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Mixed Hepatocellular Cholangiocarcinoma: A Review of Long-Term Outcomes Following Liver Transplantation
Authors:N. Machairas  P. Stamopoulos  I.D. Kostakis  Z. Garoufalia  A. Paspala  P. Tsaparas  G.C. Sotiropoulos
Affiliation:1. 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece;2. 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
Abstract:

Introduction

Mixed hepatocellular cholangiocarcinoma (HCC-CC) represents a rare hepatic tumor, which demonstrates histological features of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). HCC-CC can be an unexpected finding in patients undergoing liver transplantation (LT) for HCC. The objective of our review was to review and evaluate long-term outcomes in patients undergoing LT for mixed HCC-CC.

Methods

A meticulous MEDLINE search was performed for articles referring to long-term results in patients who underwent LT and whose final pathology revealed HCC-CC.

Results

A total of 7 studies, which comprised 93 patients who underwent LT and whose resected specimen revealed mixed HCC-CC, were included in our review. One-year overall survival (OS) rates ranged from 64% to 93%, 3-year OS ranged from 38% to 78%, and 5-year OS rates range from 14% to 78%. Disease-free-survival (DFS) rates at 1-year from LT ranged from 60-% to 64%, whereas both 3- and 5-year DFS rates ranged from 30% to 53.3%.

Conclusions

Long-term results of LT in the setting of mixed HCC-CC are associated with fairly unfavorable overall outcomes compared to LT for other indications including HCC yet are improved compared to others such as intrahepatic CC. A stricter preoperative evaluation could potentially help identify the patients with mixed HCC-CC who are at high-risk after LT, reduce the risks of recurrence, and improve OS.
Keywords:Address correspondence to Nikolaos Machairas   MD   PhD   3rd Department of Surgery   National and Kapodistrian University of Athens   Medical School   University Hospital Attikon   Rimini Str. 1   12462 Athens   Greece. Tel: +30 210 5831000.
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