Transplantation versus resection for patients with combined hepatocellular carcinoma-cholangiocarcinoma

Background and Objectives Although transplantation has demonstrated survival benefit for patients with hepatocellular carcinoma (HCC), there is limited data to support or refute transplantation for combined hepatocellular-cholangiocarcinoma (cHCCCC). We hypothesized that cHCCCC patients had poorer overall survival (OS) than HCC patients after liver transplantation. Methods Patients with localized HCC and cHCCCC treated with surgical resection or transplant were identified using the Surveillance, Epidemiology, and End Results (SEER) Database (19732007). Cox proportional hazards models were used to examine survival. Results We identified 3,378 (1,447 [43%] transplant, 1,931 [57%] resection) patients with HCC, and 54 (19 [35%] transplant, 35 [65%] resection) patients with cHCCCC. Patients undergoing resection of HCC and cHCCCC had similar 3-year OS (55% vs. 46%, P=0.4). Three-year OS of patients undergoing transplant was significantly greater for HCC (78%) than for cHCCCC (48%, P=0.01). In adjusted models, patients transplanted for cHCCCC had higher hazard of death compared to HCC patients (HR 2.5, 95% CI: 1.25.1, P=0.01). Conclusions Transplantation for localized cHCCCC confers a survival benefit similar to liver resection for cHCCCC, but inferior to transplantation for HCC. With survival data that mimics historic reports of transplant for intrahepatic cholangiocarcinoma, this study questions the benefit of transplantation for patients with cHCCCC. J. Surg. Oncol. 2013;107:608612. (c) 2013 Wiley Periodicals, Inc.