Prognostic impact of tace combined with sorafenib or lenvatinib followed by regorafenib in recurrent hepatocellular carcinoma after liver transplantation: a retrospective study

BMC Cancer. 2025 Jul 1;25(1):1049. doi: 10.1186/s12885-025-14446-9.

Abstract

Background: Tumor recurrence after liver transplantation (LT) for hepatocellular carcinoma (HCC) remains a significant challenge. This study systematically evaluates the efficacy and safety of transarterial chemoembolization (TACE) combined with tyrosine kinase inhibitors (TKIs) for post-LT tumor recurrence.

Methods: This retrospective study included 78 patients with recurrent intrahepatic HCC after LT. Seventy patients received TACE in combination with either sorafenib or lenvatinib, followed by regorafenib. Outcomes evaluated included time to progression (TTP), post-recurrence survival (PRS), post-transplantation survival (PTS), objective response rate (ORR), and adverse events (AEs).

Results: The median TTP for recurrent intrahepatic HCC with combination therapy was 6 months (95% CI: 3.685-8.315), while the median PRS and PTS were 16 months (95% CI: 13.049-18.951) and 25 months (95% CI: 20.447-29.553), respectively. The ORR for intrahepatic tumors was 71.4%. AEs, including post-embolization syndrome and myelosuppression, were manageable.

Conclusion: TACE combined with TKIs has good efficacy and safety in the treatment of HCC recurrence post-LT and is expected to prolong survival.

Keywords: Hepatocellular carcinoma; Liver transplantation; Recurrence; Transarterial chemoembolization; Tyrosine kinase inhibitors.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols* / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols* / therapeutic use
  • Carcinoma, Hepatocellular* / mortality
  • Carcinoma, Hepatocellular* / pathology
  • Carcinoma, Hepatocellular* / therapy
  • Chemoembolization, Therapeutic* / adverse effects
  • Chemoembolization, Therapeutic* / methods
  • Combined Modality Therapy
  • Female
  • Humans
  • Liver Neoplasms* / mortality
  • Liver Neoplasms* / pathology
  • Liver Neoplasms* / therapy
  • Liver Transplantation* / adverse effects
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local* / pathology
  • Neoplasm Recurrence, Local* / therapy
  • Phenylurea Compounds* / administration & dosage
  • Phenylurea Compounds* / therapeutic use
  • Prognosis
  • Pyridines / administration & dosage
  • Pyridines / therapeutic use
  • Quinolines / administration & dosage
  • Quinolines / therapeutic use
  • Retrospective Studies
  • Sorafenib* / administration & dosage
  • Sorafenib* / therapeutic use
  • Treatment Outcome

Substances

  • Phenylurea Compounds
  • Sorafenib
  • lenvatinib
  • regorafenib
  • Quinolines
  • Pyridines