The Role of Immunosuppression for Recurrent Cholangiocellular Carcinoma after Liver Transplantation

被引：4

作者：

Guel-Klein, Safak ^{[1
,2
,3
]}

Schmitz, Paulina ^{[1
,2
,3
]}

Schoning, Wenzel ^{[1
,2
,3
]}

Oelinger, Robert ^{[1
,2
,3
]}

Lurje, Georg ^{[1
,2
,3
]}

Jonas, Sven ^{[1
,2
,3
]}

Uluk, Deniz ^{[1
,2
,3
]}

Pelzer, Uwe ^{[4
,5
,6
]}

Tacke, Frank ^{[2
,3
,7
]}

Schmelzle, Moritz ^{[1
,2
,3
]}

Pratschke, Johann ^{[1
,2
,3
]}

Ossami Saidy, Ramin Raul ^{[1
,2
,3
]}

Eurich, Dennis ^{[1
,2
,3
]}

机构：

[1] Charite Univ Med Berlin, Dept Surg, Augustenburger Pl 1, D-13353 Berlin, Germany

[2] Free Univ Berlin, Augustenburger Pl 1, D-13353 Berlin, Germany

[3] Humboldt Univ, Augustenburger Pl 1, D-13353 Berlin, Germany

[4] Charite Univ Med Berlin, Dept Hematol Oncol & Canc Immunol, Charitepl 1, D-10117 Berlin, Germany

[5] Free Univ Berlin, Charitepl 1, D-10117 Berlin, Germany

[6] Humboldt Univ, Charitepl 1, D-10117 Berlin, Germany

[7] Charite Univ Med Berlin, Dept Gastroenterol & Hepatol, Augustenburger Pl 1, D-13353 Berlin, Germany

来源：

CANCERS | 2022年 / 14卷 / 12期

关键词：

cholangiocellular carcinoma; liver transplantation; recurrent cholangiocellular carcinoma; reduced immunosuppression; HEPATOCELLULAR-CARCINOMA; INTRAHEPATIC CHOLANGIOCARCINOMA; RISK-FACTORS; CANCER; TACROLIMUS; MANAGEMENT; REJECTION; DIAGNOSIS; RESECTION; SURVIVAL;

D O I：

10.3390/cancers14122890

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Simple Summary Oncological follow-up after liver transplantation for cholangiocellular carcinoma must consider the risk of recurrence. Immunosuppressive medication with so-called mTOR inhibitors seems to have a tumor-suppressive effect, as improved survival has been shown under this medication for patients with recurrent hepatocellular carcinoma after liver transplantation. The aim of our study was to investigate recurrence and survival in relation to tumor type and type of immunosuppression for cholangiocellular carcinoma after liver transplantation. The time from liver transplantation to recurrence and survival after cancer recurrence were endpoints of the study. Significant improvement in survival for recurrent cholangiocellular carcinoma was seen after surgical resection and reduction in immunosuppression, while N1 status at transplantation and histological Grading >1 were associated with worse outcomes. Liver transplantation (LT) for cholangiocarcinoma (CCA), or biliary tract cancer (BTC), remains controversial regarding high recurrence rates and poor prognosis. Oncological follow-up may benefit from tumor-inhibiting properties of mTOR inhibitors (mTORI), shown with improved survival for recurrent hepatocellular carcinoma (HCC) patients after LT. The aim of this study was to investigate the recurrence and survival in relation to tumor type and type of immunosuppression (IS). LT patients with CCA or mixed HCC/CCA (mHCC/CCA) (n = 67) were retrospectively analyzed. Endpoints were the time from LT to recurrence (n = 44) and survival after recurrence. Statistically significant impairment in survival for recurrent CCA (rCCA) was shown in patients not eligible for surgical resection (HR 2.46 (CI: 1.2-5.1; p = 0.02). Histological proven grading >1 and N1 status at initial transplantation were associated with impaired survival (HR 0.13 (CI: 0.03-0.58); p < 0.01 and HR 3.4 (CI: 1.0-11.65); p = 0.05). Reduced IS after tumor recurrence improved survival (HR 4.2/CI: 1.3-13.6; p = 0.02). MTORI initiation before recurrence or after had no significant impact on survival. Our data thereby indicate, similar to findings in recurrent HCC after LT, that patients with rCCA after LT benefit from a reduction in IS upon recurrence.

引用

页数：14

共 54 条

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