Liver transplantation for locally advanced intrahepatic cholangiocarcinoma treated with neoadjuvant therapy: a prospective case-series

Lunsford, Keri E.; Javle, Milind; Heyne, Kirk; Shroff, Rachna T.; Abdel-Wahab, Reham; Gupta, Nakul; Mobley, Constance M.; Saharia, Ashish; Victor, David W.; Nguyen, Duc T.; Graviss, Edward A.; Kaseb, Ahmed O.; McFadden, Robert; Aloia, Thomas A.; Conrad, Claudius; Li, Xian Chang; Monsour, Howard Paul; Gaber, A. Osama; Vauthey, Jean‐Nicolas; Ghobrial, Rafik M.

doi:10.1016/s2468-1253(18)30045-1

Cited by 203 publications

(196 citation statements)

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“…Despite clinical challenges, the growing understanding of ICC, led by increased investigations, is providing new insight into heterogeneity, pathogenesis, and therapeutic strategies with regard to the disease (10)(11)(12). Locally advanced ICC is no longer a contraindication for transplantation, and adjuvant treatments are now implemented more frequently worldwide, suggesting that it is important to identify the prognostic subtype for all treatments (13,14). However, prognostic subtypes that support the selection of therapeutic modality remain limited, especially for recurrent ICC.…”

Section: Introductionmentioning

confidence: 99%

Latent Risk Intrahepatic Cholangiocarcinoma Susceptible to Adjuvant Treatment After Resection: A Clinical Deep Learning Approach

Jeong

Chen

et al. 2020

Front. Oncol.

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Background: Artificial Intelligence (AI) frameworks have emerged as a novel approach in medicine. However, information regarding its applicability and effectiveness in a clinical prognostic factor setting remains unclear.Methods: The AI framework was derived from a pooled dataset of intrahepatic cholangiocarcinoma (ICC) patients from three clinical centers (n = 1,421) by applying the TensorFlow deep learning algorithm to Cox-indicated pathologic (four), serologic (six), and etiologic (two) factors; this algorithm was validated using a dataset of ICC patients from an independent clinical center (n = 234). The model was compared to the commonly used staging system (American Joint Committee on Cancer; AJCC) and methodology (Cox regression) by evaluating the brier score (BS), integrated discrimination improvement (IDI), net reclassification improvement (NRI), and area under curve (AUC) values.Results: The framework (BS, 0.17; AUC, 0.78) was found to be more accurate than the AJCC stage (BS, 0.48; AUC, 0.60; IDI, 0.29; NRI, 11.85; P < 0.001) and the Cox model (BS, 0.49; AUC, 0.70; IDI, 0.46; NRI, 46.11; P < 0.001). Furthermore, hazard ratios greater than three were identified in both overall survival (HR; 3.190; 95% confidence interval [CI], 2.150-4.733; P < 0.001) and disease-free survival (HR, 3.559; 95% CI, 2.500-5.067; P < 0.001) between latent risk and stable groups in validation. In addition, the latent risk subgroup was found to be significantly benefited from adjuvant treatment (HR, 0.459; 95% CI, 0.360-0.586; P < 0.001).Jeong et al. Latent Risk Intrahepatic CholangiocarcinomaConclusions: The AI framework seems promising in the prognostic estimation and stratification of susceptible individuals for adjuvant treatment in patients with ICC after resection. Future prospective validations are needed for the framework to be applied in clinical practice.

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Section: Introductionmentioning

confidence: 99%

Latent Risk Intrahepatic Cholangiocarcinoma Susceptible to Adjuvant Treatment After Resection: A Clinical Deep Learning Approach

Jeong

Chen

et al. 2020

Front. Oncol.

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“…In the non-cirrhotic population, Lunsford et al have published a prospective case series of 21 patients with iCCA who were assessed for LT. 107 This series had a well-defined neoadjuvant protocol. Inclusion criteria were solitary tumour greater than 2 cm or multifocal disease confined to the liver without radiological evidence of macrovascular or lymph nodal involvement.…”

Section: Lt For Hccamentioning

confidence: 99%

“…The 6 recipients were followed for a median of 36 months and 3 had CCA recurrence. 107 This approach of neoadjuvant chemotherapy with or without radiation therapy could be useful for downstaging therapy in patients with unresectable CCA or as a selection criteria for LT. 91 108 The use of radioembolisation with yttrium-90 (Y90) has been investigated as an option for downstaging and/or neoadjuvant therapy before LT. In a study from Rayar et al, patients with unresectable iCCA were treated with Y90 combined with systemic chemotherapy.…”

Section: Lt For Hccamentioning

confidence: 99%

Recent advances in liver transplantation for cancer: The future of transplant oncology

et al. 2019

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Liver transplantation is widely indicated as a curative treatment for selected patients with hepatocellular carcinoma. However, with recent therapeutic advances, as well as efforts to increase the donor pool, liver transplantation has been carefully expanded to patients with other primary or secondary malignancies in the liver. Cholangiocarcinoma, colorectal and neuroendocrine liver metastases, and hepatic epithelioid haemangioendothelioma are amongst the most relevant new indications. In this review we discuss the fundamental concepts of this ambitious undertaking, as well as the newest indications for liver transplantation, with a special focus on future perspectives within the recently established concept of transplant oncology.

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“…The significance of treatment response is also underscored by good experiences with downstaging of HCC tumours, allowing expansion of the original strict morphologically based Milan criteria. Preliminary results from a recent trial suggest that a similar approach can be used to select patients with intrahepatic cholangiocarcinoma for liver transplantation; this tumour has usually been considered an absolute contraindication.…”

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confidence: 99%

Frontiers in liver transplantation

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2020

British Journal of Surgery

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Liver transplantation for locally advanced intrahepatic cholangiocarcinoma treated with neoadjuvant therapy: a prospective case-series

Cited by 203 publications

References 35 publications

Latent Risk Intrahepatic Cholangiocarcinoma Susceptible to Adjuvant Treatment After Resection: A Clinical Deep Learning Approach

Latent Risk Intrahepatic Cholangiocarcinoma Susceptible to Adjuvant Treatment After Resection: A Clinical Deep Learning Approach

Recent advances in liver transplantation for cancer: The future of transplant oncology

Frontiers in liver transplantation

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