Hepatocholangiocarcinoma/intrahepatic cholangiocarcinoma: are they contraindication or indication for liver transplantation? A propensity score-matched analysis

  • Ka Wing Ma
  • Kenneth Siu Ho Chok
  • Wong Hoi She
  • Tan To Cheung
  • Albert Chi Yan Chan
  • Wing Chiu Dai
  • James Yan Yue Fung
  • Chung Mau Lo
Original Article
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Abstract

Background

Uncommon primary hepatic malignancies such as intrahepatic cholangiocarcinoma (ICC) and hepatocholangiocarcinoma (HCC-CC) were generally considered contraindications for liver transplantation(LT), and studies comparing the efficacy of LT and resection (LR) for ICC/HCC-CC were scarce.

Objective

To compare the survival outcomes of ICC/HCC-CC patients treated by LT and LR in a propensity score-matched population.

Method

This is a retrospective study from 1995 to 2015. Consecutive patients with the pathological diagnosis of ICC or HCC-CC in the surgical specimens were included. All patients had either hepatectomy or LT with curative intent. Factors associated with survival were identified with multivariate analysis using cox-regression model. Propensity score-matched analysis was performed.

Result

There were 181 patients diagnosed to have ICC/HCC_CC. Nine patients received LT (all with incidental ICC/HCC-CC) and 172 received hepatectomy. The median follow-up period was 27.5 months. The median age was 60 years (range 3–86); Hepatitis B and C carrier status was found in 48.1 and 2.3% of the patients, respectively. The median tumor size was 6 cm and 71.3% of them had solitary tumor. Microvascular invasion was present in 47% of the patients. After propensity score matching, there were 54 (9 in LT and 45 in LR group) patients for analysis. Cox-regression analysis showed that early AJCC (7th) staging and LT were the independent factors associated with overall survival. Patients in the LT group had significantly better overall survival (5-year OS 77.8 vs 36.6%, log-rank p = 0.013).

Conclusion

ICC/HCC-CC are uncommon tumors with poor long-term oncological outcomes despite curative hepatectomy. Liver transplantation might be a better treatment option for patients with early ICC/HCC-CC.

Keywords

Hepatocholangiocarcinoma Intrahepatic cholangiocarcinoma Resection Liver transplantation 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest in writing this article.

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Copyright information

© Asian Pacific Association for the Study of the Liver 2018

Authors and Affiliations

  • Ka Wing Ma
    • 1
  • Kenneth Siu Ho Chok
    • 1
    • 3
  • Wong Hoi She
    • 1
  • Tan To Cheung
    • 1
    • 3
  • Albert Chi Yan Chan
    • 1
    • 3
  • Wing Chiu Dai
    • 1
  • James Yan Yue Fung
    • 2
    • 3
  • Chung Mau Lo
    • 1
    • 3
  1. 1.Department of SurgeryThe University of Hong KongHong KongChina
  2. 2.Department of MedicineThe University of Hong KongHong KongChina
  3. 3.State Key Laboratory for Liver ResearchThe University of Hong KongHong KongChina

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