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Transplantation versus resection for patients with combined hepatocellular carcinoma-cholangiocarcinoma. J Surg Oncol 2013 May;107(6):608-12

Date

02/07/2013

Pubmed ID

23386397

DOI

10.1002/jso.23289

Scopus ID

2-s2.0-84876411315 (requires institutional sign-in at Scopus site)   71 Citations

Abstract

BACKGROUND AND OBJECTIVES: Although transplantation has demonstrated survival benefit for patients with hepatocellular carcinoma (HCC), there is limited data to support or refute transplantation for combined hepatocellular-cholangiocarcinoma (cHCC-CC). We hypothesized that cHCC-CC patients had poorer overall survival (OS) than HCC patients after liver transplantation.

METHODS: Patients with localized HCC and cHCC-CC treated with surgical resection or transplant were identified using the Surveillance, Epidemiology, and End Results (SEER) Database (1973-2007). Cox proportional hazards models were used to examine survival.

RESULTS: We identified 3,378 (1,447 [43%] transplant, 1,931 [57%] resection) patients with HCC, and 54 (19 [35%] transplant, 35 [65%] resection) patients with cHCC-CC. Patients undergoing resection of HCC and cHCC-CC had similar 3-year OS (55% vs. 46%, P = 0.4). Three-year OS of patients undergoing transplant was significantly greater for HCC (78%) than for cHCC-CC (48%, P = 0.01). In adjusted models, patients transplanted for cHCC-CC had higher hazard of death compared to HCC patients (HR 2.5, 95% CI: 1.2-5.1, P = 0.01).

CONCLUSIONS: Transplantation for localized cHCC-CC confers a survival benefit similar to liver resection for cHCC-CC, but inferior to transplantation for HCC. With survival data that mimics historic reports of transplant for intrahepatic cholangiocarcinoma, this study questions the benefit of transplantation for patients with cHCC-CC.

Author List

Groeschl RT, Turaga KK, Gamblin TC

Author

Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin




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

Adult
Aged
Carcinoma, Hepatocellular
Cholangiocarcinoma
Female
Hepatectomy
Humans
Kaplan-Meier Estimate
Liver Neoplasms
Liver Transplantation
Male
Middle Aged
Neoplasms, Complex and Mixed
Proportional Hazards Models
Retrospective Studies
SEER Program
Survival Rate
Treatment Outcome