Robles Ricardo, Figueras Joan, Turrión Victor S, Margarit Carlos, Moya Angel, Varo Evaristo, Calleja Javier, Valdivieso Andres, Valdecasas Juan Carlos G, López Pedro, Gómez Manuel, de Vicente Emilio, Loinaz Carmelo, Santoyo Julio, Fleitas Manuel, Bernardos Angel, Lladó Laura, Ramírez Pablo, Bueno F S, Jaurrieta Eduardo, Parrilla Pascual
Virgen de la Arrixaca University Hospital, Murcia.
Ann Surg. 2004 Feb;239(2):265-71. doi: 10.1097/01.sla.0000108702.45715.81.
To assess the real utility of orthotopic liver transplantation (OLT) in patients with cholangiocarcinoma, we need series with large numbers of cases and long follow-ups. The aim of this paper is to review the Spanish experience in OLT for hilar and peripheral cholangiocarcinoma and to try to identify the prognostic factors that could influence survival.
Palliative treatment of nondisseminated irresectable cholangiocarcinoma carries a zero 5-year survival rate. The role of OLT in these patients is controversial, due to the fact that the survival rate is lower than with other indications for transplantation and due to the lack of organs.
We retrospectively reviewed 59 patients undergoing OLT in Spain for cholangiocarcinoma (36 hilar and 23 peripheral) over a period of 13 years. We present the results and prognostic factors that influence survival.
The actuarial survival rate for hilar cholangiocarcinoma at 1, 3, and 5 years was 82%, 53%, and 30%, and for peripheral cholangiocarcinoma 77%, 65%, and 42%. The main cause of death, with both types of cholangiocarcinoma, was tumor recurrence (present in 53% and 35% of patients, respectively). Poor prognosis factors were vascular invasion (P < 0.01) and IUAC classification stages III-IVA (P < 0.01) for hilar cholangiocarcinoma and perineural invasion (P < 0.05) and stages III-IVA (P < 0.05) for peripheral cholangiocarcinoma.
OLT for nondisseminated irresectable cholangiocarcinoma has higher survival rates at 3 and 5 years than palliative treatments, especially with tumors in their initial stages, which means that more information is needed to help better select cholangiocarcinoma patients for transplantation.
为评估原位肝移植（OLT）在胆管癌患者中的实际效用，我们需要大量病例系列和长期随访。本文旨在回顾西班牙在肝门部和周围型胆管癌OLT方面的经验，并试图确定可能影响生存的预后因素。
不可切除的非播散性胆管癌的姑息治疗5年生存率为零。OLT在这些患者中的作用存在争议，因为其生存率低于其他移植适应证，且器官短缺。
我们回顾性分析了西班牙13年间接受OLT治疗胆管癌的59例患者（36例肝门部胆管癌和23例周围型胆管癌）。我们展示了影响生存的结果和预后因素。
肝门部胆管癌1年、3年和5年的精算生存率分别为82%、53%和30%，周围型胆管癌分别为77%、65%和42%。两种类型胆管癌的主要死亡原因均为肿瘤复发（分别见于53%和35%的患者）。肝门部胆管癌的不良预后因素为血管侵犯（P<0.01）和国际抗癌联盟（IUAC）分期III-IVA期（P<0.01），周围型胆管癌的不良预后因素为神经周围侵犯（P<0.05）和III-IVA期（P<0.05）。
不可切除的非播散性胆管癌行OLT的3年和5年生存率高于姑息治疗，尤其是肿瘤处于初始阶段时，这意味着需要更多信息以更好地选择适合移植的胆管癌患者。
