O37: SYSTEMATIC REVIEW AND PROPORTIONAL META-ANALYSIS OF SURVIVAL FOLLOWING NEOADJUVANT CHEMORADIATION AND LIVER TRANSPLANTATION IN UNRESECTABLE HILAR CHOLANGIOCARCINOMA

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.

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Reduced Intensity Conditioning Yields Superior Overall Survival Rates Compared to Myeloablative Regimens for Allogeneic HCT in Chronic Lymphocytic Leukemia: A Side-By-Side Systematic Review/Meta-Analysis

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2016.12.170 ◽

2017 ◽

Vol 23 (3) ◽

pp. S269 ◽

Cited By ~ 1

Author(s):

Jessica El-Asmar ◽

Tea Reljic ◽

Ambuj Kumar ◽

Mohamed A. Kharfan-Dabaja

Keyword(s):

Systematic Review ◽

Overall Survival ◽

Chronic Lymphocytic Leukemia ◽

Meta Analysis ◽

Survival Rates ◽

Lymphocytic Leukemia ◽

Reduced Intensity Conditioning ◽

Allogeneic Hct ◽

Reduced Intensity ◽

Overall Survival Rates

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Liver transplantation and whipple surgery combined with chemoradiotherapy for treatment of hilar cholangiocarcinoma in patients with primary sclerosing cholangitis

Liver Transplantation ◽

10.1002/lt.24095 ◽

2015 ◽

Vol 21 (5) ◽

pp. 696-699 ◽

Cited By ~ 7

Author(s):

Saman Nikeghbalian ◽

Alireza Shamsaeefar ◽

Ahad Eshraghian ◽

Mohsen Reza Mansoorian ◽

Kourosh Kazemi ◽

...

Keyword(s):

Liver Transplantation ◽

Primary Sclerosing Cholangitis ◽

Hilar Cholangiocarcinoma ◽

Sclerosing Cholangitis

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Immunosuppressive Agents for the Treatment of Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis

Digestive Diseases ◽

10.1159/000471874 ◽

2017 ◽

Vol 35 (5) ◽

pp. 478-485 ◽

Cited By ~ 6

Author(s):

Xia Peng ◽

Xin Luo ◽

Jing-Ying Hou ◽

Shu-Yun Wu ◽

Liang-Zong Li ◽

...

Keyword(s):

Liver Transplantation ◽

Primary Sclerosing Cholangitis ◽

Sclerosing Cholangitis ◽

Primary Outcome ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Immunosuppressive Agents ◽

Therapeutic Agents ◽

Weighted Mean ◽

Risk Of Mortality

Objectives: Currently, there are no effective therapeutic agents for patients with primary sclerosing cholangitis (PSC). This study aimed to evaluate the safety and efficiency of immunosuppressive agents (IAs) for the treatment of PSC. Methods: The literatures were searched using the following keywords singly or in combination: PSC, treatments, IAs. The primary outcome was defined as the need for liver transplantation or mortality. Results: Two hundred sixty six patients from 7 eligible studies were analyzed. IAs had no remarkable effects on the rate of mortality or liver transplantation (relative risk, RR 1.02, 95% CI 0.58-1.62, p = 0.92). Subgroup analyses showed no significant effect of IAs co-administration therapy (IAs co-administered with ursodeoxycholic acid, IA co-administered with IA; RR 1.41, 95% CI 0.40-4.95, p = 0.60). IAs caused adverse events (AEs) such as diarrhea, abdominal pain, and pruritus (RR 1.81, 95% CI 1.07-3.07, p = 0.03). IAs therapy did not significantly improve markers of liver function except for aspartate transaminase (weighted mean difference -9.76, 95% CI -12.92 to -6.6, p < 0.001). Conclusion: IAs administrated as either monotherapy or combination therapy do not reduce the risk of mortality or liver transplantation. IAs monotherapy is associated with AEs.

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Risk of Colorectal Cancer after Liver Transplantation for Primary Sclerosing Cholangitis: A Systematic Review and Meta-analysis: Presidential Poster

The American Journal of Gastroenterology ◽

10.14309/00000434-201310001-00386 ◽

2013 ◽

Vol 108 ◽

pp. S115-S116

Author(s):

Siddharth Singh ◽

Jithinraj Edakkanambeth Varayil ◽

Edward Loftus ◽

Jayant Talwalkar

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Liver Transplantation ◽

Primary Sclerosing Cholangitis ◽

Sclerosing Cholangitis ◽

Meta Analysis

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Meta-analysis of the effect of the pringle maneuver on long-term oncological outcomes following liver resection

Scientific Reports ◽

10.1038/s41598-021-82291-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Elias Khajeh ◽

Saeed Shafiei ◽

Sadeq Ali-Hasan Al-Saegh ◽

Ali Ramouz ◽

Ahmed Hammad ◽

...

Keyword(s):

Overall Survival ◽

Survival Rate ◽

Liver Resection ◽

Meta Analysis ◽

Survival Rates ◽

Pringle Maneuver ◽

Free Survival ◽

Oncological Outcomes ◽

Overall Survival Rates

AbstractHepatic pedicle clamping reduces intraoperative blood loss and the need for transfusion, but its long-term effect on survival and recurrence remains controversial. The aim of this meta-analysis was to evaluate the effect of the Pringle maneuver (PM) on long-term oncological outcomes in patients with primary or metastatic liver malignancies who underwent liver resection. Literature was searched in the Cochrane Central Register of Controlled Trials (CENTRAL), Medline (via PubMed), and Web of Science databases. Survival was measured as the survival rate or as a continuous endpoint. Pooled estimates were represented as odds ratios (ORs) using the Mantel–Haenszel test with a random-effects model. The literature search retrieved 435 studies. One RCT and 18 NRS, including 7480 patients who underwent liver resection with the PM (4309 cases) or without the PM (3171 cases) were included. The PM did not decrease the 1-year overall survival rate (OR 0.86; 95% CI 0.67–1.09; P = 0.22) or the 3- and 5-year overall survival rates. The PM did not decrease the 1-year recurrence-free survival rate (OR 1.06; 95% CI 0.75–1.50; P = 0.75) or the 3- and 5-year recurrence-free survival rates. There is no evidence that the Pringle maneuver has a negative effect on recurrence-free or overall survival rates.

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