Oncology · Surgery · 2 h ago
Selected cHCC-CCA Patients Had Favorable Outcomes After Liver Transplantation
A prospective-database study compared liver transplantation with resection in 111 patients with combined hepatocellular-cholangiocarcinoma (cHCC-CCA). Five-year overall and recurrence-free survival were higher after transplantation, particularly among patients whose tumors were within UCSF criteria.
- Five-year survival was higher after LT than after resection.
- Outcomes remained favorable for tumors within UCSF criteria.
- Macrovascular invasion and poor differentiation predicted recurrence.
Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a rare primary liver cancer for which transplantation has traditionally been avoided because of recurrence concerns. Researchers used a prospective database to identify patients treated between 2010 and 2024 and compared outcomes after liver transplantation (LT) and liver resection (LR). The study included 79 LT recipients, whose cHCC-CCA was diagnosed on explant, and 32 patients who underwent LR. LT outcomes were also compared with those for hepatocellular carcinoma (HCC).
At five years, overall survival was 89.9% after LT versus 65.6% after LR (P=0.007); recurrence-free survival was 84.8% versus 53.1% (P=0.001). Among tumors within UCSF criteria, five-year overall survival was 88.7% after LT and 65.6% after LR, while recurrence-free survival was 89.8% and 51.6%, respectively. Overall survival after LT was similar for cHCC-CCA and HCC (89.9% vs 86%; P=0.721). Macrovascular invasion and poor tumor differentiation independently predicted recurrence after LT.
The findings suggest transplantation may be a potentially effective option for carefully selected patients, but the study was not a randomized comparison and does not establish broader transplant eligibility. Tumor characteristics associated with recurrence may help inform candidate assessment; the results require cautious interpretation given the selected cohorts.
In practice
For patients with cHCC-CCA being considered for treatment, this cohort found higher five-year overall and recurrence-free survival after LT than after LR, including among tumors within UCSF criteria. The findings may inform multidisciplinary assessment of carefully selected candidates, particularly because macrovascular invasion and poor differentiation were associated with recurrence. However, the comparison was not randomized, and the LT group comprised patients whose diagnosis was made on explant; these results do not establish that transplantation should be offered broadly or change eligibility criteria.
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Annals of Surgery: Reappraising Liver Transplantation for Combined Hepatocellular-cholangiocarcinoma ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.