Comparative Analysis of Patients with Mixed Hepatocellular-Cholangiocarcinoma (HCC-CCA) Undergoing Liver Transplantation: A Single Center Matched Cohort Analysis.
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
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).
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.« Back to 2016 American Transplant Congress