Published online Aug 24, 2022. doi: 10.5306/wjco.v13.i8.688
Peer-review started: April 8, 2022
First decision: May 12, 2022
Revised: June 14, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: August 24, 2022
Processing time: 136 Days and 17.1 Hours
Cholangiocarcinoma (CC) is a rare tumor that arises from the epithelium of the bile ducts. It is classified according to anatomic location as intrahepatic, perihilar, and distal. Intrahepatic CC (ICC) is rare in patients with cirrhosis due to causes other than primary sclerosing cholangitis. Mixed hepatocellular carcinoma-CC (HCC-CC) is a rare neoplasm that shows histologic findings of both HCC and ICC within the same tumor mass. Due to the difficulties in arriving at the correct diag
To evaluate the outcomes of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma on pathological examination after liver transplant.
Propensity score matching was used to analyze tumor recurrence (TR), overall mortality (OM), and recurrence-free survival (RFS) in LT recipients with pathologically confirmed ICC or HCC-CC matched 1:8 to those with HCC. Progression-free survival and overall mortality rates were computed with the Kaplan-Meier method using Cox regression for comparison.
Of 475 HCC LT recipients, 1.7% had the diagnosis of ICC and 1.5% of HCC-CC on pathological examination of the explant. LT recipients with ICC had higher TR (46% vs 11%; P = 0.006), higher OM (63% vs 23%; P = 0.002), and lower RFS (38% vs 89%; P = 0.002) than those with HCC when matched for pretransplant tumor characteristics, as well as higher TR (46% vs 23%; P = 0.083), higher OM (63% vs 35%; P = 0.026), and lower RFS (38% vs 59%; P = 0.037) when matched for posttransplant tumor characteristics. Two pairings were performed to compare the outcomes of LT recipients with HCC-CC vs HCC. There was no significant difference between the outcomes in either pairing.
Patients with ICC had worse outcomes than patients undergoing LT for HCC. The outcomes of patients with HCC-CC did not differ significantly from those of patients with HCC.
Core Tip: This retrospective cohort study analyzes the outcomes of patients undergoing liver trans-plantation (LT) with a presumptive diagnosis of hepatocellular carcinoma (HCC) in which explant analysis identified that they actually had intrahepatic cholangiocarcinoma (ICC) or mixed hepatocellular cholangiocarcinoma (HCC-CC). Propensity score matching was used to analyze tumor recurrence, overall mortality, and recurrence-free survival in LT recipients with pathologically confirmed ICC or HCC-CC matched 1:8 to those with HCC. Patients with ICC have worse outcomes than patients undergoing LT for HCC, even when matched for explant pathology. Outcomes did not differ significantly between patients with HCC-CC and patients with HCC.