Strategies of treatments for tumor recurrence of liver cancer after liver transplantation

doi:10.3877/cma.j.issn.1674-0793.2011.04.012

Abstract

Abstract:

Objective

To investigate pre-treatment condition, mean survival time, survival rate, tumor progression condition, complications and treatment cost of transcatheter arterial chemoembolization(TACE), radiofrequency ablation(RFA) and orthotopic liver retransplantation(re-OLT).

Methods

Retrospective analysis of 53 cases reported for intrahepatic recurrence after liver transplantation of our hospital, from Jan. 2004 to Jun. 2009. There were 3 patients received surgical resection, 22 for TACE, 18 for RFA and 10 for re-OLT. The pre-treatment condition, survival time, tumor progression condition, complications and treatment cost of the patients of surgical resection are investigated. Treatment effect of the patients received TACE, RFA and re-OLT were compared and analyzed.

Results

Three patients received surgical resection. After 4-12 months follow-up, they had not been found complications and tumor progression, and they were still alive. The difference of mean survival time, survival rates and the tumor progression condition among TACE, RFA and re-OLT are considered no significant; But RFA was lower in severe degree of complication, especially the biliary complications, and the cost of treatment: RFA<TACE<re-OLT.

Conclusions

The curative effect among TACE, RFA and re-OLT are similar to one other in curing the tumor recurrence of liver cancer after liver transplantation. RFA is much lower than TACE and re-OLT in severe degree of complication and the cost of treatment.

Key words: Liver cancer, Liver transplantation, Recurrence treatment

Chun-hui QIU, Hui ZHAO, Hu-an CHEN, Ying-hua CHEN, Wei MENG, Chi XU, Shu-hong YI, Hua LI, Gen-shu WANG, Jian ZHANG, Yang YANG, Chang-jie CAI, Min-qiang LU, Gui-hua CHEN. Strategies of treatments for tumor recurrence of liver cancer after liver transplantation[J]. Chinese Archives of General Surgery(Electronic Edition), 2011, 05(04): 320-325.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2011.04.012

https://zhptwkxwx.cma-cmc.com.cn/EN/Y2011/V05/I04/320

Figures/Tables 5

References 8

1	Catalano G, Urbani L, Biancofiore G, et al. Hepatic resection after liver transplantation as a graft-saving procedure：indication criteria, timing and outcome. Transplant Proc, 2004, 36(3): 545-546.
2	Roayaie S, Schwartz JD, Sung MW, et al. Recurrence of Hepatocellular Carcinoma After Liver Transplant: Patterns and Prognosis. Liver Transpl, 2004, 10: 534-540.
3	Regalia EF, Fassati LR, Valente U, et al. Pattern and management of recurrent hepatocellular carcinoma after liver transplantation. J Hepatobiliary Pancreat Surg, 1998, 5(1): 29-34.
4	Llovet JM, Bruix J. Novel advancements in the management of hepatocellular carcinoma in 2008. J Hepatol, 2008, 4 (Suppl) 1: S37.
5	Ko HK, Ko GY, Yoon HK, et al. Tumor response to transcatheter arterial chemoembolization in recurrent hepatocellular carcinoma after living donor liver transplantation. Korean J Radiol, 2007, 8(4): 320-322.
6	Choi D, Lim HK, Rhim H, et al. Percutaneous radiofrequency ablation for recurrent repatocellular carcinoma after epatectomy: long-term results and prognostic factors. Ann Surg Oncol, 2007, 14(8): 2319-2329.
7	Ho CK, Chapman WC, Brown DB, et al. Radiofrequency ablation of recurrent hepatocellular carcinoma in a patient after liver transplantation: two-year follow-up. J Vasc Interv Radiol, 2007, 18(11): 1451-1453.
8	Schlitt HJ, Neipp M, Weimann A, et al. Recurrence patterns of hepatocellular and fibrolamellar carcinoma after liver transplantation. Clin Oncol, 1999, 17(1): 324-331.

项目		TACE组	RFA组	re-OLT组
性别		?	?	?
?	男	22	18	10
?	女	0	0	0
年龄(岁)		?	?	?
?	<30	0	0	0
?	30~50	13	12	8
?	≥50	9	6	2
AFP(μg/L)		?	?	?
?	<20	3	2	0
?	20~400	15	13	7
?	≥400	4	3	3
Child-pugh分级		?	?	?
?	A	13	13	7
?	B	7	5	2
?	C	2	0	1
MELD分级		?	?	?
?	<15	10	12	6
?	15~30	11	6	3
?	≥30	1	0	1
肿瘤数量(个)		?	?	?
?	1	1	4	4
?	2~3	12	10	4
?	>3	6	4	3
最大肿瘤直径(cm)		?	?	?
?	<3	2	2	1
?	3~7	9	10	5
?	≥7	11	6	4
血管浸润		?	?	?
?	有	4	5	2
?	无	18	13	8
淋巴结转移		?	?	?
?	有	2	0	1
?	无	20	18	9
TNM分期		?	?	?
?	Ⅰ	1	4	3
?	Ⅱ	10	8	3
?	Ⅲ	11	6	4

项目		TACE组	RFA组	re-OLT组
性别		?	?	?
?	男	22	18	10
?	女	0	0	0
年龄(岁)		?	?	?
?	<30	0	0	0
?	30~50	13	12	8
?	≥50	9	6	2
AFP(μg/L)		?	?	?
?	<20	3	2	0
?	20~400	15	13	7
?	≥400	4	3	3
Child-pugh分级		?	?	?
?	A	13	13	7
?	B	7	5	2
?	C	2	0	1
MELD分级		?	?	?
?	<15	10	12	6
?	15~30	11	6	3
?	≥30	1	0	1
肿瘤数量(个)		?	?	?
?	1	1	4	4
?	2~3	12	10	4
?	>3	6	4	3
最大肿瘤直径(cm)		?	?	?
?	<3	2	2	1
?	3~7	9	10	5
?	≥7	11	6	4
血管浸润		?	?	?
?	有	4	5	2
?	无	18	13	8
淋巴结转移		?	?	?
?	有	2	0	1
?	无	20	18	9
TNM分期		?	?	?
?	Ⅰ	1	4	3
?	Ⅱ	10	8	3
?	Ⅲ	11	6	4

项目		TACE组	RFA组	re-OLT组	P值
复发距离治疗时间(d)		?	?	?	?
?	<30	16	13	2	<0.01^*
?	≥30	6	5	8	<0.01^*
AFP(μg/L)		?	?	?	?
?	<20	8	8	4	?
?	20~400	10	8	4	?
?	≥400	4	2	2	?
Child-pugh分级		?	?	?	?
?	A	19	15	8	?
?	B	3	3	2	?
?	C	0	0	0	?
MELD分级		?	?	?	?
?	<15	13	13	7	?
?	15~30	9	5	3	?
?	≥30	0	0	0	?
肿瘤数量(个)		?	?	?	?
?	1	3	2	1	?
?	2~3	15	14	4	?
?	>3	4	2	5	?
最大肿瘤直径(cm)		?	?	?	?
?	<3	3	2	2	?
?	3~7	19	16	7	?
?	≥7	0	0	1	?
血管浸润		?	?	?	?
?	有	0	0	1	?
?	无	22	18	9	?
淋巴结转移		?	?	?	?
?	有	0	0	1	>0.05
?	无	22	18	9	>0.05

项目		TACE组	RFA组	re-OLT组	P值
复发距离治疗时间(d)		?	?	?	?
?	<30	16	13	2	<0.01^*
?	≥30	6	5	8	<0.01^*
AFP(μg/L)		?	?	?	?
?	<20	8	8	4	?
?	20~400	10	8	4	?
?	≥400	4	2	2	?
Child-pugh分级		?	?	?	?
?	A	19	15	8	?
?	B	3	3	2	?
?	C	0	0	0	?
MELD分级		?	?	?	?
?	<15	13	13	7	?
?	15~30	9	5	3	?
?	≥30	0	0	0	?
肿瘤数量(个)		?	?	?	?
?	1	3	2	1	?
?	2~3	15	14	4	?
?	>3	4	2	5	?
最大肿瘤直径(cm)		?	?	?	?
?	<3	3	2	2	?
?	3~7	19	16	7	?
?	≥7	0	0	1	?
血管浸润		?	?	?	?
?	有	0	0	1	?
?	无	22	18	9	?
淋巴结转移		?	?	?	?
?	有	0	0	1	>0.05
?	无	22	18	9	>0.05

组别	总例数	肿瘤进展例数	肿瘤进展发生率（%）	移植肝	肺	骨	移植肝及远处转移	无
TACE组	22	14	63.64	2	6	4	2	8
RFA组	18	10	55.56	4	4	2	0	8
re-OLT组	10	8	80.00	2	2	2	2	2

Please choose a citation manager

Content to export