Abstract
e15644 Background: Current limited evidence from observational studies suggest lack of survival benefit from liver transplantation (LT) for combined hepatocellular carcinoma with cholangiocarcinoma (cHCC-CC) when compared to surgical resection. This is in contrast to hepatocellular carcinoma (HCC) which has clear survival benefit with LT. We hypothesized that cHCC–CC patients have similar overall survival (OS) after LT compared to resection. Methods: Localized HCC and cHCC–CC patients treated with surgical resection versus transplant were identified in SEER Database (1973–2013). Kaplan-Meier method was used to examine survival with LT versus resection. Results: In the total period between 1973-2013, we identified 9,306 (5496 [59.06%] resection, 3810 [40.94%] transplant) patients with HCC, and 175 (107 [61.14%] resection, 68 [38.85%] transplant) patients with cHCC–CC. 3-year OS of patients undergoing LT remains significantly greater for HCC than for cHCC–CC (80.5% vs 59.9%, P < 0.01). Interesting, for period 2008-13, 3-yr OS for cHCC-CC patients undergoing LT was better than resection, although the difference was not statistically significant (66.4% vs 46.27%, p > 0.10). While there has been improved 3-year and 5-year OS from period 2002-07 to 2008-13 after LT for localized HCC patients (83.6% vs 79.4%, p < 0.002 and 76.4% vs 73.6, p < 0.01, respectively), there has been no significant improvement in 3-year or 5-year survival after for HCC-CC (66.4% vs 65.2%, p < 0.4 and 58.3% vs 55.3%, p > 0.4 respectively). Conclusions: Over the past decade, 3-yr OS of cHCC-CC with LT remains dismal and has not improved. However, LT in patients with localized cHCC–CC may have a potential survival benefit over liver resection, although clearly lower than the survival benefit of LT for HCC. Our results argue for a randomized trial for LT versus resection for localized cHCC-CC patients to obtain better understanding of survival benefit from the two surgical options.
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