Published online Apr 27, 2020. doi: 10.4240/wjgs.v12.i4.149
Peer-review started: December 30, 2019
First decision: January 28, 2020
Revised: March 21, 2020
Accepted: March 26, 2020
Article in press: March 26, 2020
Published online: April 27, 2020
Mammalian target of rapamycin (mTOR) inhibitors have been shown to reduce the risk of tumour recurrence after liver transplantation for hepatocellular carcinoma (HCC). However, their role in established post-transplant HCC recurrence is uncertain.
It is unknown whether mTOR inhibitor still confers survival benefits following HCC recurrence. Recommendations for mTOR inhibitor under this context are based on expert opinions. To address this knowledge gap in the literature, the current study was undertaken to quantify survival following post-transplant HCC recurrence with regard to the administration of mTOR inhibitors.
The objective was to ascertain any survival benefits conferred by mTOR inhibitors following HCC recurrence after liver transplantation.
A retrospective study of 143 patients who developed HCC recurrence after liver transplantation was performed. The patients were divided into 2 groups based on whether they had received mTOR inhibitor-based immunosuppression. The primary endpoint was post-recurrence survival.
Seventy-nine (55%) patients received an mTOR inhibitor-based immunosuppressive regime, while 64 (45%) patients did not. The mTOR inhibitor group had a lower number of recurrent tumours (2 vs 5, P = 0.02) and received more active treatments including radiotherapy (39 vs 22%, P = 0.03) and targeted therapy (59 vs 23%, P < 0.001). The median post-recurrence survival was 21.0 ± 4.1 mo in the mTOR inhibitor group and 11.2 ± 2.5 mo in the control group. Multivariate Cox regression analysis confirmed that mTOR inhibitor therapy was independently associated with improved post-recurrence survival (P = 0.04, OR 0.482, 95%CI: 0.241-0.966). The number of recurrent tumours and use of other treatment modalities did not affect survival. There were no survival differences between patients treated with mTOR inhibitor monotherapy and combination therapy with calcineurin inhibitor.
mTOR inhibitors prolonged survival after post-transplant HCC recurrence.
The role of mTOR inhibitor therapy in post-transplant HCC recurrences should be confirmed with further prospective randomized studies. A further area of study should include patient selection for mTOR inhibitor treatment following HCC recurrence.