Table 5.
Factors Associated With Survival After Recurrent HCC Post-LT.
| Parameter | Median survival (95% CI), months | P- value |
|---|---|---|
| Female | 5.07 (2.13–16.60) | 0.15 |
| Male | 12.97 (7.70–15.70) | |
| Caucasian | 9.10 (5.93–16.30) | 0.62 |
| Non-Caucasian | 12.80 (4.67–15.50) | |
| Age < 60 years | 6.43 (5.37–13.40) | 0.35 |
| ≥60 years | 13.97 (7.73–25.40) | |
| HCV | 8.23 (5.40–15.70) | 0.52 |
| Non-HCV | 13.68 (7.73–27.60) | |
| Peak pre-LT AFP < 1000 ng/mL | 12.77 (6.43–15.70) | 0.11 |
| ≥1000 ng/mL | 7.13 (1.07 –) | |
| Incidental HCC | 7.98 (1.57–30.30) | 0.81 |
| Nonincidental HCC | 11.10 (6.07–15.50) | |
| Poorly differentiated histology on the explant | 6.50 (4.67–11.10) | 0.02* |
| Well or Moderately differentiated | 13.90 (5.93–20.90) | |
| Microvascular invasion on the explant | 10.10 (6.43–14.70) | 0.09 |
| No microvascular invasion | 11.30 (3.37–77.70) | |
| Macrovascular invasion on the explant | 5.37 (1.07–16.30) | 0.18 |
| No macrovascular invasion | 12.97 (6.50–15.70) | |
| Explant within Milan criteria | 16.25 (4.97–27.40) | 0.18 |
| Beyond criteria | 8.63 (5.93–14.00) | |
| The explant within UCSF criteria | 10.10 (4.97–24.30) | 0.40 |
| Beyond criteria | 9.10 (5.93–14.30) | |
| Adjuvant chemotherapy | 8.23 (4.73–14.00) | 0.06 |
| No adjuvant chemotherapy | 12.97 (5.93–22.70) | |
| Time to recurrence < 12 months | 5.42 (3.67–8.00) | 0.0002* |
| ≥12 months | 14.67 (8.90–26.90) | |
| ALT at recurrence < 50 IU/mL | 10.10 (6.07–14.30) | 0.87 |
| ≥50 IU/mL | 10.90 (5.37–16.60) | |
| ALP at recurrence < 130 IU/mL | 13.50 (8.90–20.90) | 0.08 |
| ≥130 IU/mL | 5.40 (4.73–8.23) | |
| Bilirubin at recurrence < 1.2 mg/dL | 13.53 (7.70–16.60) | 0.0005* |
| ≥1.2 mg/dL | 5.37 (1.83–8.23) | |
| Creatinine at recurrence < 1.2 mg/dL | 8.00 (4.73–14.30) | 0.39 |
| ≥1.2 mg/dL | 13.80 (6.43–17.30) | |
| Albumin at recurrence < 3.5 mg/dL | 5.17 (3.07–7.73) | 0.002* |
| ≥3.5 mg/dL | 13.83 (8.63–20.90) | |
| AFP at recurrence < 1000 ng/mL | 13.83 (8.23–16.60) | <0.0001* |
| ≥1000 ng/mL | 3.42 (0.57–5.63) | |
| Sirolimus exposure | 15.70 (12.77–27.40) | <0.0001* |
| No sirolimus | 5.20 (3.07–6.43) | |
| Graft recurrence | 7.70 (4.67–14.00) | 0.02* |
| Other site | 13.00 (6.50–24.30) | |
| Lung recurrence | 6.88 (4.67–11.10) | 0.43 |
| Other site | 13.83 (6.50–20.90) | |
| Abdominal lymph node recurrence | 8.23 (4.67–13.40) | 0.42 |
| Other site | 13.15 (6.43–16.60) | |
| Adrenal recurrence | 14.70 (3.97–32.60) | 0.63 |
| Other site | 9.10 (6.07–14.30) | |
| Bone recurrence | 6.43 (2.37–26.90) | 0.56 |
| Other site | 12.77 (6.43–15.70) | |
| Peritoneal recurrence | 3.97 (1.57–9.10) | 0.024* |
| Other site | 12.97 (6.50–15.70) | |
| Pleural recurrence | 19.80 (1.83 –) | 0.84 |
| Other site | 10.10 (6.43–14.70) | |
| Abdominal wall recurrence | 17.30 (5.37 –) | 0.32 |
| Other site | 10.10 (6.43–14.70) | |
| Single lesion at recurrence | 26.50 (14.00–38.87) | <0.0001* |
| Multiple lesions at recurrence | 6.07 (5.20–8.23) | |
| Single sites of recurrence | 13.97 (8.00–24.27) | 0.005* |
| Multiple sites of recurrence | 5.63 (3.97–8.23) | |
| Initial treatment: | <0.0001* | |
| Surgical resection | 33.57 (26.50–60.43) | |
| Percutaneous ablation (e.g., RFA) | 20.90 (13.83 –) | |
| Transarterial chemoembolization (TACE)a | 22.67 ( – ) | |
| External radiation | 10.93 (1.83–15.90) | |
| Systemic therapy | 7.70 (5.43–11.10) | |
| Supportive care | 2.05 (0.57–3.97) | |
| Treatment group: | <0.0001* | |
| Surgery or ablation | 31.93 (24.27–56.63) | |
| Other treatments | 8.00 (5.93–12.97) | |
| Supportive care | 2.05 (0.57–3.97) | |
| RETREAT score < 5 | 16.30 (5.53–28.80) | 0.015* |
| ≥5 | 8.23 (5.93–13.40) |
HCC, hepatocellular carcinoma; CI, confidence interval; HCV, hepatitis C virus; LT, liver transplantation; AFP, alpha-fetoprotein; UCSF, University of California San Francisco; ALT, alanine transaminase; ALP, alkaline phosphatase; RFA, radiofrequency ablation; RETREAT, Risk Estimation of Tumor Recurrence After Transplant.
* P < 0.05.
a
There was only one patient who initially treated with TACE in our study.