Long-term outcome of patients undergoing liver transplantation for mixed hepatocellular carcinoma and cholangiocarcinoma: an analysis of the UNOS database

Vilchez, Valery; Shah, Malay B.; Daily, Michael F.; Peña, Luis; Tzeng, Ching‐Wei D.; Davenport, Daniel L.; Hosein, Peter J.; Gedaly, Roberto; Maynard, Erin

doi:10.1016/j.hpb.2015.10.001

Cited by 87 publications

(69 citation statements)

References 25 publications

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“…When compared with the LR group, patients who underwent LT were younger (59 versus 63 [48-80] years; P = 0.03) and had a lower BMI (27 versus 29 [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] kg/m 2 ; P = 0.046; Table 1). A significantly higher rate of diabetes was seen in transplanted patients (23 [47%] versus 6 [23%]; P = 0.04), and they had a significantly higher MELD score (12 versus 7 [6][7][8][9][10][11][12][13][14]; P < 0.001).…”

Section: Lr Compared With Ltmentioning

confidence: 99%

Analysis of Liver Resection Versus Liver Transplantation on Outcome of Small Intrahepatic Cholangiocarcinoma and Combined Hepatocellular‐Cholangiocarcinoma in the Setting of Cirrhosis

et al. 2020

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This multicenter study compares the outcomes of patients with cirrhosis undergoing liver transplantation (LT) or liver resection (LR) between January 2002 and July 2015 who had intrahepatic cholangiocarcinoma (iCCA) or combined hepatocellularcholangiocarcinoma (cHCC-CCA) found incidentally in the native liver. A total of 49 (65%) LT and 26 (35%) LR patients with cirrhosis and histologically confirmed iCCA/cHCC-CCA ≤5 cm were retrospectively analyzed. LT patients had significantly lower tumor recurrence (18% versus 46%; P = 0.01), for which the median diameter of the largest nodule (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.02-1.12]; P = 0.006) and tumor differentiation (HR, 3.74; 95% CI 1.71-8.17; P = 0.001) were independently predictive. The LT group had significantly higher 5-year recurrence-free survival (RFS; 75% versus 36%; P = 0.004). In patients with tumors >2 cm but ≤5 cm, LT patients had a lower recurrence rate (21% versus 48%; P = 0.06) and a higher 5-year RFS (74% versus 40%; P = 0.06). Independent risk factors for recurrence were LT (protective; HR, 0.23; 95% CI, 0.07-0.82; P = 0.02), the median diameter of the largest nodule (HR, 1.10; 95% CI, 1.02-1.73; P = 0.007), and tumor differentiation (HR, 4.16; 95% CI, 1.37-12.66; P = 0.01). In the LT group, 5-year survival reached 69% and 65% (P = 0.40) in patients with tumors ≤2 cm and >2-5 cm, respectively, and survival was also comparable between iCCA and cHCC-CCA patients (P = 0.29). LT may offer a benefit for highly selected patients with cirrhosis and unresectable iCCA/cHCC-CCA having tumors ≤5 cm. Efforts should be made to evaluate tumor differentiation, and these results need to be confirmed prospectively in a larger population. Liver Transplantation 26 785-798 2020 AASLD. SEE EDITORIAL ON PAGE 748Intrahepatic cholangiocarcinoma (iCCA) accounts for 20%-25% of all cholangiocarcinoma (CCA) cases, and its incidence is rising at an average of 14% per year in Western countries. (1,2) Moreover, the mixed form of iCCA and hepatocellular carcinoma (HCC), referred to as combined hepatocellularcholangiocarcinoma (cHCC-CCA), is well recognized and increasingly reported. (3) Liver cirrhosis is a major risk factor for iCCA, with an odds ratio of 22.92 (95% confidence interval [CI], 18.24-28.79), De Martin et al. De Martin et al. liver transplantatiOn, June 2020

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Section: Lr Compared With Ltmentioning

confidence: 99%

Analysis of Liver Resection Versus Liver Transplantation on Outcome of Small Intrahepatic Cholangiocarcinoma and Combined Hepatocellular‐Cholangiocarcinoma in the Setting of Cirrhosis

et al. 2020

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“…Currently, clinical consensus opposes the use of transplantation as a therapeutic option for patients with these tumors. [8][9][10] However, data regarding optimum management of cHCC-ICC remain murky.…”

Section: Introductionmentioning

confidence: 99%

Mixed hepatocellular and cholangiocarcinoma: a rare tumor with a mix of parent phenotypic characteristics

Bergquist

Groeschl

Ivanics

et al. 2016

HPB

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“…Biphenotypic tumors (combined hepatocellular carcinoma–cholangiocarcinoma [cHCC‐CCA]) are the rarest type of PLCs (<1% of all liver cancers) and have a natural history which is least understood. Reliant on small series of unintentionally transplanted patients with cHCC‐CCA, longterm outcomes have yielded mixed results with 5‐year posttransplant survival ranging between 8% and 86% . The poor outcomes for these patients are due in large part to the ICC component of these tumors, which recur after LT at a higher rate.…”

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confidence: 99%

“…Reliant on small series of unintentionally transplanted patients with cHCC-CCA, longterm outcomes have yielded mixed results with 5-year posttransplant survival ranging between 8% and 86%. (13)(14)(15)(16)(17) The poor outcomes for these patients are due in large part to the ICC component of these tumors, which recur after LT at a higher rate.…”

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confidence: 99%

Liver transplantation for intrahepatic cholangiocarcinoma

et al. 2018

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Although hepatocellular carcinoma (HCC) has become a common indication for liver transplantation (LT), intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA) are historically contraindicated due to their aggressive behavior. On the basis of recent experiences, some groups have proposed a clinical trial investigating the role of LT for patients with early cholangiocarcinoma (CCA), defined as a single lesion ≤ 2 cm. The purpose of this study is to assess the clinicopathologic features and outcomes following LT for patients who were initially diagnosed with HCC and subsequently found to have either ICC or cHCC-CCA on explant. Patients with the diagnosis of primary liver cancer (PLC) after LT from a single center were retrospectively reviewed. Outcomes for patients with early CCA were compared with patients with HCC within Milan criteria (MC). Out of 618 patients transplanted with PLC, 44 patients were found to have CCA on explant. On the basis of preoperative imaging, 12 patients met criteria for early CCA and were compared with 319 patients who had HCC within MC. The 1- and 5-year overall survival for early CCA versus HCC was 63.6% versus 90.0% and 63.6% versus 70.3% (log-rank, P = 0.25), respectively. Overall recurrence was 33.3% for early CCA versus 11% for HCC. On explant the patients with CCA were more likely understaged with higher tumor grade and vascular invasion. In conclusion, patients with CCA present a diagnostic challenge, which often leads to the finding of more aggressive lesions on explant after LT, higher recurrence rates, and worse post-LT survival. Careful consideration of this diagnostic conundrum needs to be made before a clinical trial is undertaken. Liver Transplantation 24 634-644 2018 AASLD.

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Long-term outcome of patients undergoing liver transplantation for mixed hepatocellular carcinoma and cholangiocarcinoma: an analysis of the UNOS database

Abstract: Patients undergoing LT for HCC had significantly better survival compared to those transplanted for HCC-CC and CC. LT for mixed HCC-CC confers a survival rate similar to selected patients with CC. Efforts should be made to identify HCC-CC patients preoperatively.

Cited by 87 publications

References 25 publications

Analysis of Liver Resection Versus Liver Transplantation on Outcome of Small Intrahepatic Cholangiocarcinoma and Combined Hepatocellular‐Cholangiocarcinoma in the Setting of Cirrhosis

Analysis of Liver Resection Versus Liver Transplantation on Outcome of Small Intrahepatic Cholangiocarcinoma and Combined Hepatocellular‐Cholangiocarcinoma in the Setting of Cirrhosis

Mixed hepatocellular and cholangiocarcinoma: a rare tumor with a mix of parent phenotypic characteristics

Liver transplantation for intrahepatic cholangiocarcinoma

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