Liver Transplantation for "Very Early" Intrahepatic Cholangiocarcinoma: International Retrospective Study Supporting a Prospective Assessment
Liver Transplantation for "Very Early" Intrahepatic Cholangiocarcinoma: International Retrospective Study Supporting a Prospective Assessment
复制标题
DOI：
10.1002/hep.28744
复制
发表时间：
2016-10-01
期刊：
影响因子：
13.5
通讯作者：
Bruix, J.
中科院分区：
文献类型：
--
作者：
Sapisochin, G.;Facciuto, M.;Bruix, J.
肝硬化肝内胆管癌（iCCA）的存在是世界上大多数中心肝移植的禁忌症。最近的研究表明，“非常早期”的iCCA（单个肿瘤2厘米）在肝移植后可能有可接受的结果。本研究在一个更大的国际多中心队列中进一步评估了这一发现。研究组由因肝细胞癌或失代偿性肝硬化而进行肝移植的患者组成，这些患者在移植病理上发现有iCCA。将患者分为“非常早期”iCCA患者和“晚期”iCCA患者（单个肿瘤面积为2 cm或多灶性疾病）。2000年1月至2013年12月期间，81例患者在植体处发现iCCA；33例分别有iCCA和肝细胞癌结节，48例仅有iCCA（研究组）。在研究组中，15/48（31%）属于“早期”iCCA组，33/48（69%）属于“晚期”iCCA组。两组术前特征差异无统计学意义。在外植体处，“晚期”组最大肿瘤的中位大小更大（3.1[2.5-4.4]比1.6[1.5-1.8]）。中位随访35（13.5-76.4）个月后，极早期iCCA组1年、3年和5年累积复发风险分别为7%、18%和18%，晚期iCCA组为30%、47%和61%，P = 0.01。早期iCCA组的1年、3年和5年精算生存率分别为93%、84%和65%，晚期iCCA组为79%、50%和45%，P = 0.02。结论：肝硬化和极早期iCCA患者可能成为肝移植的候选者；需要一项前瞻性多中心临床试验来进一步证实这些结果。
The presence of an intrahepatic cholangiocarcinoma (iCCA) in a cirrhotic liver is a contraindication for liver transplantation in most centers worldwide. Recent investigations have shown that "very early" iCCA (single tumors 2 cm) may have acceptable results after liver transplantation. This study further evaluates this finding in a larger international multicenter cohort. The study group was composed of those patients who were transplanted for hepatocellular carcinoma or decompensated cirrhosis and found to have an iCCA at explant pathology. Patients were divided into those with "very early" iCCA and those with "advanced" disease (single tumor >2 cm or multifocal disease). Between January 2000 and December 2013, 81 patients were found to have an iCCA at explant; 33 had separate nodules of iCCA and hepatocellular carcinoma, and 48 had only iCCA (study group). Within the study group, 15/48 (31%) constituted the "very early" iCCA group and 33/48 (69%) the "advanced" group. There were no significant differences between groups in preoperative characteristics. At explant, the median size of the largest tumor was larger in the "advanced" group (3.1 [2.5-4.4] versus 1.6 [1.5-1.8]). After a median follow-up of 35 (13.5-76.4) months, the 1-year, 3-year, and 5-year cumulative risks of recurrence were, respectively, 7%, 18%, and 18% in the very early iCCA group versus 30%, 47%, and 61% in the advanced iCCA group, P = 0.01. The 1-year, 3-year, and 5-year actuarial survival rates were, respectively, 93%, 84%, and 65% in the very early iCCA group versus 79%, 50%, and 45% in the advanced iCCA group, P = 0.02. Conclusion: Patients with cirrhosis and very early iCCA may become candidates for liver transplantation; a prospective multicenter clinical trial is needed to further confirm these results.