Intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma in patients undergoing liver transplantation: a Spanish matched cohort multicenter study.
OBJECTIVE
To evaluate the outcome of patients with hepatocellular-cholangiocarcinoma (HCC-CC) or intrahepatic cholangiocarcinoma (I-CC) on pathological examination after liver transplantation for HCC.


BACKGROUND
Information on the outcome of cirrhotic patients undergoing a transplant for HCC and with a diagnosis of HCC-CC or I-CC by pathological study is limited.


METHODS
Multicenter, retrospective, matched cohort 1:2 study.


METHODS
42 patients undergoing a transplant for HCC and with a diagnosis of HCC-CC or I-CC by pathological study; and control group: 84 patients with a diagnosis of HCC. I-CC subgroup: 27 patients compared with 54 controls; HCC-CC subgroup: 15 patients compared with 30 controls. Patients were also divided according to the preoperative tumor size and number: uninodular tumors 2 cm or smaller and multinodular or uninodular tumors 2 cm or larger. Median follow-up: 51 (range, 3-142) months.


RESULTS
The 1-, 3-, and 5-year actuarial survival rate differed between the study and control groups (83%, 70%, and 60% vs 99%, 94%, and 89%, respectively; P < 0.001). Differences were found in 1-, 3-, and 5-year actuarial survival rates between the I-CC subgroup and their controls (78%, 66%, and 51% vs 100%, 98%, and 93%; P < 0.001), but no differences were observed between the HCC-CC subgroup and their controls (93%, 78%, and 78% vs 97%, 86%, and 86%; P = 0.9). Patients with uninodular tumors 2 cm or smaller in the study and control groups had similar 1-, 3-, and 5-year survival rate (92%, 83%, 62% vs 100%, 80%, 80%; P = 0.4). In contrast, patients in the study group with multinodular or uninodular tumors larger than 2 cm had worse 1-, 3-, and 5-year survival rates than their controls (80%, 66%, and 61% vs 99%, 96%, and 90%; P < 0.001).


CONCLUSIONS
Patients with HCC-CC have similar survival to patients undergoing a transplant for HCC. Preoperative diagnosis of HCC-CC should not prompt the exclusion of these patients from transplant option.
*Department of HBP Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain †Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, ICMDM, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain ‡Liver Transplantation Unit, Hospital Universitario de Cruces, Universidad del País Vasco, Bilbao, Spain §Department of HBP Surgery and Transplantation, Hospital Universitario La Fe, Valencia, Spain ¶Liver Transplant Unit, Hospital Universitario de Bellvitge, L´Hospitalet, Spain ‖Liver Transplantation Unit, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain **Liver Transplant and Hepatology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Virgen de la Arrixaca, Murcia, Spain ††Liver Transplant and Hepatology Unit, Department of Surgery, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Virgen de la Arrixaca, Murcia, Spain ‡‡Liver Unit, Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain §§Hepatology and Liver Transplantation Unit, Hospital Universitario de A Coruña, A Coruña, Spain ¶¶Department of General Surgery, Clínica Universidad de Navarra, Pamplona, Spain ‖‖Liver Unit, Clínica Universidad de Navarra, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Pamplona, Spain ***Liver Transplant Unit, Hospital Universitario Rio Hortega, Valladolid, Spain †††Department of HBP Surgery and Liver Transplantation, Hospital Universitario Rio Hortega, Valladolid, Spain §§§Unit of HBP Surgery and Liver Transplantation-IMIBIC, Hospital Universitario Reina Sofía, Córdoba, Spain ¶¶¶HBP Surgery and Transplantation Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain ‖‖‖Liver Transplant Unit, Hospital Universit
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D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D044963:Biopsy, Fine-Needle; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome