Background

Traditionally, curative resection was considered the cornerstone of treatment for perihilar cholangiocarcinoma. More recently, liver transplantation (LT) offered an alternative for patients with unresectable disease. The purpose of this study was to assess our experience with perihilar cholangiocarcinoma and LT.

Methods

A perihilar cholangiocarcinoma protocol was commenced in 2006 whereby diagnosed patients were enrolled onto an institutional registry for LT consideration. Data on patient progression and oncologic outcomes were assessed.

Results

Fifty-eight patients were initially enrolled onto the protocol and 38 proceeded to LT following neoadjuvant chemoradiation (mean age 55.6 ± 11.4 years). Mean time to LT was 3.7 ± 2 months and, among those transplanted, 14 (37%) had underlying primary sclerosing cholangitis (PSC). Thirteen (34%) patients developed malignant recurrence and there were no differences in disease recurrence between PSC (n = 3) and non-PSC (n = 10) patients (p = 0.32). Overall patient survival was 91%, 58% and 52% at 1-, 3- and 5-years corresponding with 81%, 52% and 46% graft survival, respectively.

Conclusion

Rigorous patient selection and chemoradiation treatment algorithms can be highly effective in treating perihilar cholangiocarcinoma. For appropriately selected candidates, LT can provide a 52% 5-year survival for patients who would otherwise have no surgical treatment option.

中文翻译：

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肝门周围胆管癌肝移植单中心经验

背景

传统上，根治性切除被认为是肺门周围胆管癌治疗的基石。最近，肝移植 (LT) 为患有无法切除的疾病的患者提供了另一种选择。本研究的目的是评估我们对肺门周围胆管癌和 LT 的经验。

方法

2006 年开始了一项肺门周围胆管癌方案，诊断出的患者被纳入机构登记处以考虑 LT。评估了患者进展和肿瘤学结果的数据。

结果

最初有 58 名患者参加了该方案，38 名患者在新辅助放化疗后进行了 LT（平均年龄 55.6 ± 11.4 岁）。到 LT 的平均时间为 3.7 ± 2 个月，在移植的患者中，14 人 (37%) 患有潜在的原发性硬化性胆管炎 (PSC)。13 名 (34%) 患者出现恶性复发，PSC (n = 3) 和非 PSC (n = 10) 患者的疾病复发没有差异 (p = 0.32)。1 年、3 年和 5 年的患者总生存率为 91%、58% 和 52%，移植物生存率分别为 81%、52% 和 46%。

结论

严格的患者选择和放化疗治疗算法可以非常有效地治疗肺门周围胆管癌。For appropriately selected candidates, LT can provide a 52% 5-year survival for patients who would otherwise have no surgical treatment option.