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Prajapati et al. TACE in recurrent HCC after OLT

to the patients with well or moderately differentiated patients with unresectable HCC, ranged from 13.5 to
HCC of the explant liver (21.7 months, P = 0.004). The 24.5 months. [10,19-22] In the current study, the overall
survival curve generated by Kaplan Meier analysis median and mean survivals from the time of 1st DEB
according to the status of histology grading of the TACE were 15.6 and 19.6 months accordingly, which
explant liver is shown in the Figure 1C. Although, is comparable with the reported DEB TACE studies.
there was a survival difference in the patients between
Child A and B disease, statistically it was found Little is known on the survivals, efficacy and prognostic
nonsignificant. This can likely be due to small sample factors of survivals following DEB TACE in patients with
size. In this study, 25% patients received concurrent recurrent HCC status post OLT. Few similar studies
treatment with sorafenib with a median survival of 7.7 were found from English literature. [7,8] Zhou et al.
[7]
months compared to a median survival of 21.7 months reported that conventional TACE is safe following in
in patients who did not receive sorafenib (P = 0.19). patients with recurrent HCC status post OLT. Their
study indicated that TACE treatment seems to produce
DISCUSSION an effective tumor response for targeted recurrent
HCC after liver transplantation. The Child Pugh Class
Recurrence of HCC after liver transplantation has a of HCC patient is considered to be the one of the
major effect on reducing patient’s overall survival. [11] main prognostic factors for survival following TACE in
In general, all treatment options currently available for HCC patients. [24-26] In our study, there was a survival
advanced HCC are also potentially feasible after OLT. difference in the patients between Child A and B
Treatments include resection, ablation, transarterial disease. However, statistically it was found nonsignificant.
embolization or radioembolization, and systemic This can likely be due to small sample size.
treatment with sorafenib. The 5-year posttransplant
survival was 47% for patients who underwent surgical Recurrence of HCC ranged from 10% to as high as
resection to treat recurrence. The ability for surgical 40%. [2,27,28] Therefore, surveillance with MRI of the
[11]
treatment and a late onset (> 24 months) of recurrence abdomen is very important in these patients. Patients
are factors associated with long-term survival. [12] Local with early recurrence had much worse overall survival
ablative techniques, such as radiofrequency ablation, than those with late recurrence. [2,27,28] In our studies, 2
cryoablation, or percutaneous ethanol ablation, also patients had shortest tumor free survival of 13.3 and 25
yield favorable survival outcomes in patients with months and had worst overall median survivals of 3.4
small unresectable recurrent HCC. [13,14] In our study, and 7.7 months respectively. Both patients had poorly
none of the HCC tumor was feasible for surgery or differentiated HCC of the explant liver. The patients
ablation treatment due to size or close proximity with with poorly differentiated HCC had the poor overall
liver capsule or hepatic vasculature. All patients had survivals (3.4 months) compared to the patients with
cirrhosis before OLT. In 2007, sorafenib was the first well to moderately differentiated HCC of the explant
agent to demonstrate a significant improvement in the liver (21.7 months, P = 0.004). A histological grade of
overall survival of patients with advanced HCC. [15,16] HCC is an important prognostic factor affecting patient
The survival benefits from sorafenib ranged from 2 survival after OLT. The importance of the grade of the
to 3 months in advanced HCC patients. [15,16] Since histology of the explant liver HCC in patient’s prognosis
these two landmark studies, saorafenib has become has previously reported. [5,6,29]
the standard of care for advanced HCC patients. It
has also shown improved survival benefits in patients The prognostic factors for poor survivals other than the
with recurrent HCC after OLT as compared to best histology grading, the number and size of the tumors
supportive care. [17] Yittrium-90 radioembolization have been reported by many investigators. These
has shown benefits in HCC patients. [18] However, no factors include microscopic vascular invasion by the
specific radioembolization study was found in patients HCC, [30,31] presence of partial necrosis of the nodule
with recurrence of HCC after OLT. in the explanted specimen, [32] presence of microscopic
satellite nodules in the explanted specimen, [33] specific
DEB TACE is a well-known locoregional treatment type of lymphocytic infiltrate to the tumor as immune
for HCC evaluated by multiple randomized controlled response, [34] high preoperative level of serum AFP, [35]
studies. Recently, numerous studies have been and advanced tumour-node-metastasis stage and
reported favorable outcomes with the use of DEB extra-hepatic metastases. [4,5] In this study, 2 patients
TACE for HCC. [10,19-22] DEB TACE has demonstrated had elevated AFP and extra-hepatic metastases had
improved survival, better tolerability, and fewer side the poorest survivals. As these facts help in identifying
effects as compared to conventional TACE. [19,21-23] In the patients who will get the most benefit from the DEB
these reported DEB TACE studies, the survivals in TACE treatment.
186 Hepatoma Research ¦ Volume 3 ¦ August 17, 2017