Optimal treatment strategy and prognostic analysis of salvage liver transplantation for patients with early hepatocellular carcinoma recurrence after hepatectomy

AIM

We aimed to investigate the prognostic factors for salvage liver transplant in patients with early hepatocellular carcinoma recurrence after hepatectomy.

METHODS

This retrospective analysis included 53 patients who underwent salvage living-donor liver transplantation between January 2007 and January 2018. There were 24 and 29 patients in the early (recurrence ≤24 months after primary liver resection) and the late recurrence groups, respectively.

RESULTS

In the multivariate Cox regression model, pre-liver transplant downstaging therapy, early recurrence (ER) after primary liver resection , and recurrence-to-liver-transplant ≥12 months were independent risks to predict recurrent hepatocellular carcinoma recurrence after salvage living-donor liver transplantation. Compared with the late recurrence group, the ER group showed lower disease-free survival rates (p < 0.001); however, the overall survival rates did not differ between the two groups (p = 0.355). The 1-, 3-, and 5-year disease-free survival rates were 83.3%, 70.6%, and 66.2%, and 96.0%, 91.6%, and 91.6% in the early and late recurrence groups, respectively. When stratified by recurrence-to-liver transplant time and pre-liver transplant downstaging therapy in the ER group, disease-free survival and overall survival rates were significantly different.

CONCLUSION

ER after primary liver resection with advanced tumor status and a longer period of recurrence-to-liver-transplant (≥12 months) have a negative impact on salvage liver transplant. Our findings provide novel recommendations for treatment strategies and eligibility for salvage liver transplant candidates.

A nomogram prognostic model for early hepatocellular carcinoma with diabetes mellitus after primary liver resection based on the admission characteristics

Background: Patients diagnosed with early-stage hepatocellular carcinoma (HCC) and diabetes mellitus (DM) are at a higher risk of experiencing complications and facing increased mortality rates. Hence, it is crucial to develop personalized clinical strategies for this particular subgroup upon their admission. The objective of this study is to determine the key prognostic factors in early HCC patients who received liver resection combined with DM and develop a practical personalized model for precise prediction of overall survival in these individuals. Method: A total of 1496 patients diagnosed hepatitis B virus (HBV) - related liver cancer from Beijing You'an Hospital were retrospectively enrolled, spanning from 1 January 2014, to 31 December 2019, and ultimately, 622 eligible patients of hepatocellular carcinoma (HCC) patients with diabetes were included in this present investigation. A multivariate COX regression analysis was conducted to identify prognostic factors that are independent of each other and develop a nomogram. The performance of the nomogram was evaluated using various statistical measures such as the C-index, receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) in both the training and validation groups. Survival rates were estimated using the Kaplan-Meier method. Results: The study included a total of 622 early HCC patients who underwent liver resection combined with DM. Random Forrest model and Multivariate Cox regression analysis revealed that drinking, tumor number, monocyte-to-lymphocyte ratio, white blood cell count and international normalized ratio at admission were identified as independent prognostic factors for early HCC patients who underwent liver resection combined with DM. The nomogram demonstrated good predictive performance in the training and validation cohorts based on the C-index values of 0 .756 and 0 .739 respectively, as well as the area under the curve values for 3-, 5-, and 8-year overall survival (0.797, 0.807, 0.840, and 0.725, 0.791, 0.855). Calibration curves and decision curve analysis indicated high accuracy and net clinical benefit rates. Furthermore, the nomogram successfully stratified enrolled patients into low-risk and high-risk groups based on their risk of overall survival. The difference in overall survival between these two groups was statistically significant in both the training and validation cohorts (p < 0.0001 and p = 0.0064). Conclusion: Our results indicate that the admission characteristics demonstrate a highly effective ability to predict the overall survival of early HCC patients who have undergone liver resection in combination with DM. The developed model has the potential to support healthcare professionals in making more informed initial clinical judgments for this particular subgroup of patients.