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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Propensity-matched analysis of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma and hepatocellular carcinoma undergoing a liver transplant
Gabriela Perdomo Coral, Carlos TS Cerski, Matheus V Fernandes, Alex Hörbe, Mário B Wagner, Claudio Augusto Marroni, Alfeu de Medeiros Fleck Jr, Santiago Rodriguez, Ajacio Bandeira de Mello Brandão
Ajacio Bandeira de Mello Brandão, Santiago Rodriguez, Claudio Augusto Marroni, Matheus V Fernandes, Gabriela Perdomo Coral, Graduate Program in Medicine: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050170, RS, Brazil
Ajacio Bandeira de Mello Brandão, Alfeu de Medeiros Fleck Jr, Claudio Augusto Marroni, Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020090, RS, Brazil
Santiago Rodriguez, Department of Hepatology, Hospital Vozandes Quito-HVQ, Quito 170521, Ecuador
Mário B Wagner, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035002, RS, Brazil
Alex Hörbe, Interventional Radiology Unit, Santa Casa de Misericórdia de, Porto Alegre 90020090, RS, Brazil
Carlos TS Cerski, Department of Pathology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035002, RS, Brazil
Author contributions: All the authors solely contributed to this paper.
Institutional review board statement: The Institutional Review Board of Santa Casa de Misericórdia de Porto Alegre approved the study protocol (No. 4.250.889).
Informed consent statement: Informed consent was waived due to the non-interventional design of the study and retrospective nature of data collection. All investigators signed a data use agreement to ensure the ethical and secure use of the data.
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ajacio Bandeira de Mello Brandão, PhD, Academic Research, Graduate Program in Medicine: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, R. Eng. Álvaro Nunes Pereira, 400/402, Porto Alegre 90050170, RS, Brazil.
ajaciob@gmail.com
Received: April 8, 2022
Peer-review started: April 8, 2022
First decision: May 12, 2022
Revised: June 14, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: August 24, 2022
Processing time: 136 Days and 17.1 Hours
BACKGROUND
Cholangiocarcinoma (CC) is a rare tumor that arises from the epithelium of the bile ducts. It is classified according to anatomic location as intrahepatic, perihilar, and distal. Intrahepatic CC (ICC) is rare in patients with cirrhosis due to causes other than primary sclerosing cholangitis. Mixed hepatocellular carcinoma-CC (HCC-CC) is a rare neoplasm that shows histologic findings of both HCC and ICC within the same tumor mass. Due to the difficulties in arriving at the correct diagnosis, patients eventually undergo liver transplantation (LT) with a presumptive diagnosis of HCC on imaging when, in fact, they have ICC or HCC-CC.
AIM
To evaluate the outcomes of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma on pathological examination after liver transplant.
METHODS
Propensity score matching was used to analyze tumor recurrence (TR), overall mortality (OM), and recurrence-free survival (RFS) in LT recipients with pathologically confirmed ICC or HCC-CC matched 1:8 to those with HCC. Progression-free survival and overall mortality rates were computed with the Kaplan-Meier method using Cox regression for comparison.
RESULTS
Of 475 HCC LT recipients, 1.7% had the diagnosis of ICC and 1.5% of HCC-CC on pathological examination of the explant. LT recipients with ICC had higher TR (46% vs 11%; P = 0.006), higher OM (63% vs 23%; P = 0.002), and lower RFS (38% vs 89%; P = 0.002) than those with HCC when matched for pretransplant tumor characteristics, as well as higher TR (46% vs 23%; P = 0.083), higher OM (63% vs 35%; P = 0.026), and lower RFS (38% vs 59%; P = 0.037) when matched for posttransplant tumor characteristics. Two pairings were performed to compare the outcomes of LT recipients with HCC-CC vs HCC. There was no significant difference between the outcomes in either pairing.
CONCLUSION
Patients with ICC had worse outcomes than patients undergoing LT for HCC. The outcomes of patients with HCC-CC did not differ significantly from those of patients with HCC.
Core Tip: This retrospective cohort study analyzes the outcomes of patients undergoing liver trans-plantation (LT) with a presumptive diagnosis of hepatocellular carcinoma (HCC) in which explant analysis identified that they actually had intrahepatic cholangiocarcinoma (ICC) or mixed hepatocellular cholangiocarcinoma (HCC-CC). Propensity score matching was used to analyze tumor recurrence, overall mortality, and recurrence-free survival in LT recipients with pathologically confirmed ICC or HCC-CC matched 1:8 to those with HCC. Patients with ICC have worse outcomes than patients undergoing LT for HCC, even when matched for explant pathology. Outcomes did not differ significantly between patients with HCC-CC and patients with HCC.
