Adjuvant chemotherapy improves post-transplant outcome in patients with hepatocellular carcinoma

Heng-Kai Zhu; Hai-Bo Mou; Zhuo-Yi Wang; Wu Zhang; Dan Zhu; Si-Yi Zhong; Shu-Sen Zheng; Li Zhuang

doi:10.1016/j.hbpd.2025.05.004

Adjuvant chemotherapy improves post-transplant outcome in patients with hepatocellular carcinoma

Hepatobiliary Pancreat Dis Int. 2025 May 31:S1499-3872(25)00093-1. doi: 10.1016/j.hbpd.2025.05.004. Online ahead of print.

Authors

Heng-Kai Zhu¹, Hai-Bo Mou², Zhuo-Yi Wang¹, Wu Zhang¹, Dan Zhu¹, Si-Yi Zhong¹, Shu-Sen Zheng¹, Li Zhuang³

Affiliations

¹ Department of Hepatobiliary and Pancreatic Surgery, Key Laboratory of Artificial Organs and Computational Medicine in Zhejiang Province, Shulan (Hangzhou) Hospital, Shulan International Medical College, Zhejiang Shuren University, Hangzhou 310000, China.
² Department of Oncology, Shulan (Hangzhou) Hospital, Shulan International Medical College, Zhejiang Shuren University, Hangzhou 310000, China.
³ Department of Hepatobiliary and Pancreatic Surgery, Key Laboratory of Artificial Organs and Computational Medicine in Zhejiang Province, Shulan (Hangzhou) Hospital, Shulan International Medical College, Zhejiang Shuren University, Hangzhou 310000, China. Electronic address: li.zhuang@shulan.com.

PMID: 40527712
DOI: 10.1016/j.hbpd.2025.05.004

Abstract

Background: Hepatocellular carcinoma (HCC) recurrence following liver transplantation (LT) remains a major challenge. This study aimed to investigate the effect of adjuvant chemotherapy (ACT) with the modified FOLFOX-6 (mFOLFOX-6) regimen on the post-transplant prognosis of HCC patients.

Methods: HCC patients who underwent LT at our institution from June 2017 to December 2019 were enrolled. The cohort was divided into the ACT group (n = 57) and the non-ACT group (n = 93). The median post-transplant follow-up period was 54.0 months. The study endpoints were HCC recurrence and patient mortality following LT. The association between ACT and recurrence/mortality were evaluated through univariate and multivariate analyses utilizing a Cox proportional hazards model, propensity score adjustment, propensity score matching, and inverse probability of treatment weighting (IPTW) analyses. A stratification analysis was performed to determine the interaction effects.

Results: The ACT group was younger and had worse tumor characteristics including tumor number, tumor size, portal vein tumor thrombosis, pathological differentiation and microvascular invasion (MVI). The ACT group also demonstrated a lower risk of mortality than the non-ACT group (hazard ratio = 0.36, P = 0.017). It was consistent across sensitivity analyses utilizing propensity score adjustment and matching. There was a significant stronger association between ACT and recurrence-free benefit in patients with grade M2 of MVI compared to patients with grade M0/1 (P for interaction = 0.002).

Conclusions: ACT with mFOLFOX-6 regimen decreased the recurrence and mortality risks following LT for HCC patients. ACT may be considered in HCC patients with high risk of recurrence and mortality after LT.

Keywords: Adjuvant chemotherapy; Alpha-fetoprotein; Hepatocellular carcinoma; Liver transplantation; Microvascular invasion.