Brandão Ajacio Bandeira de Mello, Rodriguez Santiago, Fleck Alfeu de Medeiros, Marroni Claudio Augusto, Wagner Mário B, Hörbe Alex, Fernandes Matheus V, Cerski Carlos Ts, Coral Gabriela Perdomo
Graduate Program in Medicine: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050170, RS, Brazil.
Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020090, RS, Brazil.
World J Clin Oncol. 2022 Aug 24;13(8):688-701. doi: 10.5306/wjco.v13.i8.688.
Cholangiocarcinoma (CC) is a rare tumor that arises from the epithelium of the bile ducts. It is classified according to anatomic location as intrahepatic, perihilar, and distal. Intrahepatic CC (ICC) is rare in patients with cirrhosis due to causes other than primary sclerosing cholangitis. Mixed hepatocellular carcinoma-CC (HCC-CC) is a rare neoplasm that shows histologic findings of both HCC and ICC within the same tumor mass. Due to the difficulties in arriving at the correct diagnosis, patients eventually undergo liver transplantation (LT) with a presumptive diagnosis of HCC on imaging when, in fact, they have ICC or HCC-CC.
To evaluate the outcomes of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma on pathological examination after liver transplant.
Propensity score matching was used to analyze tumor recurrence (TR), overall mortality (OM), and recurrence-free survival (RFS) in LT recipients with pathologically confirmed ICC or HCC-CC matched 1:8 to those with HCC. Progression-free survival and overall mortality rates were computed with the Kaplan-Meier method using Cox regression for comparison.
Of 475 HCC LT recipients, 1.7% had the diagnosis of ICC and 1.5% of HCC-CC on pathological examination of the explant. LT recipients with ICC had higher TR (46% 11%; 0.006), higher OM (63% 23%; 0.002), and lower RFS (38% vs 89%; 0.002) than those with HCC when matched for pretransplant tumor characteristics, as well as higher TR (46% 23%; 0.083), higher OM (63% 35%; 0.026), and lower RFS (38% 59%; 0.037) when matched for posttransplant tumor characteristics. Two pairings were performed to compare the outcomes of LT recipients with HCC-CC HCC. There was no significant difference between the outcomes in either pairing.
Patients with ICC had worse outcomes than patients undergoing LT for HCC. The outcomes of patients with HCC-CC did not differ significantly from those of patients with HCC.
胆管癌（CC）是一种起源于胆管上皮的罕见肿瘤。根据解剖位置可分为肝内型、肝门型和远端型。除原发性硬化性胆管炎外，肝硬化患者中肝内胆管癌（ICC）罕见。肝细胞癌-胆管癌混合型（HCC-CC）是一种罕见的肿瘤，在同一肿瘤块内显示出肝细胞癌和肝内胆管癌的组织学特征。由于难以做出正确诊断，患者最终在影像学上被推测诊断为肝细胞癌而接受肝移植（LT），而实际上他们患有肝内胆管癌或肝细胞癌-胆管癌混合型。
评估肝移植后经病理检查确诊的肝内胆管癌或肝细胞癌-胆管癌混合型患者的预后。
采用倾向评分匹配法分析肝移植受者中病理确诊为ICC或HCC-CC且与肝细胞癌按1:8匹配的患者的肿瘤复发（TR）、总死亡率（OM）和无复发生存期（RFS）。采用Kaplan-Meier法计算无进展生存率和总死亡率，并使用Cox回归进行比较。
在475例肝细胞癌肝移植受者中，移植肝病理检查显示1.7%诊断为肝内胆管癌，1.5%诊断为肝细胞癌-胆管癌混合型。与肝细胞癌患者相比，匹配移植前肿瘤特征时，肝内胆管癌肝移植受者的肿瘤复发率更高（46%对11%；P = 0.006）、总死亡率更高（63%对23%；P = 0.002）、无复发生存率更低（38%对89%；P = 0.002）；匹配移植后肿瘤特征时，肿瘤复发率更高（46%对23%；P = 0.083）、总死亡率更高（63%对35%；P = 0.026）、无复发生存率更低（38%对59%；P = 0.037）。进行了两组配对比较肝细胞癌-胆管癌混合型肝移植受者与肝细胞癌患者的预后。两组配对的预后均无显著差异。
肝内胆管癌患者的预后比肝细胞癌肝移植患者差。肝细胞癌-胆管癌混合型患者的预后与肝细胞癌患者无显著差异。
