Clinical practice of MDT in recurrence of hepatocellular carcinoma following liver transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PENG Wei ¹ , LI Chuan ¹ , LI Zhiping ² , WANG Xin ³ , CHEN Weixia ⁴ ,  WEN Tianfu ¹

1. Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
2. Department of Oncology, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
3. Department of Radiotherapy, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
4. Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WEN Tianfu, Email: ccwentianfu@163.com

Keywords：

multidisciplinary team; hepatocellular carcinoma; liver transplantation

DOI：

10.7507/1007-9424.201804025

Video：

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Objective To summarize the specific treatment for a patient diagnosed with recurrence of hepatocellular carcinoma following liver transplantation. Methods Considering the patient’s condition, multidisciplinary team (MDT) consultation of the specialists in radiology, oncology, radiotherapy, and liver surgery was conducted. Results After the MDT consultation, the patient was advised to receive surgery if the metastasis could be excluded. Surgical removal of the mass located at the body and tail of pancreas+splenectomy+enterodialysis was conducted. The alpha fetoprotein (AFP) level and abdominal CT were reviewed and no recurrence was found during the follow up period (by the end of May. 2018). Conclusion The MDT mechanism could provide individualized treatment for patients with complicated hepatocellular carcinoma and benefit those patients.

Citation： PENG Wei, LI Chuan, LI Zhiping, WANG Xin, CHEN Weixia, WEN Tianfu. Clinical practice of MDT in recurrence of hepatocellular carcinoma following liver transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(8): 982-987. doi: 10.7507/1007-9424.201804025 Copy

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3.	Llovet JM, Real MI, Montaña X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet, 2002, 359(9319): 1734-1739.
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5.	Otto G, Schuchmann M, Hoppe-Lotichius M, et al. How to decide about liver transplantation in patients with hepatocellular carcinoma: size and number of lesions or response to TACE? J Hepatol, 2013, 59(2): 279-284.
6.	Roayaie S, Schwartz JD, Sung MW, et al. Recurrence of hepatocellular carcinoma after liver transplant: patterns and prognosis. Liver Transpl, 2004, 10(4): 534-540.
7.	Toso C, Cader S, Mentha-Dugerdil A, et al. Factors predicting survival after post-transplant hepatocellular carcinoma recurrence. J Hepatobiliary Pancreat Sci, 2013, 20(3): 342-347.
8.	Yeh CN, Chen MF. Resection of peritoneal implantation of hepatocellular carcinoma after hepatic resection: risk factors and prognostic analysis. World J Surg, 2004, 28(4): 382-386.
9.	Sanada Y, Osada S, Tokuyama Y, et al. Successful surgical resection for peritoneal implantation of hepatocellular carcinoma at the paracardial portion. J Oncol, 2009, 2009: 231854.
10.	Eriguchi N, Aoyagi S, Okuda K, et al. Successful surgical treatment for implanted intraperitoneal metastases of hepatocellular carcinoma. J Hepatobiliary Pancreat Surg, 2000, 7(5): 520-523.
11.	Shin WY, Suh KS, Lee HW, et al. Prognostic factors affecting survival after recurrence in adult living donor liver transplantation for hepatocellular carcinoma. Liver Transpl, 2010, 16(5): 678-684.
12.	Chok KS, Chan SC, Cheung TT, et al. Late recurrence of hepatocellular carcinoma after liver transplantation. World J Surg, 2011, 35(9): 2058-2062.
13.	Schreibman IR, Bejarano P, Martinez EJ, et al. Very late recurrence of hepatocellular carcinoma after liver transplantation: case report and literature review. Transplant Proc, 2006, 38(9): 3140-3143.
14.	Si MS, Amersi F, Golish SR, et al. Prevalence of metastases in hepatocellular carcinoma: risk factors and impact on survival. Am Surg, 2003, 69(10): 879-885.
15.	Yokoyama I, Carr B, Saitsu H, et al. Accelerated growth rates of recurrent hepatocellular carcinoma after liver transplantation. Cancer, 1991, 68(10): 2095-2100.
16.	Lee HY, Yang KH, Choi BH, et al. Complete regression of recurrent advanced hepatocellular carcinoma after liver transplantation in response to sorafenib treatment: a case report. Transplant Proc, 2016, 48(1): 247-250.
17.	Pfiffer TE, Seehofer D, Nicolaou A, et al. Recurrent hepatocellular carcinoma in liver transplant recipients: parameters affecting time to recurrence, treatment options and survival in the sorafenib era. Tumori, 2011, 97(4): 436-441.
18.	Thorat A, Jeng LB, Yang HR, et al. Assessing the role of everolimus in reducing hepatocellular carcinoma recurrence after living donor liver transplantation for patients within the UCSF criteria: re-inventing the role of mammalian target of rapamycin inhibitors. Ann Hepatobiliary Pancreat Surg, 2017, 21(4): 205-211.
19.	Rodríguez-Perálvarez M, Tsochatzis E, Naveas MC, et al. Reduced exposure to calcineurin inhibitors early after liver transplantation prevents recurrence of hepatocellular carcinoma. J Hepatol, 2013, 59(6): 1193-1199.
20.	Calne RY. Immunosuppression in liver transplantation. N Engl J Med, 1994, 331(17): 1154-1155.
21.	Hojo M, Morimoto T, Maluccio M, et al. Cyclosporine induces cancer progression by a cell-autonomous mechanism. Nature, 1999, 397(6719): 530-534.
22.	Neuhaus P, Klupp J, Langrehr JM. mTOR inhibitors: an overview. Liver Transpl, 2001, 7(6): 473-484.
23.	Cholongitas E, Mamou C, Rodríguez-Castro KI, et al. Mammalian target of rapamycin inhibitors are associated with lower rates of hepatocellular carcinoma recurrence after liver transplantation: a systematic review. Transpl Int, 2014, 27(10): 1039-1049.
24.	Dunkelberg JC, Trotter JF, Wachs M, et al. Sirolimus as primary immunosuppression is not associated with hepatic artery thrombosis or wound complications. Liver Transpl, 2003, 9(5): 463-468.
25.	Geissler EK, Schnitzbauer AA, Zülke C, et al. Sirolimus use in liver transplant recipients with hepatocellular carcinoma: a randomized, multicenter, open-label phase 3 trial. Transplantation, 2016, 100(1): 116-125.
26.	Yuan C, Zheng Y, Zhang B, et al. Thymosin α1 promotes the activation of myeloid-derived suppressor cells in a Lewis lung cancer model by upregulating Arginase 1. Biochem Biophys Res Commun, 2015, 464(1): 249-255.
27.	Ni C, Wu P, Wu X, et al. Thymosin alpha1 enhanced cytotoxicity of iNKT cells against colon cancer via upregulating CD1d expression. Cancer Lett, 2015, 356(2 Pt B): 579-588.
28.	He C, Peng W, Li C, et al. Thymalfasin, a promising adjuvant therapy in small hepatocellular carcinoma after liver resection. Medicine (Baltimore), 2017, 96(16): e6606.
29.	Ji SM, Li LS, Sun QQ, et al. Immunoregulation of thymosin alpha 1 treatment of cytomegalovirus infection accompanied with acute respiratory distress syndrome after renal transplantation. Transplant Proc, 2007, 39(1): 115-119.
30.	朱新锋, 陈刚, 张文夺, 等. 肝移植术后应用胸腺肽 α1 对急性排斥反应的影响. 中国普外基础与临床杂志, 2008, 15(6): 430-434.

1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2. Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology, 2016, 150(4): 835-853.
3. Llovet JM, Real MI, Montaña X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet, 2002, 359(9319): 1734-1739.
4. Lo CM, Ngan H, Tso WK, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology, 2002, 35(5): 1164-1171.
5. Otto G, Schuchmann M, Hoppe-Lotichius M, et al. How to decide about liver transplantation in patients with hepatocellular carcinoma: size and number of lesions or response to TACE? J Hepatol, 2013, 59(2): 279-284.
6. Roayaie S, Schwartz JD, Sung MW, et al. Recurrence of hepatocellular carcinoma after liver transplant: patterns and prognosis. Liver Transpl, 2004, 10(4): 534-540.
7. Toso C, Cader S, Mentha-Dugerdil A, et al. Factors predicting survival after post-transplant hepatocellular carcinoma recurrence. J Hepatobiliary Pancreat Sci, 2013, 20(3): 342-347.
8. Yeh CN, Chen MF. Resection of peritoneal implantation of hepatocellular carcinoma after hepatic resection: risk factors and prognostic analysis. World J Surg, 2004, 28(4): 382-386.
9. Sanada Y, Osada S, Tokuyama Y, et al. Successful surgical resection for peritoneal implantation of hepatocellular carcinoma at the paracardial portion. J Oncol, 2009, 2009: 231854.
10. Eriguchi N, Aoyagi S, Okuda K, et al. Successful surgical treatment for implanted intraperitoneal metastases of hepatocellular carcinoma. J Hepatobiliary Pancreat Surg, 2000, 7(5): 520-523.
11. Shin WY, Suh KS, Lee HW, et al. Prognostic factors affecting survival after recurrence in adult living donor liver transplantation for hepatocellular carcinoma. Liver Transpl, 2010, 16(5): 678-684.
12. Chok KS, Chan SC, Cheung TT, et al. Late recurrence of hepatocellular carcinoma after liver transplantation. World J Surg, 2011, 35(9): 2058-2062.
13. Schreibman IR, Bejarano P, Martinez EJ, et al. Very late recurrence of hepatocellular carcinoma after liver transplantation: case report and literature review. Transplant Proc, 2006, 38(9): 3140-3143.
14. Si MS, Amersi F, Golish SR, et al. Prevalence of metastases in hepatocellular carcinoma: risk factors and impact on survival. Am Surg, 2003, 69(10): 879-885.
15. Yokoyama I, Carr B, Saitsu H, et al. Accelerated growth rates of recurrent hepatocellular carcinoma after liver transplantation. Cancer, 1991, 68(10): 2095-2100.
16. Lee HY, Yang KH, Choi BH, et al. Complete regression of recurrent advanced hepatocellular carcinoma after liver transplantation in response to sorafenib treatment: a case report. Transplant Proc, 2016, 48(1): 247-250.
17. Pfiffer TE, Seehofer D, Nicolaou A, et al. Recurrent hepatocellular carcinoma in liver transplant recipients: parameters affecting time to recurrence, treatment options and survival in the sorafenib era. Tumori, 2011, 97(4): 436-441.
18. Thorat A, Jeng LB, Yang HR, et al. Assessing the role of everolimus in reducing hepatocellular carcinoma recurrence after living donor liver transplantation for patients within the UCSF criteria: re-inventing the role of mammalian target of rapamycin inhibitors. Ann Hepatobiliary Pancreat Surg, 2017, 21(4): 205-211.
19. Rodríguez-Perálvarez M, Tsochatzis E, Naveas MC, et al. Reduced exposure to calcineurin inhibitors early after liver transplantation prevents recurrence of hepatocellular carcinoma. J Hepatol, 2013, 59(6): 1193-1199.
20. Calne RY. Immunosuppression in liver transplantation. N Engl J Med, 1994, 331(17): 1154-1155.
21. Hojo M, Morimoto T, Maluccio M, et al. Cyclosporine induces cancer progression by a cell-autonomous mechanism. Nature, 1999, 397(6719): 530-534.
22. Neuhaus P, Klupp J, Langrehr JM. mTOR inhibitors: an overview. Liver Transpl, 2001, 7(6): 473-484.
23. Cholongitas E, Mamou C, Rodríguez-Castro KI, et al. Mammalian target of rapamycin inhibitors are associated with lower rates of hepatocellular carcinoma recurrence after liver transplantation: a systematic review. Transpl Int, 2014, 27(10): 1039-1049.
24. Dunkelberg JC, Trotter JF, Wachs M, et al. Sirolimus as primary immunosuppression is not associated with hepatic artery thrombosis or wound complications. Liver Transpl, 2003, 9(5): 463-468.
25. Geissler EK, Schnitzbauer AA, Zülke C, et al. Sirolimus use in liver transplant recipients with hepatocellular carcinoma: a randomized, multicenter, open-label phase 3 trial. Transplantation, 2016, 100(1): 116-125.
26. Yuan C, Zheng Y, Zhang B, et al. Thymosin α1 promotes the activation of myeloid-derived suppressor cells in a Lewis lung cancer model by upregulating Arginase 1. Biochem Biophys Res Commun, 2015, 464(1): 249-255.
27. Ni C, Wu P, Wu X, et al. Thymosin alpha1 enhanced cytotoxicity of iNKT cells against colon cancer via upregulating CD1d expression. Cancer Lett, 2015, 356(2 Pt B): 579-588.
28. He C, Peng W, Li C, et al. Thymalfasin, a promising adjuvant therapy in small hepatocellular carcinoma after liver resection. Medicine (Baltimore), 2017, 96(16): e6606.
29. Ji SM, Li LS, Sun QQ, et al. Immunoregulation of thymosin alpha 1 treatment of cytomegalovirus infection accompanied with acute respiratory distress syndrome after renal transplantation. Transplant Proc, 2007, 39(1): 115-119.
30. 朱新锋, 陈刚, 张文夺, 等. 肝移植术后应用胸腺肽 α1 对急性排斥反应的影响. 中国普外基础与临床杂志, 2008, 15(6): 430-434.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical practice of MDT in recurrence of hepatocellular carcinoma following liver transplantation

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