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A 3-Decade, Single-Center Experience of Liver Transplantation for Cholangiocarcinoma: Impact of Era, Tumor Size, Location, and Neoadjuvant Therapy
Liver Transplantation ( IF 4.6 ) Pub Date : 2021-09-05 , DOI: 10.1002/lt.26285
Takahiro Ito 1 , James R Butler , Daisuke Noguchi , Minah Ha , Antony Aziz , Vatche G Agopian , Joseph DiNorcia , Hasan Yersiz , Douglas G Farmer , Ronald W Busuttil , Johnny C Hong , Fady M Kaldas
Affiliation  

Liver transplantation (LT) for cholangiocarcinoma (CCA) remains limited to a small number of centers. Although the role of neoadjuvant therapy (NAT) has been explored over time, an in-depth analysis of NAT strategies remains limited. Furthermore, controversy exists regarding acceptable tumor size during patient selection for LT. This study explores the impact of era, tumor size, and NAT strategy on LT outcomes for CCA. We conducted a retrospective review of 53 patients with CCA treated with LT from 1985 to 2019; 19 hilar CCA (hCCA) and 30 intrahepatic CCA (iCCA) were included. The relative contributions of varying NAT (neoadjuvant chemotherapy [NAC], neoadjuvant local therapy [NALT], and combined NAC and NALT [NACLT]) as well as the implication of tumor size and era were analyzed. The primary endpoint was overall survival (OS). Compared with the old era (1985-2007), 5-year OS in patients who underwent LT in the recent era (2008-2019) showed a superior trend. The 5-year OS from initial treatment in patients receiving NACLT for hCCA and iCCA were 88% and 100% versus 9% and 41% in patients without it, respectively (P = 0.01 for hCCA; P = 0.02 for iCCA), whereas NAC or NALT alone did not show significant differences in OS versus no NAT (P > 0.05). Although 33 patients had large-size tumors (hCCA ≥ 30 mm, n = 12, or iCCA ≥ 50 mm, n = 21), tumor size had no impact on survival outcomes. Outcomes of LT for CCA seem to have improved over time. Multimodal NAT is associated with improved survival in LT for both iCCA and hCCA regardless of tumor size.

中文翻译:

胆管癌肝移植的 3 年单中心经验:时代、肿瘤大小、位置和新辅助治疗的影响

胆管癌 (CCA) 的肝移植 (LT) 仍然仅限于少数中心。尽管随着时间的推移探索了新辅助治疗 (NAT) 的作用,但对 NAT 策略的深入分析仍然有限。此外,在 LT 患者选择过程中,关于可接受的肿瘤大小存在争议。本研究探讨了时代、肿瘤大小和 NAT 策略对 CCA LT 结果的影响。我们对 1985 年至 2019 年接受 LT 治疗的 53 例 CCA 患者进行了回顾性研究;包括 19 个肝门 CCA (hCCA) 和 30 个肝内 CCA (iCCA)。分析了不同 NAT(新辅助化疗 [NAC]、新辅助局部治疗 [NALT] 以及 NAC 和 NALT 联合治疗 [NACLT])的相对贡献以及肿瘤大小和时代的意义。主要终点是总生存期(OS)。与旧时代(1985-2007)相比,近时代(2008-2019)接受 LT 的患者的 5 年 OS 表现出更好的趋势。接受 NACLT 治疗 hCCA 和 iCCA 的患者从初始治疗开始的 5 年 OS 分别为 88% 和 100%,而未接受 NACLT 的患者分别为 9% 和 41%( 对于 hCCA,P = 0.01;iCCA 的P  = 0.02),而单独的 NAC 或 NALT 与无 NAT 相比未显示 OS 的显着差异(P  > 0.05)。尽管 33 名患者的肿瘤较大(hCCA ≥ 30 mm,n = 12,或 iCCA ≥ 50 mm,n = 21),但肿瘤大小对生存结果没有影响。CCA 的 LT 结果似乎随着时间的推移而有所改善。无论肿瘤大小如何,多模式 NAT 都与 iCCA 和 hCCA 的 LT 存活率提高相关。
更新日期:2021-09-05
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