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Liver Transplantation as a New Standard of Care in Patients With Perihilar Cholangiocarcinoma? Results From an International Benchmark Study
Annals of Surgery ( IF 7.5 ) Pub Date : 2022-11-01 , DOI: 10.1097/sla.0000000000005641
Eva Breuer 1 , Matteo Mueller 1 , Majella B Doyle 2 , Liu Yang 3 , Sarwa Darwish Murad 4 , Imran J Anwar 5 , Shaheed Merani 6 , Ashley Limkemann 7 , Heithem Jeddou 8 , Steven C Kim 9 , Victor López-López 10 , Ahmed Nassar 11 , Frederik J H Hoogwater 12 , Eric Vibert 13 , Michelle L De Oliveira 1 , Daniel Cherqui 13 , Robert J Porte 12 , Joseph F Magliocca 11 , Lutz Fischer 14 , Constantino Fondevila 15 , Krzysztof Zieniewicz 16 , Pablo Ramírez 10 , David P Foley 9 , Karim Boudjema 8 , Austin D Schenk 7 , Alan N Langnas 6 , Stuart Knechtle 5 , Wojciech G Polak 17 , C Burcin Taner 3 , William C Chapman 2 , Charles B Rosen 18 , Gregory J Gores 19 , Philipp Dutkowski 1 , Julie K Heimbach 18 , Pierre-Alain Clavien 1
Affiliation  

Objective: 

To define benchmark values for liver transplantation (LT) in patients with perihilar cholangiocarcinoma (PHC) enabling unbiased comparisons.

Background: 

Transplantation for PHC is used with reluctance in many centers and even contraindicated in several countries. Although benchmark values for LT are available, there is a lack of specific data on LT performed for PHC.

Methods: 

PHC patients considered for LT after Mayo-like protocol were analyzed in 17 reference centers in 2 continents over the recent 5-year period (2014–2018). The minimum follow-up was 1 year. Benchmark patients were defined as operated at high-volume centers (≥50 overall LT/year) after neoadjuvant chemoradiotherapy, with a tumor diameter <3 cm, negative lymph nodes, and with the absence of relevant comorbidities. Benchmark cutoff values were derived from the 75th to 25th percentiles of the median values of all benchmark centers.

Results: 

One hundred thirty-four consecutive patients underwent LT after completion of the neoadjuvant treatment. Of those, 89.6% qualified as benchmark cases. Benchmark cutoffs were 90-day mortality ≤5.2%; comprehensive complication index at 1 year of ≤33.7; grade ≥3 complication rates ≤66.7%. These values were better than benchmark values for other indications of LT. Five-year disease-free survival was largely superior compared with a matched group of nodal negative patients undergoing curative liver resection (n=106) (62% vs 32%, P<0.001).

Conclusion: 

This multicenter benchmark study demonstrates that LT offers excellent outcomes with superior oncological results in early stage PHC patients, even in candidates for surgery. This provocative observation should lead to a change in available therapeutic algorithms for PHC.



中文翻译:

肝移植作为肝门部胆管癌患者的新标准治疗?国际基准研究的结果

客观的: 

确定肝门部胆管癌(PHC ) 患者肝移植 (LT) 的基准值,以便进行无偏倚比较。

背景: 

许多中心不情愿地使用 PHC 移植,甚至在一些国家禁止使用。虽然 LT 的基准值可用,但缺乏针对 PHC 执行的 LT 的具体数据。

方法: 

在最近 5 年期间(2014-2018 年),在 2 个大洲的 17 个参考中心对在类似梅奥方案后考虑进行 LT 的 PHC 患者进行了分析。最短随访时间为 1 年。基准患者被定义为在新辅助放化疗后在高容量中心(≥50 LT/年)进行手术,肿瘤直径 <3 cm,淋巴结阴性,并且没有相关合并症。基准截止值来自所有基准中心的中值的第 75 到第 25 个百分位数。

结果: 

一百三十四名连续患者在完成新辅助治疗后接受了 LT。其中,89.6%符合基准案例。基准临界值为 90 天死亡率≤5.2%;1年综合并发症指数≤33.7;≥3级并发症发生率≤66.7%。这些值优于其他 LT 适应症的基准值。与接受根治性肝切除术的匹配的淋巴结阴性患者组 (n=106) 相比,五年无病生存率明显更高(62% 对 32%,P <0.001)。

结论: 

这项多中心基准研究表明,LT 在早期 PHC 患者中提供了出色的结果和卓越的肿瘤学结果,即使在手术候选人中也是如此。这种挑衅性的观察应该会导致 PHC 可用治疗算法的改变。

更新日期:2022-10-07
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