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Abstract：
BACKGROUND: The tyrosine kinase inhibitors (TKIs) sorafenib and lenvatinib represent the first-line systemic therapy of choice for patients with hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT). Under sorafenib and lenvatinib, HCC patients have shown increasingly improved overall survival in clinical studies over the years. In contrast, data on overall survival for patients with HCC recurrence after LT under TKIs are scarce and limited to small retrospective series. In this retrospective, multicenter study, we investigated the efficacy of TKI therapy and the influence of immunosuppression in patients with HCC recurrence after LT.
METHODS: Retrospective data were collected from four transplant centers from Germany and Austria. We included patients with HCC recurrence after LT between 2007 and 2020 who were treated with a TKI.
RESULTS: In total, we analyzed data from 46 patients with HCC recurrence after LT. The most common underlying liver disease was hepatitis C, accounting for 52.2%. The median time to relapse was 11.8 months (range 0-117.7 months). The liver graft was affected in 21 patients (45.7%), and 36 patients (78.3%) had extrahepatic metastases at initial diagnosis of recurrence, with the lung being the most commonly affected (n = 25, 54.3%). Of the total, 54.3% (n = 25) of the patients were initially treated locally; 39 (85.8%) and 7 (15.2%) patients received sorafenib and lenvatinib, respectively, as first-line systemic therapy. Median overall survival of the whole cohort was 10.9 months (95% confidence interval (95% CI) 6.9-14.9 months) and median progression free survival was 5.7 months (95% CI 2.0-9.4 months) from treatment initiation.
CONCLUSIONS: Since history of liver transplantation is considered a contraindication for immunotherapy, prognosis of patients with HCC recurrence after LT remains poor.
METHODS: Retrospective data were collected from four transplant centers from Germany and Austria. We included patients with HCC recurrence after LT between 2007 and 2020 who were treated with a TKI.
RESULTS: In total, we analyzed data from 46 patients with HCC recurrence after LT. The most common underlying liver disease was hepatitis C, accounting for 52.2%. The median time to relapse was 11.8 months (range 0-117.7 months). The liver graft was affected in 21 patients (45.7%), and 36 patients (78.3%) had extrahepatic metastases at initial diagnosis of recurrence, with the lung being the most commonly affected (n = 25, 54.3%). Of the total, 54.3% (n = 25) of the patients were initially treated locally; 39 (85.8%) and 7 (15.2%) patients received sorafenib and lenvatinib, respectively, as first-line systemic therapy. Median overall survival of the whole cohort was 10.9 months (95% confidence interval (95% CI) 6.9-14.9 months) and median progression free survival was 5.7 months (95% CI 2.0-9.4 months) from treatment initiation.
CONCLUSIONS: Since history of liver transplantation is considered a contraindication for immunotherapy, prognosis of patients with HCC recurrence after LT remains poor.
摘要：
背景：酪氨酸激酶抑制剂（TKIs）索拉非尼和乐伐替尼代表了肝移植（LT）后肝细胞癌（HCC）复发患者的首选一线全身治疗。索拉非尼和乐伐替尼，多年来，HCC患者在临床研究中显示出越来越多的总体生存率。相比之下,TKIs下LT术后HCC复发患者的总生存期数据很少,仅限于小型回顾性研究.在这次回顾中,多中心研究，我们研究了TKI治疗的疗效和免疫抑制对肝癌患者肝移植后复发的影响。
方法：回顾性数据来自德国和奥地利的四个移植中心。我们纳入了2007年至2020年间接受TKI治疗的LT术后HCC复发患者。
结果：总计，我们分析了46例肝移植后HCC复发患者的数据。最常见的潜在肝病是丙型肝炎，占52.2%。中位复发时间为11.8个月（0-117.7个月）。21例患者(45.7%)肝脏移植受累,36例（78.3%）在初次诊断复发时发生肝外转移，与肺是最常见的影响（n=25，54.3%）。在总数中，54.3%(n=25)的患者最初接受了局部治疗；39例(85.8%)和7例(15.2%)患者接受了索拉非尼和乐伐替尼，分别,作为一线全身治疗。整个队列的中位总生存期为10.9个月（95％置信区间（95％CI）6.9-14.9个月），中位无进展生存期为5.7个月（95％CI2.0-9.4个月）。
结论：由于肝移植史被认为是免疫治疗的禁忌症，肝移植后HCC复发患者的预后仍然很差。
方法：回顾性数据来自德国和奥地利的四个移植中心。我们纳入了2007年至2020年间接受TKI治疗的LT术后HCC复发患者。
结果：总计，我们分析了46例肝移植后HCC复发患者的数据。最常见的潜在肝病是丙型肝炎，占52.2%。中位复发时间为11.8个月（0-117.7个月）。21例患者(45.7%)肝脏移植受累,36例（78.3%）在初次诊断复发时发生肝外转移，与肺是最常见的影响（n=25，54.3%）。在总数中，54.3%(n=25)的患者最初接受了局部治疗；39例(85.8%)和7例(15.2%)患者接受了索拉非尼和乐伐替尼，分别,作为一线全身治疗。整个队列的中位总生存期为10.9个月（95％置信区间（95％CI）6.9-14.9个月），中位无进展生存期为5.7个月（95％CI2.0-9.4个月）。
结论：由于肝移植史被认为是免疫治疗的禁忌症，肝移植后HCC复发患者的预后仍然很差。
