Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
J Surg Oncol. 2013 May;107(6):608-12. doi: 10.1002/jso.23289. Epub 2013 Feb 5.
Although transplantation has demonstrated survival benefit for patients with hepatocellular carcinoma (HCC), there is limited data to support or refute transplantation for combined hepatocellular-cholangiocarcinoma (cHCC-CC). We hypothesized that cHCC-CC patients had poorer overall survival (OS) than HCC patients after liver transplantation.
Patients with localized HCC and cHCC-CC treated with surgical resection or transplant were identified using the Surveillance, Epidemiology, and End Results (SEER) Database (1973-2007). Cox proportional hazards models were used to examine survival.
We identified 3,378 (1,447 [43%] transplant, 1,931 [57%] resection) patients with HCC, and 54 (19 [35%] transplant, 35 [65%] resection) patients with cHCC-CC. Patients undergoing resection of HCC and cHCC-CC had similar 3-year OS (55% vs. 46%, P = 0.4). Three-year OS of patients undergoing transplant was significantly greater for HCC (78%) than for cHCC-CC (48%, P = 0.01). In adjusted models, patients transplanted for cHCC-CC had higher hazard of death compared to HCC patients (HR 2.5, 95% CI: 1.2-5.1, P = 0.01).
Transplantation for localized cHCC-CC confers a survival benefit similar to liver resection for cHCC-CC, but inferior to transplantation for HCC. With survival data that mimics historic reports of transplant for intrahepatic cholangiocarcinoma, this study questions the benefit of transplantation for patients with cHCC-CC.
尽管肝移植已证明对肝细胞癌（HCC）患者具有生存获益，但目前仅有有限的数据支持或反驳其对合并肝细胞癌-胆管细胞癌（cHCC-CC）的疗效。我们假设 cHCC-CC 患者在肝移植后的总生存（OS）较 HCC 患者更差。
使用监测、流行病学和最终结果（SEER）数据库（1973-2007 年），鉴定接受手术切除或移植治疗的局限性 HCC 和 cHCC-CC 患者。采用 Cox 比例风险模型来检测生存情况。
我们共鉴定出 3378 例（1447 例[43%]接受移植，1931 例[57%]接受切除）HCC 患者和 54 例（19 例[35%]接受移植，35 例[65%]接受切除）cHCC-CC 患者。接受 HCC 切除术和 cHCC-CC 切除术的患者 3 年 OS 率相似（55%比 46%，P=0.4）。接受移植治疗的 HCC 患者的 3 年 OS 率显著高于 cHCC-CC 患者（78%比 48%，P=0.01）。在调整后的模型中，与 HCC 患者相比，接受移植治疗的 cHCC-CC 患者死亡风险更高（HR 2.5，95%CI：1.2-5.1，P=0.01）。
局部性 cHCC-CC 的移植治疗可带来与 cHCC-CC 切除术相似的生存获益，但逊于 HCC 的移植治疗。本研究以类似于肝内胆管细胞癌移植治疗的历史报告的生存数据，对移植治疗 cHCC-CC 患者的获益提出了质疑。
