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Analysis of Liver Resection Versus Liver Transplantation on Outcome of Small Intrahepatic Cholangiocarcinoma and Combined Hepatocellular‐Cholangiocarcinoma in the Setting of Cirrhosis
Author(s) -
De Martin Eleonora,
Rayar Michael,
Golse Nicolas,
Dupeux Margot,
Gelli Maximiliano,
Gnemmi Viviane,
Allard Marc Antoine,
Cherqui Daniel,
Sa Cunha Antonio,
Adam Rene,
Coilly Audrey,
Antonini Teresa Maria,
Guettier Catherine,
Samuel Didier,
Boudjema Karim,
Boleslawski Emmanuel,
Vibert Eric
Publication year - 2020
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25737
Subject(s) - medicine , gastroenterology , liver transplantation , hepatocellular carcinoma , intrahepatic cholangiocarcinoma , hazard ratio , cirrhosis , confidence interval , transplantation
This multicenter study compares the outcomes of patients with cirrhosis undergoing liver transplantation (LT) or liver resection (LR) between January 2002 and July 2015 who had intrahepatic cholangiocarcinoma (iCCA) or combined hepatocellular‐cholangiocarcinoma (cHCC‐CCA) found incidentally in the native liver. A total of 49 (65%) LT and 26 (35%) LR patients with cirrhosis and histologically confirmed iCCA/cHCC‐CCA ≤5 cm were retrospectively analyzed. LT patients had significantly lower tumor recurrence (18% versus 46%; P = 0.01), for which the median diameter of the largest nodule (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.02‐1.12]; P = 0.006) and tumor differentiation (HR, 3.74; 95% CI 1.71‐8.17; P = 0.001) were independently predictive. The LT group had significantly higher 5‐year recurrence‐free survival (RFS; 75% versus 36%; P = 0.004). In patients with tumors >2 cm but ≤5 cm, LT patients had a lower recurrence rate (21% versus 48%; P = 0.06) and a higher 5‐year RFS (74% versus 40%; P = 0.06). Independent risk factors for recurrence were LT (protective; HR, 0.23; 95% CI, 0.07‐0.82; P = 0.02), the median diameter of the largest nodule (HR, 1.10; 95% CI, 1.02‐1.73; P = 0.007), and tumor differentiation (HR, 4.16; 95% CI, 1.37‐12.66; P = 0.01). In the LT group, 5‐year survival reached 69% and 65% ( P = 0.40) in patients with tumors ≤2 cm and >2‐5 cm, respectively, and survival was also comparable between iCCA and cHCC‐CCA patients ( P = 0.29). LT may offer a benefit for highly selected patients with cirrhosis and unresectable iCCA/cHCC‐CCA having tumors ≤5 cm. Efforts should be made to evaluate tumor differentiation, and these results need to be confirmed prospectively in a larger population.