Intrahepatic Cholangiocarcinoma: Is There A Role For Liver Transplantation?
*Preston Kim1, *Michael Littau1, *Talia B Baker2, *Zaid Abdelsattar1, *Celsa Tonelli1, *Corinne Bunn1, *Sujay Kulshrestha1, Fred A Luchette1, Marshall S Baker1
1Loyola University Chicago Stritch School of Medicine, Maywood, IL;2University of Chicago Pritzker School of Medicine, Chicago, IL
For patients presenting with localized intrahepatic cholangiocarcinoma (ICC) that is anatomically or physiologically unresectable, liver transplantation (LT) offers a potential for surgical clearance. There is little empiric evidence evaluating the clinical efficacy of LT in these cases.
We queried the National Cancer Database to identify patients presenting between 2004 and 2015 with histologically confirmed clinical stage I to III ICC. Multivariable regression was used to identify factors associated with LT. Patients undergoing LT were then 1:3 propensity score matched for age, demographics, comorbid disease, use of neoadjuvant and adjuvant systemic therapy, analytic stage, and histologic resection margin to those undergoing surgical resection. In a separate analysis, patients undergoing LT were 1:3 matched for age, demographics, and clinical stage to patients undergoing systemic therapy alone. Kaplan Meier (KM) method was used to compare overall survival (OS) profiles for matched cohorts.
1411 patients met inclusion criteria: 884 (62.6%) were treated with systemic therapy alone, 461 (32.7%) underwent surgical resection, 66 (4.7%) LT. On adjusted analysis, patients undergoing LT were more likely to be male (OR 4.35, 95% CI [0.12, 0.42]), have Charlson Comorbidity Score ≥2 (OR 3.11, 95% CI [1.44, 6.57]), and to receive both neoadjuvant (OR 2.78, 95% CI [1.36,5.75], and adjuvant (OR 1.94, 95% CI [0.97, 3.87]) systemic therapy than those undergoing resection alone. On KM analysis of matched cohorts, patients undergoing LT demonstrated rates of 5-year OS (36.1% vs 34.7%, p=0.53) and median OS times (24.2 ± 3.57 vs. 30.1 ± 1.3 months, p=0.39) that were statistically identical to those for patients undergoing resection (Figure 1A) but significantly better than those for patients treated with systemic therapy alone (36.1% vs 5.3% and 24.2 ± 3.57 vs 12.6 ± 0.52 months, p<0.0001, Figure 1B).
Patients undergoing LT for ICC demonstrate OS profiles statistically similar to stage- and margin-matched patients undergoing surgical resection. LT is an effective treatment modality in select patients presenting with localized, unresectable ICC.
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