Department of Surgery, Duke University Medical Center, Durham, NC, United States of America.
Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
PLoS One. 2019 Jul 31;14(7):e0220527. doi: 10.1371/journal.pone.0220527. eCollection 2019.
Hilar cholangiocarcinoma (hCCA) is a rare and aggressive malignancy with R0 resection being currently the only option for long-term survival. With the improvement in the outcomes of liver transplantation (LT), the indications for LT have expanded to include other malignant tumors, such as hCCA. The aim of the present analysis is to demonstrate and critically evaluate the outcomes of LT compared to resection with curative intent in patients with hCCA.
We systematically searched the literature for articles published up to May 2018. The following algorithm was applied ((hilar cholangiocarcinoma) OR (perihilar cholangiocarcinoma) OR klatskin$ OR (bile duct neoplasm) OR cholangiocarcinoma) AND (transplant$ OR graft$).
Neoadjuvant treatment with chemotherapy and radiation therapy was far more common in the LT group, with very few patients having received preoperative therapy in the resection group (p = 0.0005). Moreover, length of hospital stay was shorter after LT than after resection (p<0.00001). In contrast, no difference was found between the two treatment methods concerning postoperative mortality (p = 0.57). There was a trend towards longer overall survival after LT in comparison with resection. This was not obvious in the first year postoperatively, however, the advantage of LT over resection became obvious at 3 years after the operation (p = 0.02).
In non-disseminated unresectable tumors, LT seems to have a non-inferior survival. In the same patients, neoadjuvant chemoradiotherapy and/or strict selection criteria may contribute to superior survival outcomes compared to curative-intent resection. Due to the scarcity of level 1 evidence, it remains unclear whether LT should be increasingly considered for technically resectable early stage hCCA.
肝门部胆管癌（hCCA）是一种罕见且侵袭性的恶性肿瘤，目前根治性切除是长期生存的唯一选择。随着肝移植（LT）治疗效果的提高，LT 的适应证已扩大到包括其他恶性肿瘤，如 hCCA。本分析旨在展示并批判性地评估 LT 与有治愈意图的切除治疗 hCCA 患者的结果。
我们系统地检索了截至 2018 年 5 月发表的文献。应用以下算法：（肝门部胆管癌）或（肝门周围胆管癌）或 klatskin$ 或（胆管肿瘤）或胆管癌）和（移植$ 或移植物$）。
LT 组中接受新辅助化疗和放疗的患者远多于切除术组，仅有少数患者在切除术组中接受术前治疗（p = 0.0005）。此外，LT 后住院时间短于切除术（p<0.00001）。相反，两种治疗方法的术后死亡率无差异（p = 0.57）。与切除术相比，LT 后总生存有延长趋势。但在术后第一年并不明显，然而，LT 相对于切除术的优势在术后 3 年明显（p = 0.02）。
在非播散性不可切除的肿瘤中，LT 的生存似乎并不差。在相同的患者中，新辅助放化疗和/或严格的选择标准可能比有治愈意图的切除术具有更好的生存结果。由于缺乏 1 级证据，尚不清楚 LT 是否应越来越多地用于技术上可切除的早期 hCCA。
