Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1340
Peer-review started: December 12, 2022
First decision: December 27, 2022
Revised: January 3, 2023
Accepted: April 19, 2023
Article in press: April 19, 2023
Published online: July 27, 2023
Processing time: 221 Days and 2.7 Hours
Patients with combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) tumors are not traditionally considered for liver transplantation (LT) because single centers with few cases have previously reported poor outcomes; however, several small single-center cohort studies showed satisfactory outcomes after LT for cHCC-CC equivalent to those attained for hepatocellular carcinoma (HCC). The role of LT has been investigated in several retrospective studies that included patients diagnosed incidentally during pathological examination of the explant. The variation in results among patients with cHCC-CC suggests that LT should be considered only in select cases.
Data on clinicopathologic presentation, prognostic factors, and outcomes for LT in cHCC-CC patients are lacking because cHCC-CC is rare, and few studies have been published. To overcome the limitations of single-center and small-volume cases, we collected and analyzed data to evaluate the utility of LT for cHCC-CC from high-volume LT centers in Korea.
We compared the characteristics between living donor LT (LDLT) patients with HCC and LT patients with cHCC-CC before and after propensity score matching and identified the risk factors for tumor recurrence and death after LT in cHCC-CC patients.
We performed a retrospective analysis of patients who were diagnosed with cHCC-CC in their postoperative pathology reports and who underwent LT at any of nine Korean medical centers between January 2000 and December 2018. Patients who received LDLT for HCC at Samsung Medical Center from January 2013 to March 2017 were selected as the control group. Recipients < 18 years, re-transplantation cases, and patients who received multiorgan grafts were excluded.
Cumulative disease-free survival and overall survival in the cHCC-CC group were significantly worse than in the HCC group both before and after matching. Extrahepatic recurrence incidence in the cHCC-CC group was higher than that in the HCC group (75.5% vs 33.3%, P < 0.001). Multivariate analysis demonstrated that the cHCC-CC group had significantly higher rates of tumor recurrence and death compared to the HCC group. In cHCC-CC subgroup analysis, frequency of locoregional therapies > 3, tumor size > 3 cm, and lymph node metastasis were predisposing factors for tumor recurrence in multivariate analysis. Only a maximum tumor size > 3 cm was a predisposing factor for death.
The poor prognosis of patients diagnosed with cHCC-CC after LT can be predicted based on the explanted liver. Frequent regular surveillance for cHCC-CC patients should be required for early detection of tumor recurrence.
Research is needed to determine how cHCC-CC patients are diagnosed and when to perform LT for the best outcome.