肝移植患者中的肝内胆管细胞癌或混合性肝细胞-胆管细胞癌：一项西班牙匹配队列多中心研究。

Intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma in patients undergoing liver transplantation: a Spanish matched cohort multicenter study.

机构信息

*Department of HBP Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain †Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, ICMDM, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain ‡Liver Transplantation Unit, Hospital Universitario de Cruces, Universidad del País Vasco, Bilbao, Spain §Department of HBP Surgery and Transplantation, Hospital Universitario La Fe, Valencia, Spain ¶Liver Transplant Unit, Hospital Universitario de Bellvitge, L´Hospitalet, Spain ‖Liver Transplantation Unit, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain **Liver Transplant and Hepatology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Virgen de la Arrixaca, Murcia, Spain ††Liver Transplant and Hepatology Unit, Department of Surgery, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Virgen de la Arrixaca, Murcia, Spain ‡‡Liver Unit, Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain §§Hepatology and Liver Transplantation Unit, Hospital Universitario de A Coruña, A Coruña, Spain ¶¶Department of General Surgery, Clínica Universidad de Navarra, Pamplona, Spain ‖‖Liver Unit, Clínica Universidad de Navarra, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Pamplona, Spain ***Liver Transplant Unit, Hospital Universitario Rio Hortega, Valladolid, Spain †††Department of HBP Surgery and Liver Transplantation, Hospital Universitario Rio Hortega, Valladolid, Spain §§§Unit of HBP Surgery and Liver Transplantation-IMIBIC, Hospital Universitario Reina Sofía, Córdoba, Spain ¶¶¶HBP Surgery and Transplantation Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain ‖‖‖Liver Transplant Unit, Hospital Universit

出版信息

Ann Surg. 2014 May;259(5):944-52. doi: 10.1097/SLA.0000000000000494.

DOI:10.1097/SLA.0000000000000494

PMID:24441817

Abstract

OBJECTIVE

To evaluate the outcome of patients with hepatocellular-cholangiocarcinoma (HCC-CC) or intrahepatic cholangiocarcinoma (I-CC) on pathological examination after liver transplantation for HCC.

BACKGROUND

Information on the outcome of cirrhotic patients undergoing a transplant for HCC and with a diagnosis of HCC-CC or I-CC by pathological study is limited.

METHODS

Multicenter, retrospective, matched cohort 1:2 study.

STUDY GROUP

42 patients undergoing a transplant for HCC and with a diagnosis of HCC-CC or I-CC by pathological study; and control group: 84 patients with a diagnosis of HCC. I-CC subgroup: 27 patients compared with 54 controls; HCC-CC subgroup: 15 patients compared with 30 controls. Patients were also divided according to the preoperative tumor size and number: uninodular tumors 2 cm or smaller and multinodular or uninodular tumors 2 cm or larger. Median follow-up: 51 (range, 3-142) months.

RESULTS

The 1-, 3-, and 5-year actuarial survival rate differed between the study and control groups (83%, 70%, and 60% vs 99%, 94%, and 89%, respectively; P < 0.001). Differences were found in 1-, 3-, and 5-year actuarial survival rates between the I-CC subgroup and their controls (78%, 66%, and 51% vs 100%, 98%, and 93%; P < 0.001), but no differences were observed between the HCC-CC subgroup and their controls (93%, 78%, and 78% vs 97%, 86%, and 86%; P = 0.9). Patients with uninodular tumors 2 cm or smaller in the study and control groups had similar 1-, 3-, and 5-year survival rate (92%, 83%, 62% vs 100%, 80%, 80%; P = 0.4). In contrast, patients in the study group with multinodular or uninodular tumors larger than 2 cm had worse 1-, 3-, and 5-year survival rates than their controls (80%, 66%, and 61% vs 99%, 96%, and 90%; P < 0.001).

CONCLUSIONS

Patients with HCC-CC have similar survival to patients undergoing a transplant for HCC. Preoperative diagnosis of HCC-CC should not prompt the exclusion of these patients from transplant option.

摘要

目的

评估经肝移植治疗肝细胞癌（HCC）患者中病理检查为肝内胆管细胞癌（ICC）或肝细胞-胆管细胞癌（HCC-CC）患者的结局。

背景

关于因肝硬化接受肝移植且经病理检查诊断为 HCC-CC 或 ICC 的患者的结局信息有限。

方法

多中心、回顾性、病例对照研究（1:2）。

研究组

42 例行肝移植治疗 HCC 且经病理检查诊断为 HCC-CC 或 ICC 的患者；对照组：84 例行肝移植治疗 HCC 的患者。ICC 亚组：27 例患者与 54 例对照；HCC-CC 亚组：15 例患者与 30 例对照。根据术前肿瘤大小和数量进一步分组：直径 2cm 或以下的单结节肿瘤和直径 2cm 或以上的多结节或单结节肿瘤。中位随访时间：51（范围，3-142）个月。

结果

研究组和对照组的 1、3 和 5 年总生存率存在差异（分别为 83%、70%和 60%比 99%、94%和 89%；P＜0.001）。ICC 亚组与对照组的 1、3 和 5 年总生存率也存在差异（分别为 78%、66%和 51%比 100%、98%和 93%；P＜0.001），但 HCC-CC 亚组与对照组的差异无统计学意义（分别为 93%、78%和 78%比 97%、86%和 86%；P=0.9）。研究组和对照组中直径 2cm 或以下的单结节肿瘤患者的 1、3 和 5 年生存率相似（分别为 92%、83%和 62%比 100%、80%和 80%；P=0.4）。相比之下，研究组中直径大于 2cm 的多结节或单结节肿瘤患者的 1、3 和 5 年生存率较对照组差（分别为 80%、66%和 61%比 99%、96%和 90%；P＜0.001）。