Mixed hepatocellular cholangiocarcinoma and intrahepatic... : Liver Transplantation (original) (raw)

Original Articles

Mixed hepatocellular cholangiocarcinoma and intrahepatic cholangiocarcinoma in patients undergoing transplantation for hepatocellular carcinoma

Sapisochin, Gonzalo1,4; Fidelman, Nicholas1,4; Roberts, John P.1,4; Yao, Francis Y.1,4

1_Department of Surgery, University of California San Francisco, San Francisco, CA_

2_Radiology, University of California San Francisco, San Francisco, CA_

3_Medicine, University of California San Francisco, San Francisco, CA_

4_Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Vall d'Hebron University Hospital, Universidad Autonoma of Barcelona, Barcelona, Spain_

University of California San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143–0538

E-mail: [email protected]

This study was reported in part in an oral presentation at the 61st Annual Meeting of the American Association for the Study of Liver Diseases, Boston, MA, October 31, 2010.

Gonzalo Sapisochin was supported by a scholarship grant from the Fundación Mutua Madrileña.

Telephone: 415–514–0332; FAX: 415–476–0659

Abstract

Mixed hepatocellular cholangiocarcinoma (HCC-CC) and intrahepatic cholangiocarcinoma (I-CC) are increasingly being reported in patients with cirrhosis. The aims of this study were (1) to evaluate the incidence, imaging features, and posttransplant outcomes for patients who underwent transplantation for hepatocellular carcinoma (HCC) and were found to have HCC-CC or I-CC in the explant and (2) to compare the outcomes of these patients with those of controls with HCC who were matched (1:3) by the tumor size and the number of nodules in the explant. In the explant specimens of 10 of 302 patients (3.3%) who underwent liver transplantation (LT) for HCC, mixed HCC-CC or I-CC was identified. There were 4 additional incidental cases of HCC-CC. After a median follow-up period of 32 months, 8 of the 14 patients (57%) suffered from tumor recurrence, and the median disease-free survival time was 8 months. The cumulative risk of tumor recurrence was 40% and 70% at 1 and 5 years, respectively, for these 14 patients. When the 4 incidental cases were excluded, the study group with HCC-CC or I-CC (n = 10) had a significantly lower incidence of well-differentiated tumors (11.1% versus 43.3%, P < 0.02) and a higher rate of recurrence (60% versus 16.7%, P = 0.008) in comparison with the control group of patients with HCC (n = 30). The 1- and 5-year cumulative risks of tumor recurrence were 42% and 65%, respectively, in the study group and 10% and 17%, respectively, in the control group (P < 0.002). The actuarial 1- and 5-year patient survival rates without recurrence were also significantly lower in the study group (79% and 32% in the study group and 90% and 62% in the control group, P < 0.03). Dynamic contrast-enhanced computed tomography or magnetic resonance imaging showed progressive contrast enhancement throughout the arterial and portal venous phases without washout in 8 of the 10 patients. In conclusion, HCC-CC and I-CC are associated with a poor prognosis and a high rate of tumor recurrence after LT, and both tumors exhibit radiographic features that are distinct from those observed with HCC. Liver Transpl 17:934–942, 2011. © 2011 AASLD.