Liver Transplantation for Combined Hepatocellular-Cholangiocarcinoma: A Retrospective Registry-Based Study Using the Korean Organ Transplant Registry (KOTRY)

Abstract

BACKGROUND Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare primary liver tumor with poor prognosis. This retrospective study aimed to evaluate the outcomes and prognostic factors of 40 patients who underwent liver transplantation (LT) for cHCC-CC using data from the Korean Organ Transplant Registry (KOTRY). MATERIAL AND METHODS A cohort of 40 LT recipients diagnosed with cHCC-CC was selected from the KOTRY database between 2014 and 2019. Survival analyses were performed according to key clinicopathological variables, and risk factor analyses were conducted for overall survival (OS) and recurrence-free survival (RFS). RESULTS During a median follow-up of 21.4 months, 10 patients (25.0%) died and 9 patients (22.5%) experienced tumor recurrence. The 1-, 2-, and 3-year OS rates were 91.8%, 76.2%, and 59.3%, respectively, and the corresponding RFS rates were 88.8%, 70.5%, and 50.2%. Patients with a MELD score <20 (P=0.017) and a single tumor <3 cm (P=0.046) showed significantly better OS. On multivariate analysis, MELD score ≥20 (P=0.04), perineural invasion (P=0.04), and portal vein tumor thrombosis (P=0.005) were independent risk factors for poor OS, whereas microvascular invasion (P=0.01) was an independent risk factor for poor RFS. CONCLUSIONS LT can be a feasible treatment option for patients with early-stage cHCC-CC, providing favorable long-term survival. As most prognostic factors identified were pathology-related, further studies are needed to refine the selection criteria for LT candidates in this population.

Figure 1

Kaplan-Meier survival curves for 40 patients who underwent liver transplantation for combined hepatocellular carcinoma-cholangiocarcinoma. (A) Overall survival (OS) and (B) recurrence-free survival (RFS) for the entire cohort.

Figure 2

Kaplan-Meier survival curves. (A) Overall survival (OS) and (B) recurrence-free survival (RFS) according to pretransplant model for end-stage liver disease (MELD) score (<20 vs ≥20). (C) OS and (D) RFS according to tumor size (<3 cm vs ≥3 cm) in 9 patients with a single tumor.

Figure 3

Kaplan-Meier survival curves according to preoperative downstaging treatment. (A) Overall survival (OS) and (B) recurrence-free survival (RFS) of the patients according to downstaging treatment. (C) OS and (D) RFS of the 29 patients who underwent downstaging treatments according to treatment type.

Figure 4

Kaplan-Meier survival curves. (A) Overall survival (OS) and (B) recurrence-free survival (RFS) according to Child-Pugh classification (A vs B-C). (C) OS and (D) RFS according to Milan criteria (within vs beyond).

Figure 5

Kaplan-Meier survival curves according to tumor burden. (A) Overall survival (OS) and (B) recurrence-free survival (RFS) according to the number of viable tumors (single vs multiple). (C) OS and (D) RFS according to maximum tumor size (<5 cm vs ≥5 cm).

Figure 6

Kaplan-Meier survival curves according to postoperative administration of everolimus. (A) Overall survival (OS) and (B) recurrence-free survival (RFS) by everolimus use within 1 month after liver transplantation (LT). (C) OS and (D) RFS within 6 months.

Figure 7

Kaplan-Meier curves for overall survival (OS) according to tumor recurrence. (A) OS according to recurrence status. OS of the 9 recipients with recurrence according to everolimus administration within (B) 1 month, (C) 6 months, and (D) 1 year after liver transplantation (LT).