Mi Shizheng, Hou Ziqi, Qiu Guoteng, Jin Zhaoxing, Xie Qingyun, Huang Jiwei
Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
Heliyon. 2023 Oct 13;9(10):e20945. doi: 10.1016/j.heliyon.2023.e20945. eCollection 2023 Oct.
Combined hepatocellular cholangiocarcinoma (CHC) is a rare primary liver cancer, and whether liver transplantation should be implemented among CHC patients is still controversial. We intend to conduct a retrospective cohort study based on the Surveillance, Epidemiology, and End Results (SEER) database to investigate the prognosis of liver transplantation liver resection among CHC patients.
Patients diagnosed with CHC (ICD-O-3:8180/3) and treated with transplantation or hepatectomy were extracted from the SEER database (2000-2018). We utilized Propensity Score Matching to control confounding bias. Kaplan-Meier curve was used for survival analysis, and Cox regression was used to find independent factors associated with prognosis.
We identified 123 (transplantation: 49; resection: 74) patients with CHC who were treated between 2004 and 2015. In the entire cohort, survival analysis demonstrated transplantation group was associated with better overall survival and cancer-specific survival (log-rank p = 0.004 and p = 0.003, respectively). In addition, liver transplantation still conferred better overall and cancer-specific survival than liver resection after Propensity Score Matching (log-rank p = 0.024 and p = 0.048, respectively). However, this advantage didn't appear in the subgroup, regardless of whether the tumor size was greater than 3 cm or not. (≤3 cm: OS log-rank p = 0.230, CSS log-rank p = 0.370; >3 cm: OS log-rank p = 0.110, CSS log-rank p = 0.084). Multivariate analysis validated the finding that liver transplantation was a protective factor for overall survival (HR = 0.55 [0.31-0.95], p = 0.032).
Liver transplantation may be an option in individuals with CHC and should be taken into consideration due to its advantages in terms of overall survival and cancer-specific survival. However, a sizable sample is required for future studies to determine which subset of CHC patients may benefit more from liver transplantation.
肝内胆管癌合并肝细胞癌（CHC）是一种罕见的原发性肝癌，CHC患者是否应进行肝移植仍存在争议。我们打算基于监测、流行病学和最终结果（SEER）数据库进行一项回顾性队列研究，以调查CHC患者肝移植和肝切除术后的预后情况。
从SEER数据库（2000 - 2018年）中提取诊断为CHC（ICD - O - 3：8180/3）并接受移植或肝切除术治疗的患者。我们采用倾向得分匹配法来控制混杂偏倚。采用Kaplan - Meier曲线进行生存分析，采用Cox回归分析来寻找与预后相关的独立因素。
我们确定了123例在2004年至2015年间接受治疗的CHC患者（移植组：49例；切除组：74例）。在整个队列中，生存分析表明移植组的总生存期和癌症特异性生存期更好（对数秩检验p值分别为0.004和0.003）。此外，倾向得分匹配后，肝移植的总生存期和癌症特异性生存期仍优于肝切除（对数秩检验p值分别为0.024和0.048）。然而，无论肿瘤大小是否大于3 cm，该优势在亚组中均未出现。（≤3 cm：总生存期对数秩检验p值 = 0.230，癌症特异性生存期对数秩检验p值 = 0.370；>3 cm：总生存期对数秩检验p值 = 0.110，癌症特异性生存期对数秩检验p值 = 0.084）。多因素分析验证了肝移植是总生存期的保护因素这一发现（风险比 = 0.55 [0.31 - 0.95]，p值 = 0.032）。
肝移植可能是CHC患者的一种选择，鉴于其在总生存期和癌症特异性生存期方面的优势，应予以考虑。然而，未来研究需要大量样本以确定哪些CHC患者亚组可能从肝移植中获益更多。
