Liver transplantation for “very early” intrahepatic cholangiocarcinoma: International retrospective study supporting a prospective assessment

on behalf of the iCCA International Consortium

Research output: Contribution to journalArticle

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Abstract

The presence of an intrahepatic cholangiocarcinoma (iCCA) in a cirrhotic liver is a contraindication for liver transplantation in most centers worldwide. Recent investigations have shown that “very early” iCCA (single tumors ≤2 cm) may have acceptable results after liver transplantation. This study further evaluates this finding in a larger international multicenter cohort. The study group was composed of those patients who were transplanted for hepatocellular carcinoma or decompensated cirrhosis and found to have an iCCA at explant pathology. Patients were divided into those with “very early” iCCA and those with “advanced” disease (single tumor >2 cm or multifocal disease). Between January 2000 and December 2013, 81 patients were found to have an iCCA at explant; 33 had separate nodules of iCCA and hepatocellular carcinoma, and 48 had only iCCA (study group). Within the study group, 15/48 (31%) constituted the “very early” iCCA group and 33/48 (69%) the “advanced” group. There were no significant differences between groups in preoperative characteristics. At explant, the median size of the largest tumor was larger in the “advanced” group (3.1 [2.5-4.4] versus 1.6 [1.5-1.8]). After a median follow-up of 35 (13.5-76.4) months, the 1-year, 3-year, and 5-year cumulative risks of recurrence were, respectively, 7%, 18%, and 18% in the very early iCCA group versus 30%, 47%, and 61% in the advanced iCCA group, P = 0.01. The 1-year, 3-year, and 5-year actuarial survival rates were, respectively, 93%, 84%, and 65% in the very early iCCA group versus 79%, 50%, and 45% in the advanced iCCA group, P = 0.02. Conclusion: Patients with cirrhosis and very early iCCA may become candidates for liver transplantation; a prospective multicenter clinical trial is needed to further confirm these results. (Hepatology 2016;64:1178-1188).

Original languageEnglish (US)
Pages (from-to)1178-1188
Number of pages11
JournalHepatology
Volume64
Issue number4
DOIs
StatePublished - Oct 1 2016

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Cholangiocarcinoma
Liver Transplantation
Retrospective Studies
Hepatocellular Carcinoma
Fibrosis
Neoplasms
Gastroenterology
Multicenter Studies
Survival Rate

ASJC Scopus subject areas

  • Hepatology

Cite this

Liver transplantation for “very early” intrahepatic cholangiocarcinoma : International retrospective study supporting a prospective assessment. / on behalf of the iCCA International Consortium.

In: Hepatology, Vol. 64, No. 4, 01.10.2016, p. 1178-1188.

Research output: Contribution to journalArticle

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title = "Liver transplantation for “very early” intrahepatic cholangiocarcinoma: International retrospective study supporting a prospective assessment",
abstract = "The presence of an intrahepatic cholangiocarcinoma (iCCA) in a cirrhotic liver is a contraindication for liver transplantation in most centers worldwide. Recent investigations have shown that “very early” iCCA (single tumors ≤2 cm) may have acceptable results after liver transplantation. This study further evaluates this finding in a larger international multicenter cohort. The study group was composed of those patients who were transplanted for hepatocellular carcinoma or decompensated cirrhosis and found to have an iCCA at explant pathology. Patients were divided into those with “very early” iCCA and those with “advanced” disease (single tumor >2 cm or multifocal disease). Between January 2000 and December 2013, 81 patients were found to have an iCCA at explant; 33 had separate nodules of iCCA and hepatocellular carcinoma, and 48 had only iCCA (study group). Within the study group, 15/48 (31{\%}) constituted the “very early” iCCA group and 33/48 (69{\%}) the “advanced” group. There were no significant differences between groups in preoperative characteristics. At explant, the median size of the largest tumor was larger in the “advanced” group (3.1 [2.5-4.4] versus 1.6 [1.5-1.8]). After a median follow-up of 35 (13.5-76.4) months, the 1-year, 3-year, and 5-year cumulative risks of recurrence were, respectively, 7{\%}, 18{\%}, and 18{\%} in the very early iCCA group versus 30{\%}, 47{\%}, and 61{\%} in the advanced iCCA group, P = 0.01. The 1-year, 3-year, and 5-year actuarial survival rates were, respectively, 93{\%}, 84{\%}, and 65{\%} in the very early iCCA group versus 79{\%}, 50{\%}, and 45{\%} in the advanced iCCA group, P = 0.02. Conclusion: Patients with cirrhosis and very early iCCA may become candidates for liver transplantation; a prospective multicenter clinical trial is needed to further confirm these results. (Hepatology 2016;64:1178-1188).",
author = "{on behalf of the iCCA International Consortium} and G. Sapisochin and M. Facciuto and L. Rubbia-Brandt and J. Marti and N. Mehta and Yao, {F. Y.} and E. Vibert and D. Cherqui and Grant, {D. R.} and R. Hernandez-Alejandro and Dale, {C. H.} and A. Cucchetti and A. Pinna and S. Hwang and Lee, {S. G.} and Agopian, {V. G.} and Busuttil, {R. W.} and Sumera Rizvi and Heimbach, {J. K.} and M. Montenovo and J. Reyes and M. Cesaretti and O. Soubrane and T. Reichman and J. Seal and Kim, {P. T.W.} and G. Klintmalm and C. Sposito and V. Mazzaferro and P. Dutkowski and Clavien, {P. A.} and C. Toso and P. Majno and N. Kneteman and C. Saunders and J. Bruix",
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T1 - Liver transplantation for “very early” intrahepatic cholangiocarcinoma

T2 - International retrospective study supporting a prospective assessment

AU - on behalf of the iCCA International Consortium

AU - Sapisochin, G.

AU - Facciuto, M.

AU - Rubbia-Brandt, L.

AU - Marti, J.

AU - Mehta, N.

AU - Yao, F. Y.

AU - Vibert, E.

AU - Cherqui, D.

AU - Grant, D. R.

AU - Hernandez-Alejandro, R.

AU - Dale, C. H.

AU - Cucchetti, A.

AU - Pinna, A.

AU - Hwang, S.

AU - Lee, S. G.

AU - Agopian, V. G.

AU - Busuttil, R. W.

AU - Rizvi, Sumera

AU - Heimbach, J. K.

AU - Montenovo, M.

AU - Reyes, J.

AU - Cesaretti, M.

AU - Soubrane, O.

AU - Reichman, T.

AU - Seal, J.

AU - Kim, P. T.W.

AU - Klintmalm, G.

AU - Sposito, C.

AU - Mazzaferro, V.

AU - Dutkowski, P.

AU - Clavien, P. A.

AU - Toso, C.

AU - Majno, P.

AU - Kneteman, N.

AU - Saunders, C.

AU - Bruix, J.

PY - 2016/10/1

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N2 - The presence of an intrahepatic cholangiocarcinoma (iCCA) in a cirrhotic liver is a contraindication for liver transplantation in most centers worldwide. Recent investigations have shown that “very early” iCCA (single tumors ≤2 cm) may have acceptable results after liver transplantation. This study further evaluates this finding in a larger international multicenter cohort. The study group was composed of those patients who were transplanted for hepatocellular carcinoma or decompensated cirrhosis and found to have an iCCA at explant pathology. Patients were divided into those with “very early” iCCA and those with “advanced” disease (single tumor >2 cm or multifocal disease). Between January 2000 and December 2013, 81 patients were found to have an iCCA at explant; 33 had separate nodules of iCCA and hepatocellular carcinoma, and 48 had only iCCA (study group). Within the study group, 15/48 (31%) constituted the “very early” iCCA group and 33/48 (69%) the “advanced” group. There were no significant differences between groups in preoperative characteristics. At explant, the median size of the largest tumor was larger in the “advanced” group (3.1 [2.5-4.4] versus 1.6 [1.5-1.8]). After a median follow-up of 35 (13.5-76.4) months, the 1-year, 3-year, and 5-year cumulative risks of recurrence were, respectively, 7%, 18%, and 18% in the very early iCCA group versus 30%, 47%, and 61% in the advanced iCCA group, P = 0.01. The 1-year, 3-year, and 5-year actuarial survival rates were, respectively, 93%, 84%, and 65% in the very early iCCA group versus 79%, 50%, and 45% in the advanced iCCA group, P = 0.02. Conclusion: Patients with cirrhosis and very early iCCA may become candidates for liver transplantation; a prospective multicenter clinical trial is needed to further confirm these results. (Hepatology 2016;64:1178-1188).

AB - The presence of an intrahepatic cholangiocarcinoma (iCCA) in a cirrhotic liver is a contraindication for liver transplantation in most centers worldwide. Recent investigations have shown that “very early” iCCA (single tumors ≤2 cm) may have acceptable results after liver transplantation. This study further evaluates this finding in a larger international multicenter cohort. The study group was composed of those patients who were transplanted for hepatocellular carcinoma or decompensated cirrhosis and found to have an iCCA at explant pathology. Patients were divided into those with “very early” iCCA and those with “advanced” disease (single tumor >2 cm or multifocal disease). Between January 2000 and December 2013, 81 patients were found to have an iCCA at explant; 33 had separate nodules of iCCA and hepatocellular carcinoma, and 48 had only iCCA (study group). Within the study group, 15/48 (31%) constituted the “very early” iCCA group and 33/48 (69%) the “advanced” group. There were no significant differences between groups in preoperative characteristics. At explant, the median size of the largest tumor was larger in the “advanced” group (3.1 [2.5-4.4] versus 1.6 [1.5-1.8]). After a median follow-up of 35 (13.5-76.4) months, the 1-year, 3-year, and 5-year cumulative risks of recurrence were, respectively, 7%, 18%, and 18% in the very early iCCA group versus 30%, 47%, and 61% in the advanced iCCA group, P = 0.01. The 1-year, 3-year, and 5-year actuarial survival rates were, respectively, 93%, 84%, and 65% in the very early iCCA group versus 79%, 50%, and 45% in the advanced iCCA group, P = 0.02. Conclusion: Patients with cirrhosis and very early iCCA may become candidates for liver transplantation; a prospective multicenter clinical trial is needed to further confirm these results. (Hepatology 2016;64:1178-1188).

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