Primary versus Salvage Liver Transplantation after Curative-Intent Resection or Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Oncological Outcomes
Liver transplantation for hepatocellular carcinoma (HCC) may be performed ab initio, primary liver transplantation (PLT), or for HCC recurrence after previous treatments such as liver resection (LR) or radiofrequency ablation (RFA), salvage liver transplantation (SLT). The aim of this study was to e...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-10-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/20/5030 |
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| author | Alessandro Anselmo Leandro Siragusa Paolo Brigato Camilla Riccetti Andrea Collini Bruno Sensi Giuseppe Tisone |
| author_facet | Alessandro Anselmo Leandro Siragusa Paolo Brigato Camilla Riccetti Andrea Collini Bruno Sensi Giuseppe Tisone |
| author_sort | Alessandro Anselmo |
| collection | DOAJ |
| description | Liver transplantation for hepatocellular carcinoma (HCC) may be performed ab initio, primary liver transplantation (PLT), or for HCC recurrence after previous treatments such as liver resection (LR) or radiofrequency ablation (RFA), salvage liver transplantation (SLT). The aim of this study was to evaluate the oncological outcomes of SLT vs. PLT. For this, a retrospective study was carried out on patients undergoing liver transplantation for HCC. The outcomes of PLT were compared with those of SLT. The primary outcome was disease-free survival (DFS). The secondary outcomes included overall survival (OS), cancer-specific survival (CSS), and major postoperative complications. A sub-analysis of SLT-LR and SLT-RFA was also performed. In total, 141 patients were included: 96 underwent PLT and 45 SLT. Among the SLT group, 25 patients had undergone previous LR while 20 had had RFA. There were no differences in the major postoperative complications. Unadjusted DFS was significantly longer in the PLT group (<i>p</i> = 0.02), as were OS (<i>p</i> = 0.025) and CSS (<i>p</i> = 0.001). There was no difference in DFS between PLT and SLT-LR groups, while a significant difference was found between the PLT and SLT-RFA groups (<i>p</i> = 0.035). Nonetheless, DFS was no different between the SLT-LR and SLT-RFA groups. PLT appears to offer superior long-term oncological outcomes to SLT. Both SLT-LR and SLT-RFA offer acceptable OS and CSS. Further prospective studies are needed to confirm these results, but the re-direction of grafts and transplant philosophy towards PLT rather than SLT may need to be considered. |
| first_indexed | 2024-03-10T21:21:26Z |
| format | Article |
| id | doaj.art-374a0fe2cc424269bd1d3e4f2e7c2604 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T21:21:26Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-374a0fe2cc424269bd1d3e4f2e7c26042023-11-19T15:59:34ZengMDPI AGCancers2072-66942023-10-011520503010.3390/cancers15205030Primary versus Salvage Liver Transplantation after Curative-Intent Resection or Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Oncological OutcomesAlessandro Anselmo0Leandro Siragusa1Paolo Brigato2Camilla Riccetti3Andrea Collini4Bruno Sensi5Giuseppe Tisone6Department of Surgical Sciences, Hepatobiliary and Transplant Unit, Policlinico Tor Vergata, 00133 Rome, ItalyDepartment of Surgical Science, University of Rome “Tor Vergata”, 00133 Rome, ItalyDepartment of Surgical Science, University of Rome “Tor Vergata”, 00133 Rome, ItalyDepartment of Surgical Science, University of Rome “Tor Vergata”, 00133 Rome, ItalyRenal Transplant Center, Siena University Hospital, 53100 Siena, ItalyDepartment of Surgical Science, University of Rome “Tor Vergata”, 00133 Rome, ItalyDepartment of Surgical Sciences, Hepatobiliary and Transplant Unit, Policlinico Tor Vergata, 00133 Rome, ItalyLiver transplantation for hepatocellular carcinoma (HCC) may be performed ab initio, primary liver transplantation (PLT), or for HCC recurrence after previous treatments such as liver resection (LR) or radiofrequency ablation (RFA), salvage liver transplantation (SLT). The aim of this study was to evaluate the oncological outcomes of SLT vs. PLT. For this, a retrospective study was carried out on patients undergoing liver transplantation for HCC. The outcomes of PLT were compared with those of SLT. The primary outcome was disease-free survival (DFS). The secondary outcomes included overall survival (OS), cancer-specific survival (CSS), and major postoperative complications. A sub-analysis of SLT-LR and SLT-RFA was also performed. In total, 141 patients were included: 96 underwent PLT and 45 SLT. Among the SLT group, 25 patients had undergone previous LR while 20 had had RFA. There were no differences in the major postoperative complications. Unadjusted DFS was significantly longer in the PLT group (<i>p</i> = 0.02), as were OS (<i>p</i> = 0.025) and CSS (<i>p</i> = 0.001). There was no difference in DFS between PLT and SLT-LR groups, while a significant difference was found between the PLT and SLT-RFA groups (<i>p</i> = 0.035). Nonetheless, DFS was no different between the SLT-LR and SLT-RFA groups. PLT appears to offer superior long-term oncological outcomes to SLT. Both SLT-LR and SLT-RFA offer acceptable OS and CSS. Further prospective studies are needed to confirm these results, but the re-direction of grafts and transplant philosophy towards PLT rather than SLT may need to be considered.https://www.mdpi.com/2072-6694/15/20/5030liver surgeryhepatocarcinomadownstagingRFAsalvage transplanttransplant oncology |
| spellingShingle | Alessandro Anselmo Leandro Siragusa Paolo Brigato Camilla Riccetti Andrea Collini Bruno Sensi Giuseppe Tisone Primary versus Salvage Liver Transplantation after Curative-Intent Resection or Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Oncological Outcomes Cancers liver surgery hepatocarcinoma downstaging RFA salvage transplant transplant oncology |
| title | Primary versus Salvage Liver Transplantation after Curative-Intent Resection or Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Oncological Outcomes |
| title_full | Primary versus Salvage Liver Transplantation after Curative-Intent Resection or Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Oncological Outcomes |
| title_fullStr | Primary versus Salvage Liver Transplantation after Curative-Intent Resection or Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Oncological Outcomes |
| title_full_unstemmed | Primary versus Salvage Liver Transplantation after Curative-Intent Resection or Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Oncological Outcomes |
| title_short | Primary versus Salvage Liver Transplantation after Curative-Intent Resection or Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Oncological Outcomes |
| title_sort | primary versus salvage liver transplantation after curative intent resection or radiofrequency ablation for hepatocellular carcinoma long term oncological outcomes |
| topic | liver surgery hepatocarcinoma downstaging RFA salvage transplant transplant oncology |
| url | https://www.mdpi.com/2072-6694/15/20/5030 |
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