Clinical Features and Surveillance of Very Late Hepatocellular Carcinoma Recurrence After Liver Transplantation - PubMed (original) (raw)

. 2018 Sep 21:23:659-665.

doi: 10.12659/AOT.910598.

Su-Min Ha 1, Shin Hwang 1, Chul-Soo Ahn 1, Ki-Hun Kim 1, Deok-Bog Moon 1, Tae-Yong Ha 1, Gi-Won Song 1, Dong-Hwan Jung 1, Gil-Chun Park 1, Hwi-Dong Cho 1, Jae Hyun Kwon 1, Sang-Hyun Kang 1, Sung-Gyu Lee 1

Affiliations

Clinical Features and Surveillance of Very Late Hepatocellular Carcinoma Recurrence After Liver Transplantation

Abdulwahab A Alshahrani et al. Ann Transplant. 2018.

Abstract

BACKGROUND This study aimed to assess patterns of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) and to establish long-term surveillance protocols for late HCC recurrence. MATERIAL AND METHODS The 232 LT recipients experiencing subsequent HCC recurrence were categorized as Group 1, early recurrence (within 1 year of LT; n=117); Group 2, late recurrence (occurring in years 2-5; n=93); and Group 3, very late recurrence (after year 5; n=22). RESULTS Recurrence was detected by only elevated tumor marker levels in 11.1%, 30.1%, and 45.5% of patients in Groups 1, 2, and 3, respectively (p<0.001). The proportion of intrahepatic and extrahepatic metastases was similar in all 3 groups. Common sites of extrahepatic metastasis were the lung and bone; these were also similar across the 3 groups. Overall post-recurrence patient survival rates were 60.2% at 1 year, 28.2% at 3 years, 20.5% at 5 years, and 7.0% at 10 years. Median post-recurrence survival periods were 10.2, 23.8, and 37.0 months in Groups 1, 2, and 3, respectively. CONCLUSIONS While the pattern of HCC recurrence was similar regardless of time of recurrence, post-recurrence survival was significantly longer in patients with later recurrence. Long-term surveillance for HCC recurrence beyond 5 years after LT is recommended.

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Conflict of interest statement

Cnflicts of interest

None.

Figures

Figure 1

Figure 1

Annual incidence and grouping of hepatocellular carcinoma recurrence after liver transplantation.

Figure 2

Figure 2

Comparison of the initial methods of diagnosing hepatocellular carcinoma according to the time of tumor recurrence. Both indicate concurrent detection of abnormal findings from tumor marker and imaging studies.

Figure 3

Figure 3

Comparison of the sites of initial hepatocellular carcinoma recurrence according to the time of tumor recurrence. Combined cases indicate combined intrahepatic and extrahepatic recurrences.

Figure 4

Figure 4

Comparison of the common sites of initial extrahepatic hepatocellular carcinoma recurrence according to the time of tumor recurrence. LN – lymph node.

Figure 5

Figure 5

Overall patient survival curve (A) and post-recurrence patient survival curve (B) in 232 liver transplant recipients diagnosed with hepatocellular carcinoma recurrence.

Figure 6

Figure 6

Overall patient survival curve (A) and post-recurrence patient survival curve (B) according to the time of hepatocellular carcinoma recurrence.

Figure 7

Figure 7

Changes of the serum α-fetoprotein (AFP) levels measured before transplantation and at the time of recurrence diagnosis in 22 patients diagnosed with very late hepatocellular carcinoma recurrence (>5 years after liver transplantation).

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