Department of Abdominal Organ Transplantation Surgery, Washington University School of Medicine, St Louis, MO, USA.
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
HPB (Oxford). 2022 Apr;24(4):461-469. doi: 10.1016/j.hpb.2021.08.940. Epub 2021 Aug 18.
Traditionally, curative resection was considered the cornerstone of treatment for perihilar cholangiocarcinoma. More recently, liver transplantation (LT) offered an alternative for patients with unresectable disease. The purpose of this study was to assess our experience with perihilar cholangiocarcinoma and LT.
A perihilar cholangiocarcinoma protocol was commenced in 2006 whereby diagnosed patients were enrolled onto an institutional registry for LT consideration. Data on patient progression and oncologic outcomes were assessed.
Fifty-eight patients were initially enrolled onto the protocol and 38 proceeded to LT following neoadjuvant chemoradiation (mean age 55.6 ± 11.4 years). Mean time to LT was 3.7 ± 2 months and, among those transplanted, 14 (37%) had underlying primary sclerosing cholangitis (PSC). Thirteen (34%) patients developed malignant recurrence and there were no differences in disease recurrence between PSC (n = 3) and non-PSC (n = 10) patients (p = 0.32). Overall patient survival was 91%, 58% and 52% at 1-, 3- and 5-years corresponding with 81%, 52% and 46% graft survival, respectively.
Rigorous patient selection and chemoradiation treatment algorithms can be highly effective in treating perihilar cholangiocarcinoma. For appropriately selected candidates, LT can provide a 52% 5-year survival for patients who would otherwise have no surgical treatment option.
传统上，根治性切除术被认为是肝门部胆管癌治疗的基石。最近，肝移植（LT）为不可切除疾病患者提供了另一种选择。本研究旨在评估我们在肝门部胆管癌和 LT 方面的经验。
2006 年开始实施肝门部胆管癌方案，将诊断为该病的患者纳入 LT 考虑的机构登记处。评估患者的进展和肿瘤学结局数据。
最初有 58 名患者入组该方案，38 名患者在接受新辅助放化疗后接受 LT（平均年龄 55.6±11.4 岁）。LT 的平均时间为 3.7±2 个月，在移植的患者中，14 名（37%）患有原发性硬化性胆管炎（PSC）。13 名（34%）患者发生恶性复发，PSC（n=3）和非 PSC（n=10）患者之间的疾病复发没有差异（p=0.32）。总体患者生存率为 1 年时为 91%，3 年时为 58%，5 年时为 52%，相应的移植物生存率为 1 年时为 81%，3 年时为 52%，5 年时为 46%。
严格的患者选择和放化疗治疗方案对于治疗肝门部胆管癌非常有效。对于选择合适的候选者，LT 可为那些没有手术治疗选择的患者提供 52%的 5 年生存率。
