Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2015; 21(39): 11185-11198
Published online Oct 21, 2015. doi: 10.3748/wjg.v21.i39.11185
Managements of recurrent hepatocellular carcinoma after liver transplantation: A systematic review
Nicola de’Angelis, Filippo Landi, Maria Clotilde Carra, Daniel Azoulay
Nicola de’Angelis, Filippo Landi, Daniel Azoulay, Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri-Mondor Hospital, AP-HP, 94010 Créteil, France
Nicola de’Angelis, Inserm, Unité 4394-MACBEth, 94010 Créteil, France
Nicola de’Angelis, Department of Advanced Biomedical Sciences, University Federico II of Naples, 80138 Naples, Italy
Maria Clotilde Carra, University Paris 7, Denis Diderot, Rothschild Hospital, AP-HP, 75012 Paris, France
Daniel Azoulay, Inserm, Unité 955-IMRB, 94010 Créteil, France
Author contributions: de’Angelis N and Azoulay D were at the origin of the work; de’Angelis N and Carra MC performed the systematic review of the literature (search, evaluation, selection, and quality assessment of the articles), data extraction, data analysis, and manuscript drafting; Landi F was the third blind reviewer and participated at the manuscript drafting and corrections; Azoulay D contributed at the final version of the manuscript with corrections and criticism.
Conflict-of-interest statement: Nicola de’Angelis, Filippo Landi, Maria Clotilde Carra and Daniel Azoulay have no conflict of interest to disclose in relation to the present systematic review.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at nic.deangelis@yahoo.it. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nicola de’Angelis, MD, PhD, Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri-Mondor Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France. nic.deangelis@yahoo.it
Telephone: +33-1-49812348 Fax: +33-1-49812432
Received: February 22, 2015
Peer-review started: February 26, 2015
First decision: March 30, 2015
Revised: April 6, 2015
Accepted: August 25, 2015
Article in press: August 25, 2015
Published online: October 21, 2015
Processing time: 238 Days and 14.1 Hours
Abstract

AIM: To investigate the efficacy (survival) and safety of treatments for recurrent hepatocellular carcinoma (HCC) in liver transplantation (LT) patients.

METHODS: Literature search was performed on available online databases without a time limit until January 2015. Clinical studies describing survival after HCC recurrence in LT patients were retrieved for a full-text evaluation. A total of 61 studies were selected: 13 case reports, 41 retrospective case series, and 7 retrospective comparative studies.

RESULTS: Based on all included studies, the mean HCC recurrence rate was 16% of all LTs for HCC. A total of 1021 LT patients experienced HCC recurrence. The median time from LT to HCC recurrence was 13 mo (range 2-132 mo). The majority of patients (67%) presented with HCC extra-hepatic recurrences, involving lung, bone, adrenal gland, peritoneal lymph nodes, and rarely the brain. Overall survival after HCC recurrence was 12.97 mo. Surgical resection of localized HCC recurrence and Sorafenib for controlling systemic spread of HCC recurrence were associated with the higher survival rates (42 and 18 mo, respectively). However, Sorafenib, especially when combined with mTOR, was frequently associated with severe side effects that required dose reduction or discontinuation

CONCLUSION: Management of recurrent HCC in LT patients is challenging and associated with poor prognosis independently of the type of treatment.

Keywords: Recurrent hepatocellular carcinoma; Liver transplantation; Tumor recurrence; Surgical resection; Trans-arterial chemoembolization; Sorafenib; Systematic review

Core tip: The present systematic review analyzes the current trends in the management of hepatocellular carcinoma recurrence after liver transplantation (LT). A great variety of treatment options, ranging from surgical resection to systemic therapies (e.g., Sorafenib), are tailored to the different clinical scenarios and aimed to increase patient survival. However, tumor recurrence after LT is still associated with poor prognosis. By summarizing the available literature, the present article provides to clinicians and surgeons the body of knowledge for a better decision-making process and supports researchers in future clinical trials.