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

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.