Verifying the Benefits of Radical Treatment in Post-Transplant Hepatocellular Carcinoma Oligo-recurrence: a Propensity Score Analysis.

OBJECTIVE To verify whether radical treatment for HCC oligo-recurrence after liver transplantation conveys survival benefits. METHODS A retrospective study of 144 patients with post-transplant HCC recurrence was performed. Propensity score matching was performed to adjust for baseline covariates between patients receiving radical and palliative treatment. The primary endpoint was post-recurrence survival. RESULTS Fifty patients (35%) received radical treatment for recurrence, while 76 (53%) and 18 (13%) patients received palliative and supportive treatment, respectively. Comparing to the radical group, patients who received palliative treatment had more early recurrences (time from transplant 17 vs. 11 months, p=0.01) and more extensive disease in terms of tumour numbers (1 vs. 4, p<0.001), size of largest tumour (1.8 vs. 2.5 cm, p=0.046), numbers of involved organs (IQR 1-1 vs. 1-2, p=0.02) and AFP level (7 vs. 40 ng/ml, p=0.01. Multivariate cox-regression analysis revealed that early recurrence (time from transplant HR 1.02, 95% CI 1.01-1.03, p=0.001), larger recurrent tumour (HR 1.12, 95% CI 1.03-1.23, p=0.01), liver recurrence (HR 1.84, 95% CI 1.17-2.90, p=0.01) and log10AFP level upon recurrence (HR 1.27, 95% CI 1.07-1.52, p=0.01) predicted poor survival. mTOR inhibitor (HR 0.331, 95% CI 0.213-0.548, p<0.0001) and radical treatment (HR 0.342, 95% CI 0.213-0.548, p<0.0001) were associated with improved survival. After 2-to-1 propensity score matching for covariates, the 50 patients receiving curative treatment survived significantly longer than the 25 matched patients receiving palliative treatment (median survival 30.9+/-2.4 vs. 19.5+/-3.0 months, p=0.01. CONCLUSIONS Radical treatment conveys survival benefits to hepatocellular carcinoma oligo-recurrence after liver transplantation.