Strict Selection Alone of Patients Undergoing Liver Transplantation for Hilar Cholangiocarcinoma Is Associated with Improved Survival

Liver transplantation for hilar cholangiocarcinoma (hCCA) has regained attention since the Mayo Clinic reported their favorable results with the use of a neo-adjuvant chemoradiation protocol. However, debate remains whether the success of the protocol should be attributed to the neo-adjuvant therapy or to the strict selection criteria that are being applied. The aim of this study was to investigate the value of patient selection alone on the outcome of liver transplantation for hCCA. In this retrospective study, patients that were transplanted for hCCA between1990 and 2010 in Europe were identified using the European Liver Transplant Registry (ELTR). Twenty-one centers reported 173 patients (69%) of a total of 249 patients in the ELTR. Twenty-six patients were wrongly coded, resulting in a study group of 147 patients. We identified 28 patients (19%) who met the strict selection criteria of the Mayo Clinic protocol, but had not undergone neo-adjuvant chemoradiation therapy. Five–year survival in this subgroup was 59%, which is comparable to patients with pretreatment pathological confirmed hCCA that were transplanted after completion of the chemoradiation protocol at the Mayo Clinic. In conclusion, although the results should be cautiously interpreted, this study suggests that with strict selection alone, improved survival after transplantation can be achieved, approaching the Mayo Clinic experience

Strict Selection Alone of Patients Undergoing Liver Transplantation for Hilar Cholangiocarcinoma is Associated with Improved Survival

Liver transplantation for hilar cholangiocarcinoma (hCCA) has regained attention since the Mayo Clinic reported their favorable results with the use of a neo-adjuvant chemoradiation protocol. However, debate remains whether the success of the protocol should be attributed to the neo-adjuvant therapy or to the strict selection criteria that are being applied. The aim of this study was to investigate the value of patient selection alone on the outcome of liver transplantation for hCCA. In this retrospective study, patients that were transplanted for hCCA between 1990 and 2010 in Europe were identified using the European Liver Transplant Registry (ELTR). Twenty-one centers reported 173 patients (69%) of a total of 249 patients in the ELTR. Twenty-six patients were wrongly coded, resulting in a study group of 147 patients. We identified 28 patients (19%) who met the strict selection criteria of the Mayo Clinic protocol, but had not undergone neo-adjuvant chemoradiation therapy. Five-year survival in this subgroup was 59%, which is comparable to patients with pretreatment pathological confirmed hCCA that were transplanted after completion of the chemoradiation protocol at the Mayo Clinic. In conclusion, although the results should be cautiously interpreted, this study suggests that with strict selection alone, improved survival after transplantation can be achieved, approaching the Mayo Clinic experience

Lymph Node Micrometastases are Associated with Worse Survival in Patients with Otherwise Node-Negative Hilar Cholangiocarcinoma

Lymph node metastases on routine histology are a strong negative predictor for survival after resection of hilar cholangiocarcinoma. Additional immunohistochemistry can detect lymph node micrometastases in patients who are otherwise node negative, but the prognostic value is unsure. The objective of this study was to assess the effect on survival of immunohistochemically detected lymph node micrometastases in patients with node-negative (pN0) hilar cholangiocarcinoma on routine histology. Between 1990 and 2010, a total of 146 patients underwent curative-intent resection of hilar cholangiocarcinoma with regional lymphadenectomy at two university medical centers in the Netherlands. Ninety-one patients (62 %) without lymph node metastases at routine histology were included. Micrometastases were identified by multiple sectioning of all lymph nodes and additional immunostaining with an antibody against cytokeratin 19 (K19). The association with overall survival was assessed in univariable and multivariable analysis. Median follow-up was 48 months. Micrometastases were identified in 16 (5 %) of 324 lymph nodes, corresponding to 11 (12 %) of 91 patients. There were no differences in clinical variables between K19 lymph node-positive and -negative patients. Five-year survival rates in patients with lymph node micrometastases were significantly lower compared to patients without micrometastases (27 vs. 54 %, P = 0.01). Multivariable analysis confirmed micrometastases as an independent prognostic factor for survival (adjusted Hazard ratio 2.4, P = 0.02). Lymph node micrometastases are associated with worse survival after resection of hilar cholangiocarcinoma. Immunohistochemical detection of lymph node micrometastases leads to better staging of patients who were initially diagnosed with node-negative (pN0) hilar cholangiocarcinoma on routine histolog

Clinicopathological variables of patients undergoing liver transplantation for hilar cholangiocarcinoma.

<p>Thirty four patients who underwent an attempt to surgically remove the tumor prior to transplantation and 8 patients with missing variables were excluded.</p

Flow chart illustrating the consecutive steps that were followed to select patients who met the Mayo Clinic criteria for liver transplantation, but were not treated with neo-adjuvant chemoradiotherapy.

<p>Flow chart illustrating the consecutive steps that were followed to select patients who met the Mayo Clinic criteria for liver transplantation, but were not treated with neo-adjuvant chemoradiotherapy.</p

Univariate analysis for five-year survival in patients transplanted for hilar cholangiocarcinoma.

<p>Thirty four patients who underwent an attempt to surgically remove the tumor prior to transplantation and 8 patients with missing variables were excluded.</p

Mayo clinic criteria for inclusion in the transplantation protocol for hilar cholangiocarcinoma[15–17].

<p>Mayo clinic criteria for inclusion in the transplantation protocol for hilar cholangiocarcinoma[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156127#pone.0156127.ref015" target="_blank">15</a>–<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156127#pone.0156127.ref017" target="_blank">17</a>].</p

Models based on individual level movement predict spatial patterns of genetic relatedness for two Australian forest birds

Fine-scale landscape change can alter dispersal patterns of animals, thus influencing connectivity or gene flow within a population. Furthermore, dispersal patterns of different species may be influenced by the landscape in varying ways. Our research first aimed to examine whether the spatial genetic structure within populations of closely related bird species differs in response to the same landscape. Second, we examined whether individual-level movement characteristics are a mechanistic driver of these differences. We generated a priori predictions of how landscape features will influence dispersal (particularly the response of individuals to habitat boundaries both natural and human-induced) based on a movement model developed by Fahrig (Funct Ecol 21:1003-1015, 2007). This model allowed us to predict genetic relatedness patterns in populations of two passerine bird species with different life-history traits from Queensland, Australia (yellow-throated scrubwren Sericornis citreogularis, a habitat specialist; white-browed scrubwren Sericornis frontalis, a habitat generalist). We quantified our predictions using cost-distance modelling and compared these to observed pairwise genetic distances (a (r) ) between individuals as calculated from microsatellite markers. Mantel tests showed that our a priori models correlated with genetic distance. Euclidean distance was most closely correlated to genetic distance for the generalist species (r = 0.093, P = 0.002), and landscape models that included the avoidance of unsuitable habitat were best for the specialist species (r = 0.107, P = 0.001). Our study showed that predictable movement characteristics may be the mechanism driving differences in genetic relatedness patterns within populations of different bird species