Multidisciplinary approach in hepatocellular carcinoma progression treatment after liver transplantation: the first experience in Russia
O. D. Olisov,
I. A. Dzhanyan,
M. S. Novruzbekov,
V. V. Breder,
M. E. Ilinskiy,
L. N. Zimina,
E. A. Moroz,
K. K. Laktionov,
V. A. Guliaev,
K. N. Lutsyk,
K. M. Magomedov https://doi.org/10.16931/1995-5464.2019465-73
Abstract
Aim. To improve treatment outcomes for patients with hepatocellular carcinoma progression after liver transplantation.
Material and methods. Patients with hepatocellular carcinoma progression after liver transplantation (n = 30) were divided into two groups retrospectively. Group 1 included 20 patients who underwent specialized surgical and chemotherapeutic treatment, and group 2 included 10 patients who received palliative care in connection with the advanced of the cancer.
Results. Tumor progression rate was ten times higher in patients with tumors that do not meet the Milan criteria (57.8% vs 5.7%, respectively). Early progression (within 24 months) after liver transplantation was occured in 19 (63.3%) patients. The median overall survival in patients with early and late progression was 17 and 74 months, respectively. Multiorgan metastases were found in 40% of patients. One-, three- and five-year overall survival in the group 1 and 2 were, respectively, 90%, 71%, 50% and 30% and 0%. The median overall survival in the group 1 and 2 was 37.8 and 12 months respectively.
Conclusion. Tumor lesion volume is the determining risk factor for the hepatocellular cancer progression after transplantation. Late disease progression associated with better prognosis. Multidisciplinary approach in treatment of hepatocellular carcinoma progression after liver transplantation significantly improves overall survival.
Material and methods. Patients with hepatocellular carcinoma progression after liver transplantation (n = 30) were divided into two groups retrospectively. Group 1 included 20 patients who underwent specialized surgical and chemotherapeutic treatment, and group 2 included 10 patients who received palliative care in connection with the advanced of the cancer.
Results. Tumor progression rate was ten times higher in patients with tumors that do not meet the Milan criteria (57.8% vs 5.7%, respectively). Early progression (within 24 months) after liver transplantation was occured in 19 (63.3%) patients. The median overall survival in patients with early and late progression was 17 and 74 months, respectively. Multiorgan metastases were found in 40% of patients. One-, three- and five-year overall survival in the group 1 and 2 were, respectively, 90%, 71%, 50% and 30% and 0%. The median overall survival in the group 1 and 2 was 37.8 and 12 months respectively.
Conclusion. Tumor lesion volume is the determining risk factor for the hepatocellular cancer progression after transplantation. Late disease progression associated with better prognosis. Multidisciplinary approach in treatment of hepatocellular carcinoma progression after liver transplantation significantly improves overall survival.
About the Authors
O. D. Olisov
Sklifosovsky Research Institute for Emergency Medicine
Russian Federation
Russian Federation
Cand. of Sci. (Med.), Senior Researcher of the Department of Liver Transplant
3, Bolshaya Suharevskaya, Moscow, 129090, Russian Federation
Phone: 8-495-628-35-02
I. A. Dzhanyan
Blokhin National Medical Research Center of Oncology
Russian Federation
Russian Federation
Oncologist of Chemotherapy Department No.1
115478, Moscow, 23, Kashirskoye Highway, Russian Federation
M. S. Novruzbekov
Sklifosovsky Research Institute for Emergency Medicine
Russian Federation
Russian Federation
Doct. of Sci. (Med.), Chief Research Fellow of the Department of Liver Transplant
3, Bolshaya Suharevskaya, Moscow, 129090, Russian Federation
V. V. Breder
Blokhin National Medical Research Center of Oncology
Russian Federation
Russian Federation
Doct. of Sci. (Med.), Leading Researcher of Chemotherapy Department No.1
115478, Moscow, 23, Kashirskoye Highway, Russian Federation
M. E. Ilinskiy
Sklifosovsky Research Institute for Emergency Medicine
Russian Federation
Russian Federation
Cand. of Sci. (Med.), Research Fellow of Intensive Care Unit
3, Bolshaya Suharevskaya, Moscow, 129090, Russian Federation
L. N. Zimina
Sklifosovsky Research Institute for Emergency Medicine
Doct. of Sci. (Med.), Leading Researcher of Pathology Department
3, Bolshaya Suharevskaya, Moscow, 129090, Russian Federation
E. A. Moroz
Blokhin National Medical Research Center of Oncology
Cand. of Sci. (Med.), Senior Researcher of Pathomorphology Department
115478, Moscow, 23, Kashirskoye Highway, Russian Federation
K. K. Laktionov
Blokhin National Medical Research Center of Oncology
Doct. of Sci. (Med.), Professor, Head of the Chemotherapy Department No.1
115478, Moscow, 23, Kashirskoye Highway, Russian Federation
V. A. Guliaev
Sklifosovsky Research Institute for Emergency Medicine
Doct. of Sci. (Med.), Leading Researcher of the Kidney and Pancreas Transplant Department
3, Bolshaya Suharevskaya, Moscow, 129090, Russian Federation
Doct. of Sci. (Med.), Leading Researcher of the Kidney and Pancreas Transplant Department
3, Bolshaya Suharevskaya, Moscow, 129090, Russian Federation
K. N. Lutsyk
Sklifosovsky Research Institute for Emergency Medicine
Cand. of Sci. (Med.), Head of Surgery Unit of the Liver Transplant Department
3, Bolshaya Suharevskaya, Moscow, 129090, Russian Federation
K. M. Magomedov
Sklifosovsky Research Institute for Emergency Medicine
Surgeon of the Liver Transplant Department
3, Bolshaya Suharevskaya, Moscow, 129090, Russian Federation
References
1. Kornberg A. Liver transplantation for hepatocellular carcinoma beyond Milan criteria: multidisciplinary approach to improve outcome. ISRN Hepatol. 2014; 2014: 706945. doi: 10.1155/2014/706945 PMID: 27335840
2. Clavien P.A., Lesurtel M., Bossuyt P.M. et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. 2012; 13(1): e11–e22. doi: 10.1016/S1470-2045(11)70175-9 PMID: 22047762
3. Mazzaferro V., Regalia E., Doci R. et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N. Engl. J. Med. 1996; 334(11): 693-699. doi: 10.1056/NEJM199603143341104 PMID: 8594428
4. Kneuertz P.J., Cosgrove D.P., Cameron A.M. et al. Multidisciplinary management of recurrent hepatocellular carcinoma following liver transplantation. J. Gastrointest Surg. 2012; 16(4): 874-881. doi: 10.1007/s11605-011-1710-8 PMID: 21975686
5. Jonas S., Bechstein W.O., Steinmüller T. et al. Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatology. 2001; 33(5):1080-1086. doi; 10.1053/jhep.2001.23561 PMID: 11343235
6. Piardi T., Gheza .F, Ellero B. et al. Number and tumor size are not sufficient criteria to select patients for liver transplantation for hepatocellular carcinoma. Ann Surg. Oncol. 2012; 19(6):2020-2026. doi: 10.1245/s10434-011-2170-9 PMID: 22179632
7. Zheng S.S., Chen J., Wang W.L. et al. Recurrence and metastasis of hepatocellular carcinoma after liver transplantation: single center experiences. ZhonghuaWai. Ke. Za. Zhi. 2008; 46(21):1609-1613. PMID: 19094751
8. Guerrini G.P., Berretta M., Tarantino G. et al. Multimodal oncological approach in patients affected by recurrent hepatocellular carcinoma after liver transplantation. Eur. Rev. Med. Pharmacol. Sci. 2017; 21(15):3421-3435. PMID: 28829499
9. Au K.P., Chok K.S.H. Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: A proposed management algorithm. World J. Gastroenterol. 2018; 24(45):5081-5094. doi: 10.3748/wjg.v24.i45.5081 PMID: 30568386
10. Toso C., Cader S., Mentha-Dugerdil A. et al. Factors predicting survival after post-transplant hepatocellular carcinoma recurrence. J. Hepatobiliary Pancreat. Sci. 2013; 20(3):342-347. doi: 10.1007/s00534-012-0528-4 PMID: 22710887
11. Kornberg A., Küpper B., Tannapfel A. et al. Long-term survival after recurrent hepatocellular carcinoma in liver transplant patients: clinical patterns and outcome variables. Eur. J. Surg. Oncol. 2010; 36(3):275-280. doi: 10.1016/j.ejso.2009.10.001 PMID: 19857941
12. de'Angelis N., Landi F., Carra M.C., Azoulay D. Managements of recurrent hepatocellular carcinoma after liver transplantation: A systematic review. World J. Gastroenterol. 2015; 21(39):11185-11198. doi: 10.3748/wjg.v21.i39.11185 PMID: 26494973
13. Regalia E., Fassati L.R., Valente U. et al. Pattern and management of recurrent hepatocellular carcinoma after liver transplantation. J. Hepatobiliary Pancreat. Surg. 1998; 5(1):29-34. PMID: 9683751
14. Roayaie S., Schwartz J.D., Sung M.W. et al. Recurrence of hepatocellular carcinoma after liver transplant: patterns and prognosis. Liver Transpl. 2004; 10(4):534-540. doi: 10.1002/lt.20128 PMID: 15048797
15. Huang J., Yan L, Wu H. et al. Is radiofrequency ablation applicable for recurrent hepatocellular carcinoma after liver transplantation? J. Surg. Res. 2016; 200(1):122–130. doi: 10.1016/j.jss.2015.07.033 PMID: 26277218
16. Hwang S., Kim Y.H., Kim D.K. et al. Resection of pulmonary metastases from hepatocellular carcinoma following liver transplantation. World J. Surg. 2012; 36(7):1592-1602. doi: 10.1007/s00268-012-1533-0 PMID: 22411088
17. Hau H.M., Schmelzle M., Benzing C. et al. Pulmonary metastasectomy for metastasized hepatocellular carcinoma after liver resection and liver transplantation: a single center experience. Z. Gastroenterol. 2016; 54(1): 31-39. doi: 10.1055/s-0041-104025 PMID: 26619391
18. Togashi J., Sugawara Y., Aoki T. et al. Resection of lung metastases from hepatocellular carcinoma after living donor liver transplantation: report of two cases. Surg. Today. 2011; 41(9):1294-1297. doi: 10.1007/s00595-010-4487-6 PMID: 21874434
19. Bates M.J., Farkas E., Taylor D., McFadden P.M. Pulmonary resection of metastatic hepatocellular carcinoma after liver transplantation. Ann Thorac. Surg. 2008; 85(2):412-415. doi: 10.1016/j.athoracsur.2007.10.065 PMID: 18222234
20. Yamagami T., Yoshimatsu R., Ishikawa M. et al. Transcatheter arterial chemoembolization with an interventional-CT system for recurrent hepatocellular carcinoma after living donor liver transplantation. Hepatogastroenterology. 2014; 61(133):1387-1392. PMID: 25436316
21. Ko H.K., Ko G.Y., Yoon H.K., Sung K.B. Tumor response to transcatheter arterial chemoembolization in recurrent hepatocellular carcinoma after living donor liver transplantation. Korean. J. Radiol. 2007; 8(4):320-327. doi: 10.3348/kjr.2007.8.4.320 PMID: 17673843
22. Sposito C., Mariani L., Germini A. et al. Comparative efficacy of sorafenib versus best supportive care in recurrent hepatocellular carcinoma after liver transplantation: A case-control study. J. Hepatol. 2013; 59(1): 59–66. doi: 10.1016/j.jhep.2013.02.026 PMID: 23500153
23. de'Angelis N., Landi F., Nencioni M. et al. Role of sorafenib in patients with recurrent hepatocellular carcinoma after liver transplantation. Prog. Transplant. 2016; 26(4):348-355. doi: 10.1177/1526924816664083 PMID: 27555074
24. Saab S., McTigue M., Finn R.S., Busuttil R.W. Sorafenib as adjuvant therapy for high-risk hepatocellular carcinoma in liver transplant recipients: feasibility and efficacy. Exp. Clin. Transplant. 2010; 8(4):307-313. PMID: 21143097
25. Sotiropoulos G.C., Nowak K.W., Fouzas I. et al. Sorafenib treatment for recurrent hepatocellular carcinoma after liver transplantation. Transplant. Proc. 2012; 44(9):2754-2756. doi: 10.1016/j.transproceed.2012.09.022 PMID: 23146514
26. Duvoux C., Toso C. mTOR inhibitor therapy: Does it prevent HCC recurrence after liver transplantation? Transplant. Rev. (Orlando). 2015; 29(3):168-174. doi: 10.1016/j.trre.2015.02.003 PMID: 26071984
27. Hu A., He X.S., Tai Q. et al. Efficacy and safety of sorafenib in the prevention and treatment of hepatocellular carcinoma recurrences after liver transplantation. Zhonghua Yi Xue Za Zhi. 2012; 92(18):1264-1267. PMID: 22883065
28. Waghray A., Balci B., El-Gazzaz G. et al. Safety and efficacy of sorafenib for the treatment of recurrent hepatocellular carcinoma after liver transplantation. Clin. Transplant. 2013; 27(4):555-561. doi: 10.1111/ctr.12150 PMID: 23758296
29. Alsina A.E., Makris A., Nenos V. et al. Can sorafenib increase survival for recurrent hepatocellular carcinoma after liver transplantation? A pilot study. Am Surg. 2014; 80(7):680-684. PMID: 24987900
30. Gomez-Martin C., Bustamante J., Castroagudin J.F. et al. Efficacy and safety of sorafenib in combination with mammalian target of rapamycin inhibitors for recurrent hepatocellular carcinoma after liver transplantation. Liver Transpl. 2012; 18(1):45-52. doi: 10.1002/lt.22434 PMID: 21932373
31. Kang S.H., Cho H., Cho E.J. et al. Efficacy of sorafenib for the treatment of post-transplant hepatocellular carcinoma recurrence. J. Korean Med. Sci. 2018; 33(45): e283. doi: 10.3346/jkms.2018.33.e283 PMID: 30402048
32. Kim B.H., Park J.W. Sorafenib for recurrent hepatocellular carcinoma after liver transplantation. J. Korean Med. Sci. 2018; 33(45): e286. doi: 10.3346/jkms.2018.33.e286 PMID: 30402051
33. Teng C., Hwang W., Chen Y. et al. Sorafenib for hepatocellular carcinoma patients beyond Milan criteria after orthotopic liver transplantation: a case control study. World J. Surg. Oncol. 2012; 10:41. doi: 10.1186/1477-7819-10-41 PMID: 22339891
34. Wu J., Sun H., Han Z., Peng Z. A single center experience: post-transplantation adjuvant chemotherapy impacts the prognosis of hepatocellular carcinoma patients. Chin. Med. J. (Engl.). 2014; 127(3):430-434. PMID: 24451946
35. Siegel A.B., El-Khoueiry A.B., Finn R.S. et al. Phase I trial of sorafenib following liver transplantation in patients with high-risk hepatocellular carcinoma. Liver Cancer. 2015; 4(2):115-125. doi: 10.1159/000367734 PMID: 26020033
36. Mazzola A., Costantino A., Petta S. et al. Recurrence of hepatocellular carcinoma after liver transplantation: an update. Future Oncol. 2015; 11(21):2923-2936. doi: 10.2217/fon.15.239 PMID: 26414336
Review
For citations:
Olisov O.D., Dzhanyan I.A., Novruzbekov M.S., Breder V.V., Ilinskiy M.E., Zimina L.N., Moroz E.A., Laktionov K.K., Guliaev V.A., Lutsyk K.N., Magomedov K.M. Multidisciplinary approach in hepatocellular carcinoma progression treatment after liver transplantation: the first experience in Russia. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2019;24(4):65-73. (In Russ.) https://doi.org/10.16931/1995-5464.2019465-73
Views:
544
Email this article 