Response to Loco-Regional Therapy Predicts Outcomes After Liver Transplantation for Combined Hepatocellular-Cholangiocarcinoma

Samuel Antwi, Yacob Y. Habboush, Lori A. Chase, David D. Lee, Tushar C Patel

Research output: Contribution to journalArticle

Abstract

INTRODUCTION AND AIM: Combined hepatocellular-cholangiocarcinoma (HCC-CCA) is a rare liver malignancy distinct from either hepatocellular carcinoma (HCC) or cholangiocarcinoma. Liver transplantation (LT) is not recommended for HCC-CCA because of suboptimal outcomes. Non-invasive diagnosis of HCC-CCA is extremely challenging; thus, some HCC-CCAs are presumed as HCC on imaging and listed for LT with the correct diagnosis ultimately made on explant pathology. We compared HCC-CCA with HCC to determine the utility of response to pre-transplant loco-regional therapy (LRT) in predicting outcomes for HCC-CCA after LT as a potential means of identifying appropriate HCC-CCA patients for LT. MATERIAL AND METHODS: Retrospective review of 19 patients with pathologically confirmed HCC-CCA were individually matched to 38 HCC patients (1:2) based on age, sex, and Milan criteria at listing was performed. The modified response evaluation criteria in solid tumors was used to categorize patients as responders or non-responders to pre-transplant LRT based on imaging performed before and after LRT. Overall survival (OS) and recurrence-free survival (RFS) were examined. RESULTS: OS at 3 years post-transplant was 74% for HCC-CCA and 87% for HCC. RFS at 3 years was 74% for HCC-CCA, and 87% for HCC. Among responders to LRT, the 3-year OS was 92% for HCC-CCA and 88% for HCC; among non-responders, 3-year OS was 43% for HCC-CCA and 83% for HCC. Higher 3-year OS was observed among HCC-CCA responders (77%) compared with HCC-CCA non-responders (23%). CONCLUSIONS: OS was similarly high among.

Original languageEnglish (US)
Pages (from-to)969-979
Number of pages11
JournalAnnals of Hepatology
Volume17
Issue number6
DOIs
StatePublished - Oct 16 2018

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Cholangiocarcinoma
Liver Transplantation
Hepatocellular Carcinoma
Therapeutics
Survival
Transplants

Keywords

  • combined hepatocellular and cholangiocarcinoma
  • HCC
  • Loco-regional therapy
  • LRT
  • Overall survival
  • Recurrence-free survival

ASJC Scopus subject areas

  • Hepatology

Cite this

Response to Loco-Regional Therapy Predicts Outcomes After Liver Transplantation for Combined Hepatocellular-Cholangiocarcinoma. / Antwi, Samuel; Habboush, Yacob Y.; Chase, Lori A.; Lee, David D.; Patel, Tushar C.

In: Annals of Hepatology, Vol. 17, No. 6, 16.10.2018, p. 969-979.

Research output: Contribution to journalArticle

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abstract = "INTRODUCTION AND AIM: Combined hepatocellular-cholangiocarcinoma (HCC-CCA) is a rare liver malignancy distinct from either hepatocellular carcinoma (HCC) or cholangiocarcinoma. Liver transplantation (LT) is not recommended for HCC-CCA because of suboptimal outcomes. Non-invasive diagnosis of HCC-CCA is extremely challenging; thus, some HCC-CCAs are presumed as HCC on imaging and listed for LT with the correct diagnosis ultimately made on explant pathology. We compared HCC-CCA with HCC to determine the utility of response to pre-transplant loco-regional therapy (LRT) in predicting outcomes for HCC-CCA after LT as a potential means of identifying appropriate HCC-CCA patients for LT. MATERIAL AND METHODS: Retrospective review of 19 patients with pathologically confirmed HCC-CCA were individually matched to 38 HCC patients (1:2) based on age, sex, and Milan criteria at listing was performed. The modified response evaluation criteria in solid tumors was used to categorize patients as responders or non-responders to pre-transplant LRT based on imaging performed before and after LRT. Overall survival (OS) and recurrence-free survival (RFS) were examined. RESULTS: OS at 3 years post-transplant was 74{\%} for HCC-CCA and 87{\%} for HCC. RFS at 3 years was 74{\%} for HCC-CCA, and 87{\%} for HCC. Among responders to LRT, the 3-year OS was 92{\%} for HCC-CCA and 88{\%} for HCC; among non-responders, 3-year OS was 43{\%} for HCC-CCA and 83{\%} for HCC. Higher 3-year OS was observed among HCC-CCA responders (77{\%}) compared with HCC-CCA non-responders (23{\%}). CONCLUSIONS: OS was similarly high among.",
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