Bile duct cancer patients who undergo liver transplantation have the best chance at survival, according to a Houston Methodist Hospital-led study analyzing treatment options and outcomes for the aggressive disease.
The study showed that orthotopic liver transplantation (OLT) increased survival rates compared to surgical resection for intrahepatic (iCCA) and perihilar (pCCA) cholangiocarcinoma, two of the three forms of the cancer. OLT is not an option for distal CCA (dCCA).
"This publication highlights the evolving landscape of surgical strategies for cholangiocarcinoma, emphasizing the potential of novel multifactorial models in improving patient outcomes," said Dr. Maen Abdelrahim, a gastrointestinal oncologist at Houston Methodist and the primary investigator of the study. "Our goal is to enhance the knowledge base for clinicians and researchers, ultimately contributing to improved patient outcomes in managing a challenging disease."
The study, the work of an international team of researchers, was published in the journal Cancers in May.
Evaluating the feasibility of OLT as a treatment option for CCA, the researchers note that recent advancements in patient selection criteria and neoadjuvant therapies have improved survival rates for early-stage cancers.
For pCCA, the 5-year overall survival rate following neoadjuvant OLT is significantly higher compared to surgical resection, with results of 54% versus 29%.
OLT offers survival benefits for early-detected, unresectable iCCA. A multicenter retrospective study revealed a 5-year actuarial survival rate of 65% after OLT in patients with cirrhosis and small, incidental iCCA tumors measuring less than 2 cm.
OLT in individuals with larger iCCA tumors carries a significant risk of tumor recurrence, however several smaller-scale studies have found that combining OLT with neoadjuvant therapy resulted in notable improvements to survival rates. A 10-person study led by Dr. Abdelrahim, for instance, reported that 90% did not experience recurrence or metastasis. The overall survival rates were 100% for both one and two years and 75% for years three to five.
OLT is not a treatment option for distal cholangiocarcinoma because of its extrahepatic location. However, pancreatoduodenectomy, also known as the Whipple procedure, is commonly performed on dCCA patients to remove the tumor or tumors. Tumor-negative resection margins are achievable up to 50% of the time in dCCA, with five-year survival rates of 27-37%.
The researchers also emphasized the importance of accurate diagnostic evaluations, including carbohydrate antigen (CA)19-9, computed tomography (CT) and magnetic resonance imaging (MRI), for precise tumor localization and assessment.
Dr. Abdullah Esmail, an assistant professor at Houston Methodist, was the paper's first author. Others on the team included researchers at the University of Texas MD Anderson Cancer Center, Yale, Arizona State, Almaarefa University in Saudi Arabia and the University of Jordan.
For more on Dr. Abdelrahim's groundbreaking approach to liver transplant oncology, read an in-depth article in our sister publication, Methodology.