Abstract
Introduction
Despite improvements in survival for other tumour types, the prognosis of hilar cholangiocarcinoma (CC) continues to be extremely poor. Since publication of the Mayo protocol in 2000, an increasing number of case series around the world have reported excellent outcomes after neoadjuvant chemoradiation followed by liver transplantation (NCR-LT) in unresectable hilar CC.
Method
MEDLINE, EMBASE, Scopus and Web of Science databases were searched and data extracted from relevant studies. A proportional meta-analysis was conducted to pool 1, 3- and 5-year survival and disease recurrence rates following NCR-LT.
Result
Twenty studies comprising 428 patients were eligible for final analysis. The pooled 1, 3- and 5-year overall survival rates following LT without neoadjuvant therapy were 71.2% (95% CI 62.2 - 79.4), 48.0% (95% CI 35.0 - 60.9) and 31.6% (95% CI 23.1 - 40.7). These rates improved to 82.8% (95% CI 73.0 - 90.8), 65.5% (95% CI 48.7 - 80.5) and 65.1% (95% CI 55.1 - 74.5) following administration of a neoadjuvant chemoradiation protocol. The pooled recurrence rate was 51.7% (95% CI 33.8 - 69.4) in patients who did not undergo neoadjuvant treatment and 24.1% (95% CI 17.9 - 30.9) in those who did.
Conclusion
In unresectable hilar CC, NCR-LT confers long-term survival in selected patients able to complete neoadjuvant chemoradiation followed by transplantation. Patients with primary sclerosing cholangitis have the most favourable survival outcomes. A high disease recurrence rate is of concern when considering extending national graft allocation schemes. CC - Cholangiocarcinoma, NCR-LT - Neoadjuvant Chemoradiation & Liver Transplantation
Take-home message
In selected patients, the treatment of unresectable hilar cholangiocarcinoma with neoadjuvant chemoradiation and liver transplantation results in 5-year overall survival rates greater than 50%. Patients with hilar cholangiocarcinoma and concomitant primary sclerosing cholangitis have the most favourable outcomes post-transplantation.
O37: SYSTEMATIC REVIEW AND PROPORTIONAL META-ANALYSIS OF SURVIVAL FOLLOWING NEOADJUVANT CHEMORADIATION AND LIVER TRANSPLANTATION IN UNRESECTABLE HILAR CHOLANGIOCARCINOMA
