Liver transplantation for combined hepatocellular carcinoma and cholangiocarcinoma in Korea

Introduction: There is still no consensus about the actual role of liver transplantation (LT) in the therapeutic algorithm of combined hepatocellular-cholangiocarcinoma (cHCC-CC) because of low incidence and few clinical information. Methods: We retrospectively identified 111 patients at nine centers from 2001 to 2019 in Korea. Results: Of the 111 patients, 85.6% (n = 95) was male and the median age was 54 years (range, 31–66 years). HBV is 82% (n = 91) and HCC is 96% (86.3%) preoperatively. Seventy-four patients (66.7%) received locoregional therapy (LRT) before LT. Median tumor size was 2.5 cm (range, 0.5–7.2 cm) and the ratio of beyond Milan criteria was 40.5% (n = 45). The 1-year, 3-year, and 5-year disease-free survival rates and tumor-related patient survival rates were 77.6%, 56.3%, and 51.1% and 84.4%, 63.8%, and 56.7%, respectively. The extrahepatic site was 75.5% as an initial tumor recurrence site in recurrent tumor patients. Numbers of LRT before LT >3 and tumor size > 3 cm were closely associated tumor recurrence and early tumor recurrence within 1 year after LT. Tumor size > 3 cm was only predisposing factor for tumor-related death. Conclusions: It is difficult to diagnose cHCC-CC before LT, but a good prognosis can be expected if the tumor size is less than 3 cm in pathology.