title: Portal vein encasement predicts neoadjuvant therapy response in liver transplantation for perihilar cholangiocarcinoma protocol.
abstract: BACKGROUND
  Survival and recurrence of cancer after liver transplant (LT) for perihilar cholangiocarcinoma (CCA) following neoadjuvant chemoradiotherapy are strongly correlated with the presence of residual CCA in the liver explant.
  
  
  OBJECTIVE
  To determine factors predicting response to neoadjuvant therapy using the presence of residual CCA on explant as a surrogate marker.
  
  
  METHODS
  Characteristics of 109 patients having undergone LT for cholangiocarcinoma were abstracted, with attention to parameters hypothesized to influence radiation therapy efficacy.
  
  
  RESULTS
  In the multivariable model, the presence of portal vein encasement (OR 11.8; 95% CI: 2.43-57.21; P = 0.002) and MELD score (OR 1.13; 95% CI: 1.02-1.26; P = 0.017) were predictive of residual macroscopic disease (c-statistics 0.78). Oral capecitabine in addition to standard 5-fluorouracil chemotherapy (OR 0.32, 95% CI: 0.14, 0.71; P = 0.006) was independently protective against residual cancer, independent of MELD score.
  
  
  CONCLUSIONS
  Portal vein encasement was strongly predictive of residual macroscopic disease. Radial tumor diameter did not have greater predictive value than longitudinal diameter, confirming the appropriateness of current protocol selection criteria. No particular tumor morphology predicted better response. Maintenance oral capecitabine following 5-fluorouracil infusion was independently protective against residual disease. Portal vein encasement as a negative prognostic finding should be taken into account to optimize patient selection and management.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Mamatha
authors.initials: M
authors.lastname: Bhat
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hathcock
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Walter K
authors.initials: WK
authors.lastname: Kremers
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sarwa
authors.initials: S
authors.lastname: Darwish Murad
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Grant
authors.initials: G
authors.lastname: Schmit
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
authors.forename: James
authors.initials: J
authors.lastname: Martenson
authors.affiliation: Department of Oncology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Alberts
authors.affiliation: Division of Transplantation Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Rosen
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Gores
authors.affiliation: Division of Transplantation Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Heimbach
mesh_terms: D000328:Adult; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D018285:Klatskin Tumor / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011169:Portal Vein / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Cholangiocarcinoma; chemotherapy; liver transplantation; portal vein encasement; radiotherapy