Page 187 - ebook HCC

184 PROGRAMME AND ABSTRACTS GENEVA, SWITZERLAND EASL HCC SUMMIT 185
FEBRUARY 13 - 16, 2014

ADJUVANT AND NEOADJUVANT TREATMENT OLT FOR HCC - EXTENDING THE INDICATION
WITH RESECTION
Yaman Tokat 1
1 Organ Transplantation and Research Center, Izmir, Turkey
Francis Yao 1
1 University of California, San Francisco, United States
Corresponding author’s e-mail: tokat@florence.com.tr
Corresponding author’s e-mail: Francis.Yao@ucsf.edu

Introduction: In liver transplantation (LT) for hepatocellular carcinoma (HCC), patient
selection depends on morphological features. We performed a clinicopathological analysis
- One of the major challenges of hepatic resection for hepatocellular carcinoma (HCC) is of risk factors that affected survival after liver transplantation for HCC.
the high incidence of HCC recurrence (within 1-2 years) or de novo HCC (> 2 years) after Aims:
curative resection. Methodology: Between June 2004 and September 2013, 710 liver transplants (533
- Pre-operative local regional therapy (chemoembolization) has not been shown in living donor LT and 177 deceased donor LT) were performed in Florence Nightingale
randomized controlled trials (RCT) to improve outcome after resection. Hospital, Liver Transplantation Unit. In a total of 130 patients were diagnosed HCC after
- There has been no proven benefit of systemic chemotherapy in HCC, and the safety and the examination of the pathology specimens. Ten patients were excluded (4 patients with
toxicity are of major concern after resection in patients with cirrhosis. Most RCT involving perioperative death and 6 patients with mixed HCC and cholangiocellular carcinoma) and
Uracil-tegafur, Carmofur, Epirubicin + Carmofur, and Cepecitabine have shown no benefit. the remaining 120 patients were analyzed retrospectively.
- Acyclic retinoid Polyprenoic Acid has been shown in one study by Muto et al. in 1996 to Results: There were 106 male and 14 female patients. The mean age was 55.3 (range,
have a significant benefit in preventing second HCC after resection (2). Additional studies 23-72). In a mean follow-up of 36.1 (range, 1-105) months, recurrence was seen in 19
using Peretinoin are currently in progress. patients (15.8%). Of 24 patients with post-transplant mortality, 14 were related to HCC
- A recent RCT involving 31 Japanese centers using vitamin K2 (Menatetrenone) did recurrence. The recurrence rate was significantly higher in patients with a pre-LT alpha-
not show a significant benefit of vitamin K2 in DFS or time to recurrence after curative fetoprotein (AFP)>400 (5/9, 55.5%) vs. those with pre-LT AFP
CLINICAL SPEAKERS ABSTRACTS resection (STORM trial: http://clinicaltrials.gov.com, NCT00692770) are not yet available. are indicators of poor prognosis after LT. For better patient selection for LT, prognostic CLINICAL SPEAKERS ABSTRACTS
resection (2).
Conclusions: In patients with HCC, pre-LT AFP>400 and grade 3 histologic differentiation
- Results of Sorafenib as adjuvant treatment in the prevention of HCC recurrence after
criteria related to tumor biology should also be considered.
- Many RCTs have investigated anti-viral therapy (primarily Interferon based regimen) after
resection for patients with chronic hepatitis C or B, with mixed results. Meta-analysis of
these RCT before 2012 appears to favor treatment (3). However, a recent large RCT
of adjuvant alpha-interferon from the Taiwan Cooperative Oncology group involving 268
patients (80% HBV and 20% HCV) showed that alpha-interferon did not reduce post-
operative recurrence of HCC (4).
- The advance of new Direct Acting Agents (DAA) for hepatitis C with very high rates of
sustained virologic response opens the opportunity for future studies of these new anti-viral
agents in preventing HCC after resection for patients with chronic hepatitis C infection (5).

References
1. Muto Y, et al. N Engl J Med 1996;334:1561-1567.
2. Yoshida H, et al. Hepatology 2011;54:532-540.
3. Breitenstein S, et al. Br J Surg 2009;975-981.
4. Chen LT, et al. Ann Surg 2012;255:8-17.
5. Schmidt WN et al. Clin Gastroenterol Hepatol 2013 [Epub]