title: Liver transplantation for "very early" intrahepatic cholangiocarcinoma: International retrospective study supporting a prospective assessment.
abstract: The presence of an intrahepatic cholangiocarcinoma (iCCA) in a cirrhotic liver is a contraindication for liver transplantation in most centers worldwide. Recent investigations have shown that "very early" iCCA (single tumors ≤2 cm) may have acceptable results after liver transplantation. This study further evaluates this finding in a larger international multicenter cohort. The study group was composed of those patients who were transplanted for hepatocellular carcinoma or decompensated cirrhosis and found to have an iCCA at explant pathology. Patients were divided into those with "very early" iCCA and those with "advanced" disease (single tumor >2 cm or multifocal disease). Between January 2000 and December 2013, 81 patients were found to have an iCCA at explant; 33 had separate nodules of iCCA and hepatocellular carcinoma, and 48 had only iCCA (study group). Within the study group, 15/48 (31%) constituted the "very early" iCCA group and 33/48 (69%) the "advanced" group. There were no significant differences between groups in preoperative characteristics. At explant, the median size of the largest tumor was larger in the "advanced" group (3.1 [2.5-4.4] versus 1.6 [1.5-1.8]). After a median follow-up of 35 (13.5-76.4) months, the 1-year, 3-year, and 5-year cumulative risks of recurrence were, respectively, 7%, 18%, and 18% in the very early iCCA group versus 30%, 47%, and 61% in the advanced iCCA group, P = 0.01. The 1-year, 3-year, and 5-year actuarial survival rates were, respectively, 93%, 84%, and 65% in the very early iCCA group versus 79%, 50%, and 45% in the advanced iCCA group, P = 0.02.
  
  
  
  Patients with cirrhosis and very early iCCA may become candidates for liver transplantation; a prospective multicenter clinical trial is needed to further confirm these results. (Hepatology 2016;64:1178-1188).
authors.affiliation: Multi-Organ Transplant, Division of General Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada. gonzalo.sapisochin@uhn.ca.
authors.forename: G
authors.initials: G
authors.lastname: Sapisochin
authors.affiliation: Recanati-Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY.
authors.forename: M
authors.initials: M
authors.lastname: Facciuto
authors.affiliation: Service de Pathologie Clinique, Faculté de Médecine, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Rubbia-Brandt
authors.affiliation: Recanati-Miller Transplantation Institute, The Mount Sinai Medical Center, New York, NY.
authors.forename: J
authors.initials: J
authors.lastname: Marti
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA.
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authors.lastname: Mehta
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA.
authors.forename: F Y
authors.initials: FY
authors.lastname: Yao
authors.affiliation: Centre Hépato-Biliaire, Paul Brousse Hospital, AP-HP, Villejuif, France.
authors.forename: E
authors.initials: E
authors.lastname: Vibert
authors.affiliation: Centre Hépato-Biliaire, Paul Brousse Hospital, AP-HP, Villejuif, France.
authors.forename: D
authors.initials: D
authors.lastname: Cherqui
authors.affiliation: Multi-Organ Transplant, Division of General Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
authors.forename: D R
authors.initials: DR
authors.lastname: Grant
authors.affiliation: Division of Transplantation, Western University, London, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Hernandez-Alejandro
authors.affiliation: Division of Transplantation, Western University, London, Canada.
authors.forename: C H
authors.initials: CH
authors.lastname: Dale
authors.affiliation: Department of Medical and Surgical Sciences, General and Transplant Surgery Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Cucchetti
authors.affiliation: Department of Medical and Surgical Sciences, General and Transplant Surgery Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pinna
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: S
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authors.lastname: Hwang
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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authors.initials: SG
authors.lastname: Lee
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.
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authors.initials: VG
authors.lastname: Agopian
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.
authors.forename: R W
authors.initials: RW
authors.lastname: Busuttil
authors.affiliation: Division of Transplant Surgery, William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN.
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authors.initials: S
authors.lastname: Rizvi
authors.affiliation: Division of Transplant Surgery, William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN.
authors.forename: J K
authors.initials: JK
authors.lastname: Heimbach
authors.affiliation: Department of Surgery, Division of Transplantation, University of Washington, Seattle, WA.
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authors.initials: M
authors.lastname: Montenovo
authors.affiliation: Department of Surgery, Division of Transplantation, University of Washington, Seattle, WA.
authors.forename: J
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authors.lastname: Reyes
authors.affiliation: Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Paris Diderot University-Paris 7, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Cesaretti
authors.affiliation: Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Paris Diderot University-Paris 7, Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Soubrane
authors.affiliation: Multi-Organ Transplant Institute, Ochsner Medical Center, New Orleans, LA.
authors.forename: T
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authors.lastname: Reichman
authors.affiliation: Multi-Organ Transplant Institute, Ochsner Medical Center, New Orleans, LA.
authors.forename: J
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authors.lastname: Seal
authors.affiliation: Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.
authors.forename: P T W
authors.initials: PT
authors.lastname: Kim
authors.affiliation: Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.
authors.forename: G
authors.initials: G
authors.lastname: Klintmalm
authors.affiliation: Department of Surgery, G.I. Surgery, and Liver Transplantation, Istituto Nazionale Tumori, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Sposito
authors.affiliation: Department of Surgery, G.I. Surgery, and Liver Transplantation, Istituto Nazionale Tumori, Milan, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Mazzaferro
authors.affiliation: Swiss HPB and Transplant Center Zurich, Department of Surgery, University Hospital Zurich, Zurich, Switzerland.
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authors.initials: P
authors.lastname: Dutkowski
authors.affiliation: Swiss HPB and Transplant Center Zurich, Department of Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: P A
authors.initials: PA
authors.lastname: Clavien
authors.affiliation: Division of Abdominal and Transplantation Surgery, Hepato-pancreato-biliary Centre, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Toso
authors.affiliation: Division of Abdominal and Transplantation Surgery, Hepato-pancreato-biliary Centre, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Majno
authors.affiliation: Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Kneteman
authors.affiliation: Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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authors.lastname: Saunders
authors.affiliation: Barcelona Clínic Liver Cancer Group, Liver Unit, Institut d'Investigacions Biomèdiques, August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, CIBERehd, Barcelona, Spain. jbruix@clinic.ub.es.
authors.forename: J
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mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate