Intrahepatic Cholangiocarcinoma or Mixed Hepatocellular-Cholangiocarcinoma in Patients Undergoing Liver Transplantation

Sapisochín, Gonzalo; Lope, Carlos Rodríguez de; Gastaca, Mikel; Urbina, J. Ortiz de; López‐Andújar, Rafael; Palacios, F.; Ramos, Emilio; Fabregat, J.; Castroagudı́n, J.F.; Varó, Evaristo; Pons, José Antonio; Parrilla, Pascual; González-Diéguez, M.L.; García, Manuel Rodríguez; Otero, Alejandra; Vázquez, María Ángeles Rodríguez; Zozaya, Gabriel; Herrero, J.I.; Sánchez-Antolín, Gloria; Pérez, B. Sánchez; Ciria, Rubén; Rufián, Sebastián; Fundora, Y.; Ferrón, José Antonio; Guiberteau, A.; Blanco‐Fernández, Gerardo; Varona, M.A.; Barrera, Manuel; Suárez, Miguel Ángel; Santoyo-Santoyo, Julio; Bruix, Jordi; Charco, Ramón

doi:10.1097/sla.0000000000000494

Cited by 163 publications

(137 citation statements)

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“…53 Most recently, a multicenter study from Spain demonstrated better survival rates in 27 patients reaching 51% at 5 y. 54 The University of California Los Angeles group described promising data of neoadjuvant and adjuvant therapy combined with LT in the treatment of intrahepatic and hilar CCA. 55 They further proposed a prognostic scoring system to identify patients who may benefit from LT. 56 Seven independent risk factors (multifocal tumor, perineural invasion, infiltrative subtype, lack of neoadjuvant and/or adjuvant therapies, primary sclerosing cholangitis, hilar CCA, and lymphovascular invasion) were assigned certain risk score points based on the corresponding parameter estimate using the Cox model.…”

Section: -52mentioning

confidence: 99%

“…Needle biopsy of the tumor should ideally be performed to confirm histology, although it might be difficult in a clinical setting. 54,62,63 A recent systematic review described marginal outcomes of LT for fibrolamellar HCC with 5-y survival rates ranging from 29-55%. 64 However, most of the collected cases were from the 1980s and early 1990s before the proposal of the Milan criteria.…”

Section: -52mentioning

confidence: 99%

“…63 At the moment, liver resection is preferred over LT for resectable combined HCC-CCA. Intriguingly, the Spanish study previously mentioned showed similar 5-y survival rates between combined HCC-CCA (15 patients, 78%) and the matched cohort of HCC (30 patients, 86%) after LT. 54 Precise imaging criteria for the pretransplant diagnosis of HCC are important to identify lesions suspicious for combined HCC-CCA. Needle biopsy of the tumor should ideally be performed to confirm histology, although it might be difficult in a clinical setting.…”

Section: -52mentioning

confidence: 99%

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Section: -52mentioning

confidence: 99%

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confidence: 99%

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“…Intense contrast uptake in the arterial phase followed by contrast washout in the venous phase, both on computed tomography or magnetic resonance, is considered diagnostic for HCC > 1 cm [9,14] . Nevertheless, on cirrhotic patients, small lesions may be misdiagnosed as being HCC and can in fact be intrahepatic cholangiocarcinomas (iCCA) or mixed hepatocellular-cholangiocarcinomas (HCC-CC), being their frequency much lower [15,16] . If the lesion does not show the typical HCC pattern on imaging, biopsy is mandatory [10] .…”

Section: Diagnosis Of Very Early Hccmentioning

confidence: 99%

Management of “very early” hepatocellular carcinoma on cirrhotic patients

Sevilla

Echeverri

Charco

2014

WJH

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Due to the advances in screening of cirrhotic patients, hepatocellular carcinoma (HCC) is being diagnosed in earlier stages. For this reason the number of patients diagnosed of very early HCC (single tumors ≤ 2 cm) is continuously increasing. Once a patient has been diagnosed with this condition, treatment strategies include liver resection, local therapies or liver transplantation. The decision on which therapy should the patient undergo depends on the general patients performance status and liver disease. Anyway, even in patients with similar conditions, the best treatment offer is debatable. In this review we analyze the state of the art on the management of very early HCC on cirrhotic patients to address the best treatment strategy for this patient population.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Hepatocellular carcinoma; Very early; Liver resection; Liver transplantation; Local therapiesCore tip: Very early hepatocellular carcinoma patients are deemed too early for liver transplantation candidacy, known as the best treatment regarding long-term survival and tumor recurrence. Strategies as surgical resection and radiofrequency ablation have gained popularity. Although resection is considered as the first line of treatment, recent studies claim equal results with ablation techniques. Ablation used as a test of time in patients who remain candidates for liver transplantation is attractive. In this review we will analyze in detail the novel strategy repertoire used in the management of these patients.Sapisochin G, Fernandez de Sevilla E, Echeverri J, Charco R. Management of "very early" hepatocellular carcinoma on cirrhotic patients.

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“…This lower recurrence rate than previous reports could be attributed to the fact that 67% of patients had a single tumor and <20% showed microvascular invasion or satellite lesions. The authors concluded that a preoperative biopsy resulting in a diagnosis of combined HCC-cholangiocarcinoma should not exclude patients from LT. 15 Hepatic epithelioid hemangioendothelioma Hepatic epithelioid hemangioendothelioma was first described and characterized in 1982 as a low-grade malignant soft tissue tumor. 16 This disease has an incidence of 1per million, and diagnosis is often challenging.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Haberal

2017

Exp Clin Transplant

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Liver transplant is now an acceptable and effective treatment for specific nonhepatocellular malignancies. Worldwide, hilar cholangiocarcinoma accounts for 3% of all primary gastrointestinal malignancies and for 10% of primary hepatobiliary malignancies. For patients who have early-stage, unresectable cholangiocarcinoma, liver transplant preceded by neoadjuvant radiotherapy can result in tumor-free margins, accomplish a radical resection, and treat the underlying primary sclerosing cholangitis when present. Hepatic epithelioid hemangioendothelioma is a rare tumor of vascular origin with a variable malignant potential. Excellent results have been reported with liver transplant for patients with unresectable hepatic epithelioid hemangioendothelioma, with 1-year and 10-year survival rates of 96% and 72%. Hepatoblastoma is the most common primary hepatic malignancy in children. The long-term survival rate after transplant ranges from 66% to 77% in patients with unresectable tumors and good response to chemotherapy. Metastatic liver disease is not an indication for liver transplant, with the exception of cases in which the primary tumor is a neuroendocrine tumor. Indication for liver transplant for hepatic metastasis from neuroendocrine tumors is mainly for patients with unresectable tumors and for palliation of medically uncontrollable symptoms. Posttransplant survival in those patients with low tumor activity index is excellent, despite recurrence of the tumor. Some recent data on liver transplant for unresectable hepatic metastases from colorectal cancer have reported limited survival benefits compared with previous reports. However, due to the high rate of tumor recurrence in a very short time after liver transplant, especially in the era of organ shortage, this indication has not been favored by the transplant community. The indications for liver transplant for nonhepatocellular carcinoma malignancy and its limitations have evolved dramatically over the past decades and will continue to be redefined through future research and investigations.

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Intrahepatic Cholangiocarcinoma or Mixed Hepatocellular-Cholangiocarcinoma in Patients Undergoing Liver Transplantation

Abstract: Patients with HCC-CC have similar survival to patients undergoing a transplant for HCC. Preoperative diagnosis of HCC-CC should not prompt the exclusion of these patients from transplant option.

Cited by 163 publications

References 31 publications

Current status of the organ replacement approach for malignancies and an overture for organ bioengineering and regenerative medicine

Current status of the organ replacement approach for malignancies and an overture for organ bioengineering and regenerative medicine

Management of “very early” hepatocellular carcinoma on cirrhotic patients

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