Chang Cheng-Chih, Chen Ying-Ju, Huang Tzu-Hao, Chen Chun-Han, Kuo Fang-Ying, Eng Hock-Liew, Yong Chee-Chien, Liu Yueh-Wei, Lin Ting-Lung, Li Wei-Feng, Lin Yu-Hung, Lin Chih-Che, Wang Chih-Chi, Chen Chao-Long
Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Department of Surgery, Chang Gung Memorial Hospital-Chiayi, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Ann Transplant. 2017 Feb 28;22:115-120. doi: 10.12659/aot.900779.
BACKGROUND Because the outcome of liver transplantation for cholangiocarcinoma is often poor, cholangiocarcinoma is a contraindication for liver transplantation in most centers. Combined hepatocellular carcinoma and cholangiocarcinoma is a rare type of primary hepatic malignancy containing features of hepatocellular carcinoma and cholangiocarcinoma. Diagnosing combined hepatocellular carcinoma and cholangiocarcinoma pre-operatively is difficult. Because of sparse research presentations worldwide, we report our experience with living donor liver transplantation for combined hepatocellular carcinoma and cholangiocarcinoma. MATERIAL AND METHODS A total of 710 patients underwent living donor liver transplantation at our institution from April 2006 to June 2014; 377 of them received transplantation because of hepatocellular carcinoma with University of California San Francisco (UCSF) staging criteria fulfilled pre-operatively. Eleven patients (2.92%) were diagnosed with combined hepatocellular carcinoma and cholangiocarcinoma confirmed pathologically from explant livers; we reviewed these cases retrospectively. Long-term survival was compared between patients diagnosed with combined hepatocellular carcinoma and cholangiocarcinoma and patients diagnosed with hepatocellular carcinoma. RESULTS The mean age of the patients in our series was 60.2 years, and the median follow-up period was 23.9 months. Four patients were diagnosed with a recurrence during the follow-up period, including one intra-hepatic and three extra-hepatic recurrences. Four patients died due to tumor recurrence. Except for patients with advanced-stage cancer, disease-free survival of patients with combined hepatocellular carcinoma and cholangiocarcinoma compared with that of patients with hepatocellular carcinoma was 80% versus 97.2% in 1 year, and 46.7% versus 92.5% in 3 years (p<0.001), and overall survival was 90% versus 97.2% in 1 year, and 61.7% versus 95.1% in 3 years (p<0.001). CONCLUSIONS Outcomes of liver transplantation for patients with combined hepatocellular carcinoma and cholangiocarcinoma were worse than those for patients with hepatocellular carcinoma in this study. Combined hepatocellular carcinoma and cholangiocarcinoma are presumed to be a relative contraindication for liver transplantation.
由于胆管癌肝移植的预后通常较差，在大多数中心，胆管癌是肝移植的禁忌证。肝细胞癌合并胆管癌是一种罕见的原发性肝脏恶性肿瘤，具有肝细胞癌和胆管癌的特征。术前诊断肝细胞癌合并胆管癌很困难。鉴于全球范围内相关研究报道较少，我们报告我们进行活体肝移植治疗肝细胞癌合并胆管癌的经验。
2006年4月至2014年6月，共有710例患者在我院接受了活体肝移植；其中377例因术前符合加利福尼亚大学旧金山分校（UCSF）肝细胞癌分期标准而接受移植。11例患者（2.92%）经病理证实为肝细胞癌合并胆管癌，取自切除肝脏；我们对这些病例进行了回顾性分析。比较了肝细胞癌合并胆管癌患者与肝细胞癌患者的长期生存率。
本系列患者的平均年龄为60.2岁，中位随访期为23.9个月。4例患者在随访期间被诊断为复发，包括1例肝内复发和3例肝外复发。4例患者因肿瘤复发死亡。除晚期癌症患者外，肝细胞癌合并胆管癌患者与肝细胞癌患者的无病生存率在1年时分别为80%和97.2%，3年时分别为46.7%和92.5%（p<0.001），总生存率在1年时分别为90%和97.2%，3年时分别为61.7%和95.1%（p<0.001）。
本研究中，肝细胞癌合并胆管癌患者的肝移植预后比肝细胞癌患者差。肝细胞癌合并胆管癌被认为是肝移植的相对禁忌证。
