I am very interested in reading the entire article from the Mayo group (our doctors, actually). I went to the link, but could only get the abstract. Do you have a PDF of the whole article? Just checking.
In a study that will be published soon about” Predictors pf Pre-transpant dropout and post-transplant recurrence in patient with perihilar CCA” from Mayo Clinic.
there are some interesting findings.
1. The study was done between 1/1993 to 10/2010. Median age was 51 (range 19-70).
2. Of 199 patients,62 pts (31%)dropout & 131 pt received liver transplant.and 72% of the 199 patients are male and 127(64%) had underlying PSC.
3. Predictors of dropout:tumor>/=3cm; CA19-9>500;malignant biopsy and MELD score>/=20.
4. A total of 26 patients(20%) developed cancer recurrence at a Median of 23 months(1-128) after transplantation.
5. Predictors of recurrence:residual tumor cells on explant (the liver that took out from the patient)was the strongest predictor,with a near10 fold increased risk.;elevated CA19-9 level and encasement of the portal vein(related to increase tumor burden for the patient) are risk factors too.
7.currently there are no proven benefit of adjuvant therapy for recurrence.
8. 61 patients with residual tumor cells , but 38 out of the 61 patients with residual cells did not develop recurrence were not DIFFERENT from those who did,suggesting of inherent tumor biologic differences of individuals in response to the chemoradiotherapy before transplantation which may determine the outcome of recurrence.
9.The waiting time is not a factor associated with risk of recurrence;the reason may be contribute to the response to neoadjuvant therapy rather than time before the transplant.
10 .Age and PSC were not significant factor in the analyses and 1,2,and 5 year recurrence free survival for perihilar CCA=87%,80% and 68% .
from Murad SD;Ray Kim t,Therneau T;Gores GJ;RosenCBmartenson “Predictors of pre-transplant dropout and post-transplant recurrence in patients with perihiliar chonalgiocarcinoma” – pre-print copy from Hepatology(Baltmore Md.). Feb.2012.