Chuan JIANG, Linhui GONG
Eurasian Journal of Medicine and Oncology - 2026;10(4):1-17
Introduction: Liver transplantation (LT) offers a curative option for early-stage hepatocellular carcinoma (HCC). However, its role in intrahepatic cholangiocarcinoma (ICC) remains controversial, with limited comparative evidence on long-term outcomes, especially for early-stage disease. Objective: To assess long-term survival outcomes and identify prognostic risk factors among patients with HCC and ICC who have undergone LT. Methods: The Surveillance, Epidemiology, and End Results database (2004-2015) was used to identify patients with American Joint Committee on Cancer 6th edition stage I HCC or ICC who underwent LT. The primary endpoints were cancer-specific survival (CSS) and overall survival (OS). Kaplan-Meier analysis, log-rank tests, and Cox proportional hazards regression were used for survival comparison analyses, and random subsampling and bootstrap resampling were performed to assess the robustness of the results. Results: Among 944 eligible patients, 925 had HCC, and 19 had ICC. The five-year OS and CSS rates were significantly higher for HCC patients (OS: 95.1%; CSS: 97.7%) compared to ICC patients (OS: 82.3%; CSS: 82.3%) ( p < 0.001). Multivariate Cox analysis for HCC identified age and marital status as independent risk factors for OS, and tumor size for CSS. For ICC, given the limited sample size, only descriptive analysis and univariate comparisons were performed. Tumor size showed a potential association with OS in exploratory analysis, but these findings require validation in larger cohorts. Conclusion: LT provides excellent long-term survival for patients with early-stage HCC. In contrast, outcomes for early-stage ICC patients after LT are significantly inferior, with an approximate 15% absolute difference at five years. Prognostic factors differ between the two histological types, underscoring the need for distinct LT selection criteria and management strategies. Given the small ICC sample size and inherent database limitations, these findings underscore the urgent need for larger multicenter studies that incorporate comprehensive clinical and molecular profiling to identify ICC subpopulations that may benefit from LT.
