F Mo; Philip J Johnson; Edwin P Hui; Brigette B Y Ma; Wing M Ho; Kwok C Lam; Anthony T C Chan; Tony S K Mok; Winnie Yeo Journal: J Clin Oncol Date: 2008-12-08 Impact factor: 44.544
Authors: Jinsoo Rhu; Jong Man Kim; Gyu Seong Choi; Choon Hyuck David Kwon; Jae-Won Joh Journal: Ann Surg Treat Res Date: 2018-08-31 Impact factor: 1.859