title: Predictive index for tumor recurrence after liver transplantation for locally advanced intrahepatic and hilar cholangiocarcinoma.
abstract: BACKGROUND
  Current criteria for orthotopic liver transplantation (OLT) for cholangiocarcinoma (CCA) remain restricted to early stage and small hilar tumors, excluding patients with locally advanced intrahepatic and hilar CCA for potential cure. The present study was undertaken to define a prognostic scoring system for risk stratification of patients with intrahepatic and hilar CCA who might benefit from OLT and to allow expansion of current OLT criteria.
  
  
  METHODS
  We conducted a retrospective review of 40 patients who underwent OLT for locally advanced intrahepatic and hilar CCA at our center between February 1985 and June 2010. Median follow-up was 3 years. Independent risk factors for tumor recurrence after OLT were identified using the Cox model and were assigned risk score points. Points were summed and assigned to predictive index categories: 0 to 3 for low risk, 4 to 7 for intermediate risk, and 8 to 15 for high risk.
  
  
  RESULTS
  Seven multivariate factors predictive for tumor recurrence included multifocal tumor, perineural invasion, infiltrative growth pattern, lack of neoadjuvant and adjuvant therapy, history of primary sclerosing cholangitis, hilar tumors, and lymphovascular invasion. The 5-year tumor recurrence-free patient survival was significantly higher in low-risk (78%) compared with intermediate- (19%) and high-risk (0%) groups (p < 0.001); survival benefit was also seen in intermediate- compared with high-risk groups.
  
  
  CONCLUSIONS
  This model was highly predictive of long-term outcomes after OLT for locally advanced intrahepatic and hilar CCA and can be applied clinically for risk stratification of patients considered for OLT. Long-term disease recurrence-free survival was excellent in low-risk and acceptable in intermediate-risk groups, justifying the expansion of liver transplant criteria for treatment of this challenging malignancy.
authors.affiliation: Dumont-UCLA Liver Cancer and Transplant Centers, Pfleger Liver Institute, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA 90095-7054, USA. johnnyhong@mednet.ucla.edu
authors.forename: Johnny C
authors.initials: JC
authors.lastname: Hong
authors.forename: Henrik
authors.initials: H
authors.lastname: Petrowsky
authors.forename: Fady M
authors.initials: FM
authors.lastname: Kaldas
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Farmer
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Durazo
authors.forename: Richard S
authors.initials: RS
authors.lastname: Finn
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.forename: Steven-Huy
authors.initials: SH
authors.lastname: Han
authors.forename: Percy
authors.initials: P
authors.lastname: Lee
authors.forename: Daniela
authors.initials: D
authors.lastname: Markovic
authors.forename: Charles
authors.initials: C
authors.lastname: Lassman
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Hiatt
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors