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Open Access Highly Accessed Research

Sorafenib for hepatocellular carcinoma patients beyond Milan criteria after orthotopic liver transplantation: a case control study

Chieh-Lin Teng123, Wen-Li Hwang1, Yi-Ju Chen4, Kuang-Hsi Chang5 and Shao-Bin Cheng34*

Author Affiliations

1 Division of Hematology/Oncology, Department of Medicine, Taichung Veterans General Hospital, 160, Section 3, Chungkang Road, Taichung 407, Taiwan

2 Department of Life Science, Tunghai University, 181, Section 3, Chungkang Road, Taichung 407, Taiwan

3 Department of Medicine, Chung Shan Medical University, 110, Section 1, Jianguo N. Road, Taichung 402, Taiwan

4 Division of General Surgery, Department of Surgery, Taichung Veterans General Hospital, 160, Section 3, Chungkang Road, Taichung 407, Taiwan

5 Department of Research, Taichung Veterans General Hospital, 160, Section 3, Chungkang Road, Taichung 407, Taiwan

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World Journal of Surgical Oncology 2012, 10:41  doi:10.1186/1477-7819-10-41

Published: 17 February 2012

Abstract

Background

Orthotopic liver transplantation (OLT) is one of the most effective treatments for patients with hepatocellular carcinoma (HCC) within the Milan criteria. However, for patients beyond these criteria, the recurrence rate is higher and the prognosis is worse. Sorafenib is the only drug showing survival benefits in advanced HCC patients; however, its role in patients beyond the Milan criteria after OLT remains unclear and requires further investigation.

Methods

As a case-control study, we retrospectively analyzed 17 Chinese patients beyond Milan criteria undergoing OLT for HCC. These patients were stratified into adjuvant (n = 5), palliative (n = 6), and control groups (n = 6).

Results

Nine of 11 patients who received sorafenib after OLT needed dose reduction due to more than grade 2 side effects. The disease-free survival rates for patients with or without adjuvant sorafenib were 100% versus 37.5% (p = 0.034) at 6 months, 66.7% versus 9.4% (p = 0.026) at 12 months, and 66.7% versus 0.0% (p = 0.011) at 18 months, respectively. The overall survival rates for patients in palliative and control groups were 66.7% versus 40.0% (p = 0.248) at 6 months, 66.7% versus 40.0% (p = 0.248) at 12 months, and 50.0% versus 20.0% (p = 0.17) at 18 months, respectively. Patients in the adjuvant group had better overall survival rates than those in the palliative and control groups (p = 0.031) at 24-month follow-up.

Conclusions

Adjuvant sorafenib could possibly extend both disease-free and overall survival for HCC patients beyond Milan criteria after OLT.

Keywords:
HCC; OLT; Adjuvant therapy; Sorafenib