Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA.
Ann Hepatol. 2018 Oct 16;17(6):969-979. doi: 10.5604/01.3001.0012.7197.
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.
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.
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%).
OS was similarly high among.
肝细胞癌-胆管细胞癌（HCC-CCA）是一种罕见的肝脏恶性肿瘤，与肝细胞癌（HCC）或胆管细胞癌不同。由于预后不佳，肝移植（LT）不推荐用于 HCC-CCA。HCC-CCA 的非侵入性诊断极具挑战性；因此，一些 HCC-CCAs 被认为是成像上的 HCC，并被列入 LT 名单，最终在移植病理上做出正确诊断。我们比较了 HCC-CCA 与 HCC，以确定移植前局部区域治疗（LRT）的反应在预测 LT 后 HCC-CCA 结果中的效用，作为识别适合 LT 的 HCC-CCA 患者的潜在手段。
对 19 例经病理证实的 HCC-CCA 患者进行回顾性分析，根据年龄、性别和米兰标准在列表上与 38 例 HCC 患者（1:2）进行匹配。根据 LRT 前后的影像学检查，使用实体瘤反应评估标准对患者进行分类，分为 LRT 反应者和非反应者。检查总生存期（OS）和无复发生存期（RFS）。
移植后 3 年的 OS 为 HCC-CCA 组 74%，HCC 组 87%。RFS 在 3 年内为 HCC-CCA 组 74%，HCC 组 87%。LRT 反应者的 3 年 OS 为 HCC-CCA 组 92%，HCC 组 88%；非反应者的 3 年 OS 为 HCC-CCA 组 43%，HCC 组 83%。HCC-CCA 反应者的 3 年 OS 明显高于 HCC-CCA 无反应者（77%比 23%）。
OS 在 HCC-CCA 患者中同样较高。
