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Intrahepatic Cholangiocarcinoma or Mixed Hepatocellular-Cholangiocarcinoma in Patients Undergoing Liver Transplantation: A Spanish Matched Cohort Multicenter Study

Sapisochin, G. MD, PhD*; de Lope, C. Rodríguez MD; Gastaca, M. MD; de Urbina, J. Ortiz MD; López-Andujar, R. MD, PhD§; Palacios, F. MD§; Ramos, E. MD, PhD; Fabregat, J. MD, PhD; Castroagudín, J. F. MD, PhD; Varo, E. MD, PhD; Pons, J. A. MD, PhD**; Parrilla, P. MD, PhD††; González-Diéguez, M. L. MD‡‡; Rodriguez, M. MD, PhD‡‡; Otero, A. MD, PhD§§; Vazquez, M. A. MD§§; Zozaya, G. MD¶¶; Herrero, J. I. MD, PhD‖‖; Antolin, G. Sanchez MD***; Perez, B. MD, PhD†††; Ciria, R. MD, PhD§§§; Rufian, S. MD, PhD§§§; Fundora, Y. MD, PhD¶¶¶; Ferron, J. A. MD, PhD¶¶¶; Guiberteau, A. MD‖‖‖; Blanco, G. MD, PhD‖‖‖; Varona, M. A. MD****; Barrera, M. A. MD****; Suarez, M. A. MD, PhD††††; Santoyo, J. MD, PhD††††; Bruix, J. MD‡‡‡‡; Charco, R. MD, PhD*

doi: 10.1097/SLA.0000000000000494
Original Articles

Objective: To evaluate the outcome of patients with hepatocellular-cholangiocarcinoma (HCC-CC) or intrahepatic cholangiocarcinoma (I-CC) on pathological examination after liver transplantation for HCC.

Background: Information on the outcome of cirrhotic patients undergoing a transplant for HCC and with a diagnosis of HCC-CC or I-CC by pathological study is limited.

Methods: Multicenter, retrospective, matched cohort 1:2 study. Study group: 42 patients undergoing a transplant for HCC and with a diagnosis of HCC-CC or I-CC by pathological study; and control group: 84 patients with a diagnosis of HCC. I-CC subgroup: 27 patients compared with 54 controls; HCC-CC subgroup: 15 patients compared with 30 controls. Patients were also divided according to the preoperative tumor size and number: uninodular tumors 2 cm or smaller and multinodular or uninodular tumors 2 cm or larger. Median follow-up: 51 (range, 3–142) months.

Results: The 1-, 3-, and 5-year actuarial survival rate differed between the study and control groups (83%, 70%, and 60% vs 99%, 94%, and 89%, respectively; P < 0.001). Differences were found in 1-, 3-, and 5-year actuarial survival rates between the I-CC subgroup and their controls (78%, 66%, and 51% vs 100%, 98%, and 93%; P < 0.001), but no differences were observed between the HCC-CC subgroup and their controls (93%, 78%, and 78% vs 97%, 86%, and 86%; P = 0.9). Patients with uninodular tumors 2 cm or smaller in the study and control groups had similar 1-, 3-, and 5-year survival rate (92%, 83%, 62% vs 100%, 80%, 80%; P = 0.4). In contrast, patients in the study group with multinodular or uninodular tumors larger than 2 cm had worse 1-, 3-, and 5-year survival rates than their controls (80%, 66%, and 61% vs 99%, 96%, and 90%; P < 0.001).

Conclusions: Patients with HCC-CC have similar survival to patients undergoing a transplant for HCC. Preoperative diagnosis of HCC-CC should not prompt the exclusion of these patients from transplant option.

The presence of a cholangiocarcinoma on pathological examination of cirrhotic patients undergoing a transplant for hepatocellular carcinoma (HCC) may affect prognosis. The outcome of patients with a diagnosis of HCC-cholangiocarcinoma or intrahepatic cholangiocarcinoma on pathological study was compared with those with HCC.

*Department of HBP Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain

Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, ICMDM, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain

Liver Transplantation Unit, Hospital Universitario de Cruces, Universidad del País Vasco, Bilbao, Spain

§Department of HBP Surgery and Transplantation, Hospital Universitario La Fe, Valencia, Spain

Liver Transplant Unit, Hospital Universitario de Bellvitge, L`Hospitalet, Spain

Liver Transplantation Unit, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain

**Liver Transplant and Hepatology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Virgen de la Arrixaca, Murcia, Spain

††Liver Transplant and Hepatology Unit, Department of Surgery, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Virgen de la Arrixaca, Murcia, Spain

‡‡Liver Unit, Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain

§§Hepatology and Liver Transplantation Unit, Hospital Universitario de A Coruña, A Coruña, Spain

¶¶Department of General Surgery, Clínica Universidad de Navarra, Pamplona, Spain

‖‖Liver Unit, Clínica Universidad de Navarra, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Pamplona, Spain

***Liver Transplant Unit, Hospital Universitario Rio Hortega, Valladolid, Spain

†††Department of HBP Surgery and Liver Transplantation, Hospital Universitario Rio Hortega, Valladolid, Spain

§§§Unit of HBP Surgery and Liver Transplantation-IMIBIC, Hospital Universitario Reina Sofía, Córdoba, Spain

¶¶¶HBP Surgery and Transplantation Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain

‖‖‖Liver Transplant Unit, Hospital Universitario Infanta Cristina, Badajoz, Spain

****Department of HBP Surgery and Liver Transplantation, Hospital Universitario Nuestra Señora de Candelaria. Santa Cruz de Tenerife, Spain

††††Department of General, Digestive and Transplant Surgery, Hospital Carlos Haya, Malaga, Spain

‡‡‡‡Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, ICMDM, Hospital Clínic, IDIBAPS, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.

Reprints: Gonzalo Sapisochin, MD, PhD, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Passeig de la Vall d`Hebron 119-129, 08035 Barcelona, Spain. E-mail: sapisochin@me.com or Jordi Bruix, MD, BCLC group, Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Villarroel 170, Barcelona 08036, Spain. E-mail: jbruix@clinic.ub.es.

Disclosure: CIBERehd is funded by Instituto de Salud Carlos III. Carlos Rodríguez de Lope is supported by a grant of the Instituto de Salud Carlos III (FI09/00510). The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.