Portal vein encasement predicts neoadjuvant therapy response in liver transplantation for perihilar cholangiocarcinoma protocol

Mamatha Bhat, Matthew Hathcock, Walter K Kremers, Sarwa Darwish Murad, Grant Schmit, James Martenson, Steven Robert Alberts, Charles B. Rosen, Gregory James Gores, Julie Heimbach

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Survival and recurrence of cancer after liver transplant (LT) for perihilar cholangiocarcinoma (CCA) following neoadjuvant chemoradiotherapy are strongly correlated with the presence of residual CCA in the liver explant. Aim To determine factors predicting response to neoadjuvant therapy using the presence of residual CCA on explant as a surrogate marker. Methods Characteristics of 109 patients having undergone LT for cholangiocarcinoma were abstracted, with attention to parameters hypothesized to influence radiation therapy efficacy. Results In the multivariable model, the presence of portal vein encasement (OR 11.8; 95% CI: 2.43-57.21; P = 0.002) and MELD score (OR 1.13; 95% CI: 1.02-1.26; P = 0.017) were predictive of residual macroscopic disease (c-statistics 0.78). Oral capecitabine in addition to standard 5-fluorouracil chemotherapy (OR 0.32, 95% CI: 0.14, 0.71; P = 0.006) was independently protective against residual cancer, independent of MELD score. Conclusions Portal vein encasement was strongly predictive of residual macroscopic disease. Radial tumor diameter did not have greater predictive value than longitudinal diameter, confirming the appropriateness of current protocol selection criteria. No particular tumor morphology predicted better response. Maintenance oral capecitabine following 5-fluorouracil infusion was independently protective against residual disease. Portal vein encasement as a negative prognostic finding should be taken into account to optimize patient selection and management.

Original languageEnglish (US)
Pages (from-to)1383-1391
Number of pages9
JournalTransplant International
Volume28
Issue number12
DOIs
StatePublished - Dec 1 2015

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Klatskin Tumor
Neoadjuvant Therapy
Cholangiocarcinoma
Portal Vein
Liver Transplantation
Fluorouracil
Patient Selection
Transplants
Liver
Residual Neoplasm
Chemoradiotherapy
Liver Neoplasms
Neoplasms
Radiotherapy
Biomarkers
Maintenance
Recurrence
Drug Therapy
Survival
Capecitabine

Keywords

  • chemotherapy
  • Cholangiocarcinoma
  • liver transplantation
  • portal vein encasement
  • radiotherapy

ASJC Scopus subject areas

  • Transplantation

Cite this

Portal vein encasement predicts neoadjuvant therapy response in liver transplantation for perihilar cholangiocarcinoma protocol. / Bhat, Mamatha; Hathcock, Matthew; Kremers, Walter K; Darwish Murad, Sarwa; Schmit, Grant; Martenson, James; Alberts, Steven Robert; Rosen, Charles B.; Gores, Gregory James; Heimbach, Julie.

In: Transplant International, Vol. 28, No. 12, 01.12.2015, p. 1383-1391.

Research output: Contribution to journalArticle

Bhat, Mamatha ; Hathcock, Matthew ; Kremers, Walter K ; Darwish Murad, Sarwa ; Schmit, Grant ; Martenson, James ; Alberts, Steven Robert ; Rosen, Charles B. ; Gores, Gregory James ; Heimbach, Julie. / Portal vein encasement predicts neoadjuvant therapy response in liver transplantation for perihilar cholangiocarcinoma protocol. In: Transplant International. 2015 ; Vol. 28, No. 12. pp. 1383-1391.
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abstract = "Background Survival and recurrence of cancer after liver transplant (LT) for perihilar cholangiocarcinoma (CCA) following neoadjuvant chemoradiotherapy are strongly correlated with the presence of residual CCA in the liver explant. Aim To determine factors predicting response to neoadjuvant therapy using the presence of residual CCA on explant as a surrogate marker. Methods Characteristics of 109 patients having undergone LT for cholangiocarcinoma were abstracted, with attention to parameters hypothesized to influence radiation therapy efficacy. Results In the multivariable model, the presence of portal vein encasement (OR 11.8; 95{\%} CI: 2.43-57.21; P = 0.002) and MELD score (OR 1.13; 95{\%} CI: 1.02-1.26; P = 0.017) were predictive of residual macroscopic disease (c-statistics 0.78). Oral capecitabine in addition to standard 5-fluorouracil chemotherapy (OR 0.32, 95{\%} CI: 0.14, 0.71; P = 0.006) was independently protective against residual cancer, independent of MELD score. Conclusions Portal vein encasement was strongly predictive of residual macroscopic disease. Radial tumor diameter did not have greater predictive value than longitudinal diameter, confirming the appropriateness of current protocol selection criteria. No particular tumor morphology predicted better response. Maintenance oral capecitabine following 5-fluorouracil infusion was independently protective against residual disease. Portal vein encasement as a negative prognostic finding should be taken into account to optimize patient selection and management.",
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AU - Hathcock, Matthew

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AU - Darwish Murad, Sarwa

AU - Schmit, Grant

AU - Martenson, James

AU - Alberts, Steven Robert

AU - Rosen, Charles B.

AU - Gores, Gregory James

AU - Heimbach, Julie

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N2 - Background Survival and recurrence of cancer after liver transplant (LT) for perihilar cholangiocarcinoma (CCA) following neoadjuvant chemoradiotherapy are strongly correlated with the presence of residual CCA in the liver explant. Aim To determine factors predicting response to neoadjuvant therapy using the presence of residual CCA on explant as a surrogate marker. Methods Characteristics of 109 patients having undergone LT for cholangiocarcinoma were abstracted, with attention to parameters hypothesized to influence radiation therapy efficacy. Results In the multivariable model, the presence of portal vein encasement (OR 11.8; 95% CI: 2.43-57.21; P = 0.002) and MELD score (OR 1.13; 95% CI: 1.02-1.26; P = 0.017) were predictive of residual macroscopic disease (c-statistics 0.78). Oral capecitabine in addition to standard 5-fluorouracil chemotherapy (OR 0.32, 95% CI: 0.14, 0.71; P = 0.006) was independently protective against residual cancer, independent of MELD score. Conclusions Portal vein encasement was strongly predictive of residual macroscopic disease. Radial tumor diameter did not have greater predictive value than longitudinal diameter, confirming the appropriateness of current protocol selection criteria. No particular tumor morphology predicted better response. Maintenance oral capecitabine following 5-fluorouracil infusion was independently protective against residual disease. Portal vein encasement as a negative prognostic finding should be taken into account to optimize patient selection and management.

AB - Background Survival and recurrence of cancer after liver transplant (LT) for perihilar cholangiocarcinoma (CCA) following neoadjuvant chemoradiotherapy are strongly correlated with the presence of residual CCA in the liver explant. Aim To determine factors predicting response to neoadjuvant therapy using the presence of residual CCA on explant as a surrogate marker. Methods Characteristics of 109 patients having undergone LT for cholangiocarcinoma were abstracted, with attention to parameters hypothesized to influence radiation therapy efficacy. Results In the multivariable model, the presence of portal vein encasement (OR 11.8; 95% CI: 2.43-57.21; P = 0.002) and MELD score (OR 1.13; 95% CI: 1.02-1.26; P = 0.017) were predictive of residual macroscopic disease (c-statistics 0.78). Oral capecitabine in addition to standard 5-fluorouracil chemotherapy (OR 0.32, 95% CI: 0.14, 0.71; P = 0.006) was independently protective against residual cancer, independent of MELD score. Conclusions Portal vein encasement was strongly predictive of residual macroscopic disease. Radial tumor diameter did not have greater predictive value than longitudinal diameter, confirming the appropriateness of current protocol selection criteria. No particular tumor morphology predicted better response. Maintenance oral capecitabine following 5-fluorouracil infusion was independently protective against residual disease. Portal vein encasement as a negative prognostic finding should be taken into account to optimize patient selection and management.

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