Prognosis Analysis of Liver Transplantation for Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma in Stage 6 AJCC I: A SEER Database Study

BackgroundLiver transplantation (LT) offers a curative option for early-stage hepatocellular carcinoma (HCC). Its role in intrahepatic cholangiocarcinoma (ICC) remains controversial, with limited comparative evidence on long-term outcomes, especially for early-stage disease. MethodsThis retrospective population-based study utilized the SEER database (2004-2015). Patients with AJCC 6th edition Stage I HCC or ICC who underwent LT were included. Cancer-specific survival (CSS) and overall survival (OS) were primary endpoints. Kaplan-Meier ana lysis, log-rank tests, and Cox proportional hazards regression were used for survival comparison and identification of prognostic factors. ResultsAmong 944 eligible patients, 925 had HCC and 19 had ICC. The 5-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%). Multivariate Cox analysis for HCC identified age and marital status as independent risk factors for OS, and tumor size for CSS. For ICC, only tumor size was associated with OS in univariate analysis; no independent risk factors for CSS were identified due to the small sample size. ConclusionsLT provides excellent long-term survival for patients with early-stage HCC. In contrast, outcomes for early-stage ICC patients after LT are significantly inferior. Prognostic factors differ between the two histological types, underscoring the need for distinct LT selection criteria and management strategies. The findings highlight the limited utility of LT for ICC based on current selection paradigms and emphasize the necessity for larger studies incorporating molecular pro filing to identify potential ICC subpopulations that may benefit from LT.