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Comparative Analysis of Patients with Mixed Hepatocellular-Cholangiocarcinoma (HCC-CCA) Undergoing Liver Transplantation: A Single Center Matched Cohort Analysis.

K. Lunsford, M. Harlander-Locke, J. Gornbein, A. Zarrinpar, F. Kaldas, H. Yersiz, D. Farmer, R. Busuttil, V. Agopian.

Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Meeting: 2016 American Transplant Congress

Abstract number: A189

Keywords: Hepatocellular carcinoma, Liver transplantation, Survival, Tumor recurrence

Session Information

Date: Saturday, June 11, 2016

Session Name: Poster Session A: Liver - Hepatocellular Carcinoma and Cholangiocarcinoma Malignancies

Session Time: 5:30pm-7:30pm

 Presentation Time: 5:30pm-7:30pm

Location: Halls C&D

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  • Intrahepatic Cholangiocarcinoma (I-CC) or Mixed Hepatocellular-Cholangiocarcinoma (HCC-CC) in Patients Undergoing Liver Transplantation (LT). A Spanish Case Control Multicenter Study
  • Is Pretransplant Determination of Hepatocellular Carcinoma Tumor Grade Using Needle Biopsy Reliable for Transplant Candidate Selection? Analysis of 217 Liver Transplant Recipients.

Liver transplant (LT) is the gold standard for hepatocellular carcinoma (HCC) but is contraindicated in known HCC-CCA due to poor prognosis. We compared posttransplant oncologic outcomes for HCC-CCA and a matched cohort of HCC.

METHODS:

Retrospective single-center analysis (1984-2014) identified 12 patients with HCC-CCA who were matched 1:3 to HCC on pretransplant (HCC-PreTx, radiologic diameter and AFP) or explant (HCC-Exp, pathologic diameter, grade, and vascular invasion) tumor characteristics.

RESULTS:

Compared to HCC-PreTx, HCC-CCA had higher grade and worse differentiation, but similar stage and vascular invasion (Tab1). HCC-CCA trended toward inferior recurrence-free survival (RFS, 27.8% vs 60.9%, p=0.12; Fig1A) and greater recurrence (HCC-CCA: 50% [6/12] with median recurrence time (MRT) 297d vs HCC-PreTx: 25% [9/36] with MRT 347d). When matched to HCC-Exp (Tab1), HCC-CCA had equivalent RFS (Fig1B). All 6 recurrences occurred with poorly differentiated tumors (MST 21.3mo) and none with well/moderately differentiated tumors (MST 60.2mo).

CONCLUSIONS:

Mixed HCC-CCA tumors are more likely higher grade and less differentiated compared to HCC with similar PreTx characteristics. Compared to HCC with similar pathology, they display equivalent RFS and are not inherently more aggressive. Low-grade HCC-CCA should not prompt exclusion from LT; however, improved PreTx pathologic identification is necessary.

 

HCC-CCA (N=12)

PreTx-HCC (N=36)

p value

Exp-HCC (N=36)

p value

  Nuclear Grade 3-4

58% (7)

13% (4)

0.003*

58% (21)

0.1
  Differentiation-Poor 58% (7) 9% (3) 0.002* 58% (21) 1.0
  Median Cumulative Diameter 7.1 5.0 0.4 8.5 0.3
  Necrosis 58% (7) 72% (26) 0.2 75% (27) 0.5
  Bilobar 33% (4) 11% (4) 0.08 39% (14) 0.9
  Multifocal 58% (7) 53% (19) 1.0 58% (21) 0.5
  Microvascular Invasion 50% (6) 31% (11) 0.3 8% (3) 1.0
  Macrovascular Invasion 8% (1) 3% (1) 0.4 50% (18) 1.0

CITATION INFORMATION: Lunsford K, Harlander-Locke M, Gornbein J, Zarrinpar A, Kaldas F, Yersiz H, Farmer D, Busuttil R, Agopian V. Comparative Analysis of Patients with Mixed Hepatocellular-Cholangiocarcinoma (HCC-CCA) Undergoing Liver Transplantation: A Single Center Matched Cohort Analysis. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Lunsford K, Harlander-Locke M, Gornbein J, Zarrinpar A, Kaldas F, Yersiz H, Farmer D, Busuttil R, Agopian V. Comparative Analysis of Patients with Mixed Hepatocellular-Cholangiocarcinoma (HCC-CCA) Undergoing Liver Transplantation: A Single Center Matched Cohort Analysis. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/comparative-analysis-of-patients-with-mixed-hepatocellular-cholangiocarcinoma-hcc-cca-undergoing-liver-transplantation-a-single-center-matched-cohort-analysis/. Accessed January 25, 2021.

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