Liver transplantation for combined hepatocellular cholangiocarcinoma: Current evidence, selection criteria, and therapeutic controversies

Table 1 Outcomes of liver resection and liver transplantation for combined hepatocellular cholangiocarcinoma

Ref.	Study interval	Number of cases (LR:LT)	Outcomes
			LR	LT
Groeschl et al[54], 2013	1973-2007	35:19	1-year OS: 71%; 3-year OS: 46%	1-year OS: 89%; 3-year OS: 48%
Garancini et al[3], 2014	1988-2009	32:42:551	5-year OS of minor/major resection: 28.1/27.1	5-year OS: 41.1
Wang et al[42], 2021	2004-2015	122:38/65:26 (AJCC stage I + II)	Median OS: 13 months/31 months (AJCC stage I+II)	Median OS: 19 months/57 months (AJCC stage I + II)
Chen et al[7], 2021	2004-2018	32:32 (after PSM)	1-year CSD: 12.8%; 3-year CSD: 52.7%; 5-year CSD: 60.9%	1-year CSD: 10.2%; 3-year CSD: 21.1%; 5-year CSD: 35.4%
Chen et al[55], 2022	2004-2015	37:37 (after PSM)	5-year OS: 38.6%; 5-year CSS: 45.2%	5-year OS: 62.8%; 5-year CSS: 73.1%
Mi et al[56], 2023	2000-2018	74:49	1 year OS: 70.3%; 3-year OS: 44.4%; 5-year OS: 34.5%	1 year OS: 86.2%; 3-year OS: 72.4%; 5-year OS: 60.3%
Peng et al[57], 2023	2002-2018	119:49	1-year CSS: 76.1%; 3-year CSS: 44.5%; 5-year CSS: 42.7%	1-year CSS: 86.3%; 3-year CSS: 73%; 5-year CSS: 61.4%

¹Number of cases for patients who underwent minor hepatectomy, major hepatectomy, and liver transplantation. LR: Liver resection; LT: Liver transplantation OS: Overall survival; AJCC: American Joint Committee on Cancer; PSM: Propensity score matching; CSD: Cancer-specific death; CSS: Cancer-specific survival.

Table 2 Liver transplantation criteria for combined hepatocellular cholangiocarcinoma

Criteria	Tumor size	Nodules	Vascular invasion	Risk stratification
Milan	≤ 5 cm	≤ 3	Excluded	None
UCSF	≤ 6.5 cm	≤ 3 (total tumor burden ≤ 8 cm)	Excluded	None
SEER-derived RSM[55]	> 2 cm (+ 1 point)	≥ 3 (+ 2 points)	+ 1 point	Low-risk: ≤ 2 points; high-risk: > 2 points or extrahepatic metastasis
“Very early” stage cHCC-CCA[38]	≤ 2 cm	1-2	Excluded	None

UCSF: University of California, San Francisco; SEER: Surveillance, Epidemiology, and End Results; RSM: Risk scoring model; cHCC-CCA: Combined hepatocellular cholangiocarcinoma.