Machairas Nikolaos, Kostakis Ioannis D, Tsilimigras Diamantis I, Prodromidou Anastasia, Moris Dimitrios
Department of HPB Surgery and Liver Transplantation, Royal Free London, London, United Kingdom.
Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Transplant Rev (Orlando). 2020 Jan;34(1):100516. doi: 10.1016/j.trre.2019.100516. Epub 2019 Nov 7.
Patients with hilar cholangiocarcinoma (hCCA) have advanced disease at presentation and therefore curative treatment options are limited. Liver transplantation (LT), in the case of unresectable disease, is theoretically an attractive option, as it offers the maximum resection margin and at the same time removes the underlying parenchymal liver disease. In the past years a number of studies have aimed to evaluate to potential beneficial role of neo adjuvant therapy followed by LT for treating patients with unresectable hCCA. The objective of our systematic review was to collect and evaluate long-term outcomes of patients with hCCA undergoing LT. A systematic search of 4 electronic databases (Medline, Scopus, Google Scholar and ClinicalTrails.gov databases) was performed for articles published between January 2000 and May 2019. A total of 13 studies with 698 patients were finally included in the present systematic review. A proportion of 74.4% of patients received combination of chemotherapy and radiation as a part of neoadjuvant therapy. One-, 3- and 5-year overall survival rates ranged greatly among the included studies from 58% to 92%, 31% to 80% and 20% to 74%, respectively. Recurrence rates ranged from 16% to 61%, whilst perioperative mortality ranged from 0% to 25.5%. LT could provide acceptable long-term outcomes in the setting of neoadjuvant chemoradiation and strict patient selection criteria. Taking into account organ shortage, combined with the lack of level I evidence, more prospective randomized trials are needed in order to establish certain indications, rigorous criteria and standardized protocols for LT in hCCA and provide the maximal potential benefits for these patients.
肝门部胆管癌（hCCA）患者在初诊时病情已属晚期，因此根治性治疗选择有限。对于无法切除的疾病，肝移植（LT）理论上是一个有吸引力的选择，因为它能提供最大的切除 margins，同时消除潜在的肝实质疾病。在过去几年中，一些研究旨在评估新辅助治疗后行肝移植治疗无法切除的hCCA患者的潜在益处。我们系统评价的目的是收集和评估接受肝移植的hCCA患者的长期结局。对4个电子数据库（Medline、Scopus、谷歌学术和ClinicalTrails.gov数据库）进行了系统检索，以查找2000年1月至2019年5月发表的文章。本系统评价最终纳入了13项研究，共698例患者。74.4%的患者接受了化疗和放疗联合作为新辅助治疗的一部分。纳入研究中1年、3年和5年总生存率差异很大，分别为58%至92%、31%至80%和20%至74%。复发率为16%至61%，围手术期死亡率为0%至25.5%。在新辅助放化疗和严格的患者选择标准的情况下，肝移植可以提供可接受的长期结局。考虑到器官短缺，再加上缺乏I级证据，需要更多的前瞻性随机试验，以便为hCCA肝移植确定特定的适应症、严格的标准和标准化方案，并为这些患者提供最大的潜在益处。
