Table 4.
Univariate and multivariate Cox models of characteristics at presentation and at time of transplantation for transplanted patients who developed recurrence (N=26) versus those who remained free of recurrence (N=105) at our institution. Categorical variables are expressed in N (%) and continuous variables as median (range).
| UNIVARIATE | MULTIVARIATE | |||||||
|---|---|---|---|---|---|---|---|---|
|
| ||||||||
| Recurrence N=26 | Free of recurrence (N=105) | Hazard Ratio | 95% CI | P-value | Hazard Ratio | 95% CI | P-value | |
| Baseline Characteristics | ||||||||
|
| ||||||||
| Age | 53 (36–67) | 50 (22–66) | 1.06 | 1.01–1.10 | .01 | – | – | – |
| PSC | 11 (42) | 76 (72) | 0.35 | 0.16–0.77 | .009 | – | – | – |
| PTC drain vs. ERCP stent | 8 (31) 14 (54) |
12 (11) 47 (45) |
0.61 | 0.26–1.45 | .26 | – | – | – |
| Cholecystectomy | 9 (35) | 24 (23) | 1.49 | 0.66–3.34 | .34 | – | – | – |
| Onset of symptoms (d) | 104 (51–274) | 111 (22–866) | 1.00 | 0.99–1.00 | .41 | – | – | – |
| Mass seen on imaging | 18 (69) | 48 (46) | 3.66 | 1.56–8.59 | .003 | – | – | – |
| Mass largest diameter (cm) | 2.5 (2.0–4.0) | 2.4 (0.6–4.5) | 1.79 | 0.89–3.59 | .10 | – | – | – |
| Mass ≥ 3 cm | 6 (23) | 10 (9) | 3.97 | 1.53–10.35 | .005 | – | – | – |
| Positive / suspicious brushing or biopsy | 17 (65) | 71 (68) | 1.07 | 0.47–2.41 | .87 | – | – | – |
| CA 19-9 (log)* | 2.05 (0.48–4.46) | 1.70 (0–4.42) | 1.85 | 1.24–2.78 | .003 | 1.79 | 1.14–2.80 | .011 |
| CA 19-9 (U/ml) | ||||||||
| <100 (ref) | 13 (50) | 65 (62) | 1.57 | 0.59–4.17 | .12 | – | – | – |
| 100–499 | 6 (23) | 27 (26) | 2.61 | 1.04–6.54 | ||||
| ≥500 | 7 (27) | 11 (10) | ||||||
| MELD score | 10 (6–25) | 10 (6–35) | 1.00 | 0.93–1.07 | .96 | – | – | – |
| Vascular encasement | 12 (46) | 30 (29) | 2.25 | 1.03–4.88 | .04 | – | – | – |
| Complete portal vein encasement | 8 (31) | 11 (11) | 4.19 | 1.78–9.87 | .001 | 3.30 | 1.38–7.86 | .007 |
|
| ||||||||
| Transplant characteristics | ||||||||
|
| ||||||||
| Time on waitlist until OLT (d) | 200 (65–423) | 211 (60–1044) | 1.00 | 1.00–1.00 | .19 | – | – | – |
| Waitlist time ≥1 year | 2 (8) | 29 (28) | 0.25 | 0.06–1.08 | .06 | – | – | – |
| Living donor vs. | 7 (27) | 36 (34) | 0.97 | 0.41–2.33 | .95 | – | – | – |
| Deceased donor (ref) | 19 (73) | 69 (66) | ||||||
| Extended criteria donor# vs. Standard (ref) | 3 (12) 23 (88) |
22 (21) 83 (79) |
0.79 | 0.23–2.63 | .70 | – | – | – |
| Pancreaticoduodenectomy | 4 (15) | 8 (31) | 1.85 | 0.64–5.37 | .26 | – | – | – |
| Cell Saver derived autologous blood transfusion | 11 (42) | 39 (37) | 1.64 | 0.75–3.60 | .22 | – | – | – |
| CA 19-9 (log)* | 2.15 (0.95–3.37) | 1.73 (0.48–3.23) | 2.33 | 1.14–4.75 | .02 | – | – | – |
| MELD | 10 (6–23) | 12 (6–41) | 0.98 | 0.92–1.04 | .51 | – | – | – |
| Residual tumor tissue on explant | 23 (88) | 38 (36) | 9.83 | 2.95–32.76 | <.001 | 9.83 | 2.95–32.76 | <.001 |
| Perineural invasion | 11 (42) | 13 (12) | 4.05 | 1.86–8.83 | <.001 | |||
Given the wide distribution of tumor marker CA 19-9, a logarithmic conversion is used. Each log changes signifies a change of 101 (e.g. from 10 to 100, or 100 to 1000). At presentation, actual median CA 19-9 values were 112 (0-28750) and 45.8 U/ml (0-26200) for the recurrence and no-recurrence group, respectively. At transplant, median CA 19-9 values were 132 (0-2370) and 47.3 U/ml (0-1701) for the recurrence and no-recurrence group, respectively.
ECD criteria included age >65 (N=14), Death after Cardiac Death (N=6), >20% macrosteatosis (N=3) and high risk donor (N=2).