Krasnodębski Maciej, Grąt Michał, Jastrzębski Maciej, Szczęśniak Michalina, Morawski Marcin, Zając Krzysztof, Patkowski Waldemar, Zieniewicz Krzysztof
Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Transplant Proc. 2020 Oct;52(8):2463-2467. doi: 10.1016/j.transproceed.2020.02.095. Epub 2020 Apr 21.
Cholangiocarcinoma is the primary liver tumor forming from the biliary epithelium. Two major subtypes of this disease are distinguished because of the initial location: the extra- and intrahepatic form. The latter disease is currently a controversial indication for liver transplant (LT). The aim of this study was to evaluate the outcomes of LT of patients with intrahepatic cholangiocarcinoma.
Based on postoperative histopathologic examination of the explanted liver, 8 patients with intrahepatic cholangiocarcinoma were identified from all LT recipients in the period between 1994 and 2019 and included in this retrospective cohort study. Four of the patients received transplants with a preoperative diagnosis of hepatocellular carcinoma; the remaining tumors were incidental findings. Patient survival was the primary outcome measure.
Six recipients had solitary lesion with a maximum tumor diameter of 6 cm. The median carbohydrate antigen 19-9 concentration prior to LT was 52.3 U/mL. The overall survival was 75.0%, 37.5%, and 25% after the first, third, and fifth year, respectively, with a median survival of 18 months. Age (P = .758), carbohydrate antigen 19-9 (P = .282), largest tumor size (P = .862), and the sum of the number of lesions and diameter of the largest tumor (P = .530) were not significantly associated with overall survival. Recurrence-free survival was 71.4% after 1 year and 28.6% after 3 and 5 years. Correspondingly, no significant predictors of worse recurrence-free survival were found.
Intrahepatic cholangiocarcinoma remains associated with a very high risk of recurrence and dismal survival after LT irrespective of macroscopic disease burden.
胆管癌是起源于胆管上皮的原发性肝脏肿瘤。根据肿瘤的初始位置，该疾病可分为两种主要亚型：肝外胆管癌和肝内胆管癌。后者目前是肝移植（LT）的一个有争议的适应证。本研究的目的是评估肝内胆管癌患者肝移植的结局。
基于对移植肝脏的术后组织病理学检查，从1994年至2019年期间所有肝移植受者中识别出8例肝内胆管癌患者，并纳入本回顾性队列研究。其中4例患者术前诊断为肝细胞癌而行移植手术；其余肿瘤为偶然发现。患者生存率是主要结局指标。
6例受者有单个病灶，最大肿瘤直径为6 cm。肝移植前碳水化合物抗原19-9的中位浓度为52.3 U/mL。1年、3年和5年的总生存率分别为75.0%、37.5%和25%，中位生存期为18个月。年龄（P = 0.758）、碳水化合物抗原19-9（P = 0.282）、最大肿瘤大小（P = 0.862）以及病灶数量与最大肿瘤直径之和（P = 0.530）与总生存率均无显著相关性。1年无复发生存率为71.4%，3年和5年为28.6%。相应地，未发现无复发生存率较差的显著预测因素。
无论宏观疾病负担如何，肝内胆管癌肝移植后仍具有很高的复发风险和较差的生存率。
