Incidental combined hepatocellular-cholangiocarcinoma: a propensity score analysis exploring the efficacy of liver transplantation

Combined hepatocellular-cholangiocarcinoma (cHCC–CC) is a tumor with a challenging differential diagnosis from HCC. Some patients who undergo LT for a supposed HCC are eventually diagnosed with cHCC-CC. The purpose of this study is to assess the outcomes of patients whose final pathology revealed cHCC-CC after they received LT for HCC. From 2004 to 2021 we retrospectively analyzed all patients who underwent LT for cHCC-CC in our Center. Outcomes after LT were compared to HCC recipients. We performed a case match analysis pairing patients at the same propensity score without reinsertion matching for number of nodules, size and aFP-level. Next, we examined the recipients' overall survival, disease-free survival and associated prognostic variables. cHCC-CCs were discovered in 27 patients that underwent LT during the research period. At five years, there were notable variations in overall survival (p=0,011). Both OS and DFS results showed a significant difference following PS matching. The overall survival was 85.41% vs 91.89%, 69.6% vs 74.34% and 49.8% vs 68.44% at 1, 3 and 5 years, in cHCC and HCC respectively [p=0,0098]. Tumor biology was a negative predictive factor at the multivariate Cox regression analysis for disease recurrence (HR 2.40, p=0,031) . Based on our analysis, cHCC-CC had a worse oncological outcome compared to HCC. Nonetheless, the survival rate of cHCC-CC recipients reaches nearly 50% at 5-years , therefore this primary liver cancer could also be approached from a “Transplant Oncology" perspective. For these reasons, new studies are required for optimized the management of cHCC-CC patients.