F. M. Kaldas1, T. Ito1, D. S. Graham1, S. M. Younan1, V. G. Agopian1, J. DiNorcia1, H. Yersiz1, D. G. Farmer1, R. W. Busuttil1 1University Of California – Los Angeles,Surgery,Los Angeles, CA, USA
Introduction: Liver transplantation (LT) for cholangiocarcinoma (CCA) remains limited to a small number of centers with mixed practice patterns and results. While the role of neoadjuvant therapy (NT) has been explored, an in depth analysis including the type of CCA, NT, and outcomes over time is lacking.
Methods: Multivariate Cox regression was used in a retrospective review of a prospectively collected database to examine factors impacting survival. Hilar CCA (HC) was compared to intrahepatic CCA (IC). NT type and impact were sub analyzed (50 consecutive adults 1985-2018, single academic center)
Results: Among 50 patients (HC 20, IC 30), 33 patients (66%) presented with large tumors (hilar≥3cm, intrahepatic≥5cm). 5 year overall survival (OS) after LT for the entire cohort was 35%. However, patients who underwent LT in the recent Era (2008 to 2018) tended to have better survival compared to the older Era (1985-2007) (5y OS: 41% vs 32%, p=0.290). Patients with IC tended to have better outcomes compared to those with HC (5y OS: 42% vs 20%, p=0.151). Furthermore, IC patients receiving LT in the recent Era showed a trend towards improved survival compared to the older Era at 5 years (75% vs 37% p=0.313). 22/50 patients (44%) received NT. NT type was unknown in 4 patients excluding them from the NT sub-analysis. NT was divided into four sub-groups (No NT n=28, chemotherapy n=4, local n=3, combined chemotherapy + local n=11). All patients undergoing local NT alone and 82% of patients undergoing combined NT were in the recent Era, while most patients in the no NT group 89% or chemotherapy alone group 75% were the older Era (p<0.001). 5 year OS from time of initial treatment in the combined NT group was 78%, significantly superior to all other groups (p=0.024) (Fig 1). Tumor multifocality (HR: 2.749, p=0.009) and perineural invasion (HR: 2.669, p=0.019) were significant independent predictors of poor prognosis. The absence of combined therapy also trended towards predicting a poorer outcome (HR: 3.795, p=0.075).Tumor size had no impact on survival outcomes.
Conclusion: LT for IC and HC has improved considerably over time. While combined (chemotherapy + local) NT followed by LT offers the most optimal long term outcomes, tumor size did not impact survival regardless of NT modality used. These findings suggest that careful patient selection and management offer acceptable outcomes in LT for CCA.
