Contemporary trends and outcomes after liver transplantation and resection for intrahepatic cholangiocarcinoma
Liver transplantation (LT) has been shown to be superior to resection in highly selected patients with perihilar cholangiocarcinoma (CCA), yet has traditionally been contraindicated for intrahepatic CCA (iCCA). Herein, we aimed to examine contemporary trends and outcomes for surgical resection and L...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2024-05, Vol.28 (5), p.738-745 |
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| creator | Howell, Thomas Clark Rhodin, Kristen E. Shaw, Brian Bao, Jiayin Kanu, Elishama Masoud, Sabran Bartholomew, Alex J. Gao, Qimeng Anwar, Imran J. Ladowski, Joseph M. Nussbaum, Daniel P. Blazer, Dan G. Zani, Sabino Allen, Peter J. Barbas, Andrew S. Lidsky, Michael E. |
| description | Liver transplantation (LT) has been shown to be superior to resection in highly selected patients with perihilar cholangiocarcinoma (CCA), yet has traditionally been contraindicated for intrahepatic CCA (iCCA). Herein, we aimed to examine contemporary trends and outcomes for surgical resection and LT for iCCA.
The National Cancer Database was queried for patients presenting with stage I-III iCCA between 2010 and 2018 who underwent resection or LT. Overall survival (OS) was compared with Kaplan-Meier and multivariable Cox proportional hazards methods stratified by management. Secondary analysis of patients undergoing transplant for CCA was performed with the United Network for Organ Sharing database.
Of 2565 patients, 2412 (94.0%) underwent resection and 153 (5.96%) LT of whom 84 (54.9%) received neoadjuvant therapy. Utilization of LT remained between 3.9% and 7.8% annually. Unadjusted 5-year OS was higher for LT than resection (59.8% vs 39.9%, P = .0067), yet adjusted analysis revealed no significant difference in mortality (hazard ratio, 0.91; 95% CI, 0.66-1.27; P = .58). On secondary analysis including 437 patients with all subtypes of CCA, unadjusted 5-year OS was higher for non-CCA indications (79% vs 52%-54%, P |
| doi_str_mv | 10.1016/j.gassur.2024.02.029 |
| format | Article |
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The National Cancer Database was queried for patients presenting with stage I-III iCCA between 2010 and 2018 who underwent resection or LT. Overall survival (OS) was compared with Kaplan-Meier and multivariable Cox proportional hazards methods stratified by management. Secondary analysis of patients undergoing transplant for CCA was performed with the United Network for Organ Sharing database.
Of 2565 patients, 2412 (94.0%) underwent resection and 153 (5.96%) LT of whom 84 (54.9%) received neoadjuvant therapy. Utilization of LT remained between 3.9% and 7.8% annually. Unadjusted 5-year OS was higher for LT than resection (59.8% vs 39.9%, P = .0067), yet adjusted analysis revealed no significant difference in mortality (hazard ratio, 0.91; 95% CI, 0.66-1.27; P = .58). On secondary analysis including 437 patients with all subtypes of CCA, unadjusted 5-year OS was higher for non-CCA indications (79% vs 52%-54%, P < .001).
Utilization of LT for iCCA remains low and many cases are likely incidental. Although partial hepatectomy remains the standard of care for patients with resectable disease, our findings suggest that highly selected patients with unresectable iCCA may achieve favorable outcomes after LT. Granular, prospective data are needed to identify patients most likely to benefit from transplant and allocate scarce liver grafts.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1016/j.gassur.2024.02.029</identifier><identifier>PMID: 38704208</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Aged ; Bile Duct Neoplasms - mortality ; Bile Duct Neoplasms - pathology ; Bile Duct Neoplasms - surgery ; Cholangiocarcinoma - mortality ; Cholangiocarcinoma - pathology ; Cholangiocarcinoma - surgery ; Databases, Factual ; Female ; Hepatectomy ; Humans ; Intrahepatic cholangiocarcinoma ; Kaplan-Meier Estimate ; Liver transplantation ; Liver Transplantation - statistics & numerical data ; Male ; Middle Aged ; Neoadjuvant Therapy - statistics & numerical data ; Neoplasm Staging ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate ; Treatment Outcome</subject><ispartof>Journal of gastrointestinal surgery, 2024-05, Vol.28 (5), p.738-745</ispartof><rights>2024 Society for Surgery of the Alimentary Tract</rights><rights>Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-798a88db36a0b1664e396d818d0174df020ea10366e9838ac0b7cf33cd1f0d413</citedby><cites>FETCH-LOGICAL-c362t-798a88db36a0b1664e396d818d0174df020ea10366e9838ac0b7cf33cd1f0d413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38704208$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Howell, Thomas Clark</creatorcontrib><creatorcontrib>Rhodin, Kristen E.</creatorcontrib><creatorcontrib>Shaw, Brian</creatorcontrib><creatorcontrib>Bao, Jiayin</creatorcontrib><creatorcontrib>Kanu, Elishama</creatorcontrib><creatorcontrib>Masoud, Sabran</creatorcontrib><creatorcontrib>Bartholomew, Alex J.</creatorcontrib><creatorcontrib>Gao, Qimeng</creatorcontrib><creatorcontrib>Anwar, Imran J.</creatorcontrib><creatorcontrib>Ladowski, Joseph M.</creatorcontrib><creatorcontrib>Nussbaum, Daniel P.</creatorcontrib><creatorcontrib>Blazer, Dan G.</creatorcontrib><creatorcontrib>Zani, Sabino</creatorcontrib><creatorcontrib>Allen, Peter J.</creatorcontrib><creatorcontrib>Barbas, Andrew S.</creatorcontrib><creatorcontrib>Lidsky, Michael E.</creatorcontrib><title>Contemporary trends and outcomes after liver transplantation and resection for intrahepatic cholangiocarcinoma</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><description>Liver transplantation (LT) has been shown to be superior to resection in highly selected patients with perihilar cholangiocarcinoma (CCA), yet has traditionally been contraindicated for intrahepatic CCA (iCCA). Herein, we aimed to examine contemporary trends and outcomes for surgical resection and LT for iCCA.
The National Cancer Database was queried for patients presenting with stage I-III iCCA between 2010 and 2018 who underwent resection or LT. Overall survival (OS) was compared with Kaplan-Meier and multivariable Cox proportional hazards methods stratified by management. Secondary analysis of patients undergoing transplant for CCA was performed with the United Network for Organ Sharing database.
Of 2565 patients, 2412 (94.0%) underwent resection and 153 (5.96%) LT of whom 84 (54.9%) received neoadjuvant therapy. Utilization of LT remained between 3.9% and 7.8% annually. Unadjusted 5-year OS was higher for LT than resection (59.8% vs 39.9%, P = .0067), yet adjusted analysis revealed no significant difference in mortality (hazard ratio, 0.91; 95% CI, 0.66-1.27; P = .58). On secondary analysis including 437 patients with all subtypes of CCA, unadjusted 5-year OS was higher for non-CCA indications (79% vs 52%-54%, P < .001).
Utilization of LT for iCCA remains low and many cases are likely incidental. Although partial hepatectomy remains the standard of care for patients with resectable disease, our findings suggest that highly selected patients with unresectable iCCA may achieve favorable outcomes after LT. Granular, prospective data are needed to identify patients most likely to benefit from transplant and allocate scarce liver grafts.</description><subject>Aged</subject><subject>Bile Duct Neoplasms - mortality</subject><subject>Bile Duct Neoplasms - pathology</subject><subject>Bile Duct Neoplasms - surgery</subject><subject>Cholangiocarcinoma - mortality</subject><subject>Cholangiocarcinoma - pathology</subject><subject>Cholangiocarcinoma - surgery</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Hepatectomy</subject><subject>Humans</subject><subject>Intrahepatic cholangiocarcinoma</subject><subject>Kaplan-Meier Estimate</subject><subject>Liver transplantation</subject><subject>Liver Transplantation - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy - statistics & numerical data</subject><subject>Neoplasm Staging</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kN1LBCEQwCWKvv-DiH3sZa9R91z3JYijLwh6KehNPJ0tj1vd1A3677OuegwGdfA3jvMj5ITCjAIV56vZi05pijMGrJkBK9FtkX0qW143gontcoaO1mw-f94jBymtAGgLVO6SPS5baBjIfeIXwWccxhB1_KhyRG9Tpb2twpRNGLAkfcZYrd17WXPUPo1r7bPOLvhvMGJC8531IVbOF-YVx3JvKvMaCvvigtHROB8GfUR2er1OePyzH5Kn66vHxW19_3Bzt7i8rw0XLNdtJ7WUdsmFhiUVokHeCSuptGWExvbAADUFLgR2kkttYNmannNjaQ-2ofyQnG3eHWN4mzBlNbhkcF2-g2FKisMcuga6uShos0FNDClF7NUY3VBsKArqy7RaqY1p9WVaASvRlbLTnw7TckD7V_SrtgAXGwDLnO8Oo0rGoTdoXSzClA3u_w6fzkuUIQ</recordid><startdate>202405</startdate><enddate>202405</enddate><creator>Howell, Thomas Clark</creator><creator>Rhodin, Kristen E.</creator><creator>Shaw, Brian</creator><creator>Bao, Jiayin</creator><creator>Kanu, Elishama</creator><creator>Masoud, Sabran</creator><creator>Bartholomew, Alex J.</creator><creator>Gao, Qimeng</creator><creator>Anwar, Imran J.</creator><creator>Ladowski, Joseph M.</creator><creator>Nussbaum, Daniel P.</creator><creator>Blazer, Dan G.</creator><creator>Zani, Sabino</creator><creator>Allen, Peter J.</creator><creator>Barbas, Andrew S.</creator><creator>Lidsky, Michael E.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202405</creationdate><title>Contemporary trends and outcomes after liver transplantation and resection for intrahepatic cholangiocarcinoma</title><author>Howell, Thomas Clark ; Rhodin, Kristen E. ; Shaw, Brian ; Bao, Jiayin ; Kanu, Elishama ; Masoud, Sabran ; Bartholomew, Alex J. ; Gao, Qimeng ; Anwar, Imran J. ; Ladowski, Joseph M. ; Nussbaum, Daniel P. ; Blazer, Dan G. ; Zani, Sabino ; Allen, Peter J. ; Barbas, Andrew S. ; Lidsky, Michael E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-798a88db36a0b1664e396d818d0174df020ea10366e9838ac0b7cf33cd1f0d413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Bile Duct Neoplasms - mortality</topic><topic>Bile Duct Neoplasms - pathology</topic><topic>Bile Duct Neoplasms - surgery</topic><topic>Cholangiocarcinoma - mortality</topic><topic>Cholangiocarcinoma - pathology</topic><topic>Cholangiocarcinoma - surgery</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Hepatectomy</topic><topic>Humans</topic><topic>Intrahepatic cholangiocarcinoma</topic><topic>Kaplan-Meier Estimate</topic><topic>Liver transplantation</topic><topic>Liver Transplantation - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy - statistics & numerical data</topic><topic>Neoplasm Staging</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Howell, Thomas Clark</creatorcontrib><creatorcontrib>Rhodin, Kristen E.</creatorcontrib><creatorcontrib>Shaw, Brian</creatorcontrib><creatorcontrib>Bao, Jiayin</creatorcontrib><creatorcontrib>Kanu, Elishama</creatorcontrib><creatorcontrib>Masoud, Sabran</creatorcontrib><creatorcontrib>Bartholomew, Alex J.</creatorcontrib><creatorcontrib>Gao, Qimeng</creatorcontrib><creatorcontrib>Anwar, Imran J.</creatorcontrib><creatorcontrib>Ladowski, Joseph M.</creatorcontrib><creatorcontrib>Nussbaum, Daniel P.</creatorcontrib><creatorcontrib>Blazer, Dan G.</creatorcontrib><creatorcontrib>Zani, Sabino</creatorcontrib><creatorcontrib>Allen, Peter J.</creatorcontrib><creatorcontrib>Barbas, Andrew S.</creatorcontrib><creatorcontrib>Lidsky, Michael E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Howell, Thomas Clark</au><au>Rhodin, Kristen E.</au><au>Shaw, Brian</au><au>Bao, Jiayin</au><au>Kanu, Elishama</au><au>Masoud, Sabran</au><au>Bartholomew, Alex J.</au><au>Gao, Qimeng</au><au>Anwar, Imran J.</au><au>Ladowski, Joseph M.</au><au>Nussbaum, Daniel P.</au><au>Blazer, Dan G.</au><au>Zani, Sabino</au><au>Allen, Peter J.</au><au>Barbas, Andrew S.</au><au>Lidsky, Michael E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Contemporary trends and outcomes after liver transplantation and resection for intrahepatic cholangiocarcinoma</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><addtitle>J Gastrointest Surg</addtitle><date>2024-05</date><risdate>2024</risdate><volume>28</volume><issue>5</issue><spage>738</spage><epage>745</epage><pages>738-745</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Liver transplantation (LT) has been shown to be superior to resection in highly selected patients with perihilar cholangiocarcinoma (CCA), yet has traditionally been contraindicated for intrahepatic CCA (iCCA). Herein, we aimed to examine contemporary trends and outcomes for surgical resection and LT for iCCA.
The National Cancer Database was queried for patients presenting with stage I-III iCCA between 2010 and 2018 who underwent resection or LT. Overall survival (OS) was compared with Kaplan-Meier and multivariable Cox proportional hazards methods stratified by management. Secondary analysis of patients undergoing transplant for CCA was performed with the United Network for Organ Sharing database.
Of 2565 patients, 2412 (94.0%) underwent resection and 153 (5.96%) LT of whom 84 (54.9%) received neoadjuvant therapy. Utilization of LT remained between 3.9% and 7.8% annually. Unadjusted 5-year OS was higher for LT than resection (59.8% vs 39.9%, P = .0067), yet adjusted analysis revealed no significant difference in mortality (hazard ratio, 0.91; 95% CI, 0.66-1.27; P = .58). On secondary analysis including 437 patients with all subtypes of CCA, unadjusted 5-year OS was higher for non-CCA indications (79% vs 52%-54%, P < .001).
Utilization of LT for iCCA remains low and many cases are likely incidental. Although partial hepatectomy remains the standard of care for patients with resectable disease, our findings suggest that highly selected patients with unresectable iCCA may achieve favorable outcomes after LT. Granular, prospective data are needed to identify patients most likely to benefit from transplant and allocate scarce liver grafts.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>38704208</pmid><doi>10.1016/j.gassur.2024.02.029</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Bile Duct Neoplasms - mortality Bile Duct Neoplasms - pathology Bile Duct Neoplasms - surgery Cholangiocarcinoma - mortality Cholangiocarcinoma - pathology Cholangiocarcinoma - surgery Databases, Factual Female Hepatectomy Humans Intrahepatic cholangiocarcinoma Kaplan-Meier Estimate Liver transplantation Liver Transplantation - statistics & numerical data Male Middle Aged Neoadjuvant Therapy - statistics & numerical data Neoplasm Staging Proportional Hazards Models Retrospective Studies Survival Rate Treatment Outcome |
| title | Contemporary trends and outcomes after liver transplantation and resection for intrahepatic cholangiocarcinoma |
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