Liver transplantation in patients with incidental hepatocellular carcinoma/cholangiocarcinoma and intrahepatic cholangiocarcinoma: a single-center experience
Liver transplantation in patients with incidental hepatocellular carcinoma/cholangiocarcinoma and intrahepatic cholangiocarcinoma: a single-center experience
复制标题
DOI：
10.1016/s1499-3872(17)60016-x
复制
发表时间：
2017-06-01
影响因子：
3.3
通讯作者：
Aucejo, Federico N.
中科院分区：
文献类型：
--
作者：
Elshamy, Mohammed;Presser, Naftali;Aucejo, Federico N.
背景技术背景：混合型肝细胞癌/胆管细胞癌（HCC/CC）和肝内胆管细胞癌（ICC）患者的肝移植（LT）报告不多，并且大多是在假定HCC的病理分类后进行回顾性研究。一些研究表明，接受LT的小且单灶性ICC或混合型HCC/CC患者可实现约40%-60%的移植后5年生存率。本研究旨在报告我们对移植物病理显示HCC/CC和ICC.METHODS的LT患者的经验：从前瞻性维护的数据库中，我们进行了队列分析。我们确定了13例接受LT与外植体病理显示HCC/CC或ICC.RESULTS：观察到的复发率后LT为31%（4/13），总生存率分别为85%，51%，51%，在1，3和5年，分别。1年、3年和5年的无病生存率分别为68%、51%和41%。在我们的队列中，四名患者将有资格的例外点的基础上更新的HCC器官采购和移植网络imaging guidelines.CONCLUSIONS：病变缺乏完整的影像学特征的HCC可能需要预LT活检，以充分阐明其病理。已确定的早期HCC/CC或ICC患者如果不能切除，可能从LT中获益。此外，合并连续的围手术期治疗，如肝门部胆管癌患者接受LT可能会改善结局，但这需要进一步研究。
BACKGROUND: Reports of liver transplantation (LT) in patients with mixed hepatocellular carcinoma/cholangiocarcinoma (HCC/CC) and intrahepatic cholangiocarcinoma (ICC) are modest and have been mostly retrospective after pathological categorization in the setting of presumed HCC. Some studies suggest that patients undergoing LT with small and unifocal ICC or mixed HCC/CC can achieve about 40%-60% 5-year post-transplant survival. The study aimed to report our experience in patients undergoing LT with explant pathology revealing HCC/CC and ICC.METHODS: From a prospectively maintained database, we performed cohort analysis. We identified 13 patients who underwent LT with explant pathology revealing HCC/CC or ICC.RESULTS: The observed recurrence rate post-LT was 31% (4/13) and overall survival was 85%, 51%, and 51% at 1, 3 and 5 years, respectively. Disease-free survival was 68%, 51%, and 41% at 1, 3 and 5 years, respectively. In our cohort, four patients would have qualified for exception points based on updated HCC Organ Procurement and Transplantation Network imaging guidelines.CONCLUSIONS: Lesions which lack complete imaging characteristics of HCC may warrant pre-LT biopsy to fully elucidate their pathology. Identified patients with early HCC/CC or ICC may benefit from LT if unresectable. Additionally, incorporating adjunctive perioperative therapies such as in the case of patients undergoing LT with hilar cholangiocarcinoma may improve outcomes but this warrants further investigation.