The Role of Liver Transplantation in Hepatobiliary Malignancy. A Retrospective Analysis of 95 Patients with Particular Regard to Tumor Stage and Recurrence

TLDR

The role of hepatic transplantation for non‑resectable liver or bile duct cancer remains controversial. The study aimed to evaluate the pathological tumor stage and post‑transplantation outcomes of 95 consecutive hepatobiliary malignancy patients using the TNM system. A retrospective analysis of 95 consecutive cases was performed, assessing TNM staging and survival outcomes after liver transplantation. Among these patients, 5‑year actuarial survival was 20.4 %, median survival increased from 4.0 to 18.06 months in the most recent four years, and those with hepatocellular or bile duct carcinoma without extra‑hepatic spread achieved markedly longer survival (120 months and 35 months, respectively), whereas cholangiocarcinoma and metastatic disease showed no prolonged disease‑free survival, highlighting the need for careful patient selection.

Abstract

The role of hepatic transplantation in patients with nonresectable liver or bile duct cancer remains a controversial issue. An analysis of 95 consecutive cases was undertaken to evaluate retrospectively the pathological tumor stage in accordance with the TNM systematic and outcome after transplantation. Included were patients with the following diagnoses: hepatocellular carcinoma (n = 52), cholangiocellular carcinoma (n = 10), hepatoblastoma (n = 2), hemangiosarcoma (n = 2), bile duct carcinoma (n = 20), and liver metastases from different primary tumors (n = 9).The overall actuarial survival rate at 5 years was 20.4%. Median survival improved significantly within the last 4 years as compared to the preceding era (18.06 vs. 4.0 months). Currently 27 patients are alive, with the longest follow-up more than 12 years. The incidences of residual or recurrent tumor were 27 and 28, respectively. Particularly in patients who underwent transplantation for hepatocellular or bile duct carcinoma without extra-hepatic tumor spread, the results were significantly better; median survival time achieved for these two groups were 120 (p < 0.01) and 35 months (p < 0.05). Prolonged survival without tumor recurrence was not seen in patients with cholangiocellular carcinoma or liver metastases. These results demonstrate clearly that liver transplantation for hepatobiliary malignancy is still justified on the premises of careful patient selection by adequate tumor staging.