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. 2023 Oct 18;15(20):5030.
doi: 10.3390/cancers15205030.

Primary versus Salvage Liver Transplantation after Curative-Intent Resection or Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Oncological Outcomes

Alessandro Anselmo  1 , Leandro Siragusa  2 , Paolo Brigato  2 , Camilla Riccetti  2 , Andrea Collini  3 , Bruno Sensi  2 , Giuseppe Tisone  1   2
Affiliations

Primary versus Salvage Liver Transplantation after Curative-Intent Resection or Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Oncological Outcomes

Alessandro Anselmo et al. Cancers (Basel). .

Abstract

Liver transplantation for hepatocellular carcinoma (HCC) may be performed ab initio, primary liver transplantation (PLT), or for HCC recurrence after previous treatments such as liver resection (LR) or radiofrequency ablation (RFA), salvage liver transplantation (SLT). The aim of this study was to evaluate the oncological outcomes of SLT vs. PLT. For this, a retrospective study was carried out on patients undergoing liver transplantation for HCC. The outcomes of PLT were compared with those of SLT. The primary outcome was disease-free survival (DFS). The secondary outcomes included overall survival (OS), cancer-specific survival (CSS), and major postoperative complications. A sub-analysis of SLT-LR and SLT-RFA was also performed. In total, 141 patients were included: 96 underwent PLT and 45 SLT. Among the SLT group, 25 patients had undergone previous LR while 20 had had RFA. There were no differences in the major postoperative complications. Unadjusted DFS was significantly longer in the PLT group (p = 0.02), as were OS (p = 0.025) and CSS (p = 0.001). There was no difference in DFS between PLT and SLT-LR groups, while a significant difference was found between the PLT and SLT-RFA groups (p = 0.035). Nonetheless, DFS was no different between the SLT-LR and SLT-RFA groups. PLT appears to offer superior long-term oncological outcomes to SLT. Both SLT-LR and SLT-RFA offer acceptable OS and CSS. Further prospective studies are needed to confirm these results, but the re-direction of grafts and transplant philosophy towards PLT rather than SLT may need to be considered.

Keywords: RFA; downstaging; hepatocarcinoma; liver surgery; salvage transplant; transplant oncology.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patients selection.
Figure 2
Figure 2
PLT vs. SLT Kaplan–Meier curves: (a) disease-free survival; (b) overall survival.
Figure 3
Figure 3
PLT vs. SLT cancer-specific survival: (a) incidence curve; (b) cumulative incidence curve.
Figure 4
Figure 4
PLT vs. R vs. RFA Kaplan–Meier curves: (a) disease-free survival; (b) overall survival.
Figure 5
Figure 5
PLT vs. R vs. RFA cancer-specific survival: (a) incidence curve; (b) cumulative incidence curve.
See this image and copyright information in PMC

References

    1. Rumgay H., Arnold M., Ferlay J., Laversanne M., Mcglynn K.A. Global burden of primary liver cancer in 2020 and predictions to 2040. J Hepatol. 2022;77:1598–1606. doi: 10.1016/j.jhep.2022.08.021. - DOI - PMC - PubMed
    1. European Association for the Study of the Liver. European Organisation for Research and Treatment of Cancer EASL–EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma. J. Hepatol. 2012;56:908–943. doi: 10.1016/j.jhep.2011.12.001. - DOI - PubMed
    1. Forner A., Reig M.E., de Lope C.R., Bruix J. Current strategy for staging and treatment: The BCLC update and future prospects. Semin. Liver Dis. 2010;30:61–74. doi: 10.1055/s-0030-1247133. - DOI - PubMed
    1. Menahem B., Lubrano J., Duvoux C., Mulliri A., Alves A., Costentin C., Mallat A., Launoy G., Laurent A. Liver transplantation versus liver resection for hepatocellular carcinoma in intention to treat: An attempt to perform an ideal meta-analysis. Liver Transpl. 2017;23:836–844. doi: 10.1002/lt.24758. - DOI - PubMed
    1. Facciuto M.E., Rochon C., Pandey M., Rodriguez-Davalos M., Samaniego S., Wolf D.C., Kim-Schluger L., Rozenblit G., Sheiner P.A. Surgical dilemma: Liver resection or liver transplantation for hepatocellular carcinoma and cirrhosis. Intention-to-treat analysis in patients within and outwith Milan criteria. HPB. 2009;11:398–404. doi: 10.1111/j.1477-2574.2009.00073.x. - DOI - PMC - PubMed

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