Faculty Collaboration Database

Downstaging Locally Advanced Cholangiocarcinoma Pre-Liver Transplantation: A Prospective Pilot Study. J Surg Res 2019 Oct;242:23-30

Date

05/07/2019

Pubmed ID

31059945

DOI

10.1016/j.jss.2019.04.023

Scopus ID

2-s2.0-85065040956 (requires institutional sign-in at Scopus site)   27 Citations

Abstract

BACKGROUND: Orthotopic liver transplantation (OLT) after neoadjuvant therapy (NT) in well-selected patients with unresectable hilar cholangiocarcinoma (CCA) achieves excellent recurrence-free survival. Current criteria for NT-OLT exclude patients with locally advanced hilar and intrahepatic CCA from potential cure. We sought to evaluate the efficacy of NT in downstaging locally advanced CCA, and examine outcomes after OLT.

METHODS: Among 24 patients referred for unresectable hilar and intrahepatic CCA from January 2013 through August 2017, 18 met center-specific inclusion criteria for the NT-OLT treatment protocol: hilar tumor size ≤3.5 cm or intrahepatic ≤8 cm, and regional lymphadenopathy but without distant metastasis. Median follow-up was 22.1 mo from diagnosis.

RESULTS: Of 18 patients who initiated NT, 11 were removed from the protocol due to tumor progression (n = 6) or uncontrolled infection and failure-to-thrive (n = 5). Median NT duration tended to be shorter for patients progressing to dropout than for those surviving to OLT (5.5 versus 13.5 mo, P = 0.109). Among five patients who received OLT, 1-y post-OLT patient survival was 80%: three survive recurrence-free (14.5-29.2 mo post-OLT); one developed an isolated tumor recurrence in a single portacaval lymph node at 12 mo post-OLT; and one experienced non-tumor-related death. All dropout patients died at a median of 14.4 mo after diagnosis.

CONCLUSIONS: This is the first prospective study to show successful NT downstaging of unresectable locally advanced hilar and intrahepatic CCA before OLT. NT-OLT for select patients with locally advanced hilar and intrahepatic CCA achieved acceptable short-term recurrence-free survival.

Author List

Wong M, Kim J, George B, Eriksen C, Pearson T, Robbins J, Zimmerman MA, Hong JC

Authors

Calvin Martin Eriksen MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Terra Pearson MD, PhD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Bile Duct Neoplasms
Bile Ducts, Intrahepatic
Chemoradiotherapy, Adjuvant
Cholangiocarcinoma
Common Bile Duct Neoplasms
Female
Follow-Up Studies
Humans
Klatskin Tumor
Liver Transplantation
Logistic Models
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Pilot Projects
Prospective Studies
Survival Analysis
Treatment Outcome