William Cambridge

Medical Student Essay Prize

“Meta-analysis and Meta-regression of Survival After Liver Transplantation for Unresectable Perihilar Cholangiocarcinoma.”

Sadly, the survival rate for many types of liver cancer is extremely low. However, surgery does have the potential to extend life expectancy for at least some patients.

In the United Kingdom, curative therapy for perihilar cholangiocarcinoma (pCCA – a rare type of bile duct cancer) remains limited to surgical resection. However, the majority of patients with pCCA present with unresectable disease and are treated palliatively, whilst those with resectable pCCA have poor outcomes, 5-year overall survival reported as between 35 and 45%.

Nevertheless, in various centres across the United States & Europe, the use of neoadjuvant chemoradiation and liver transplantation to treat unresectable pCCA has become increasingly common, with impressive outcomes reported.

“We completed a systematic review and meta-analysis aiming to evaluate the outcomes of patients undergoing transplantation, with and without neoadjuvant chemoradiation, for unresectable pCCA. Sub-group analysis of papers identified through this review found that those undergoing neoadjuvant chemoradiation and liver transplantation had a pooled 5-year overall survival of 65.1%.

Additionally, we undertook to determine whether the proportion of patients with primary sclerosing cholangitis (PSC) per study affected overall survival.

At 5-years there was a positive correlation between the number of PSC patients and overall survival. Despite these results, transplantation is still contraindicated for those with unresectable pCCA in the UK. Our systematic review and meta-analysis has shown that, in selected patients able to complete a neoadjuvant-transplant protocol, survival exceeds the 50% 5-year overall survival threshold required by many European transplant centres, and that serious consideration should be given to expanding transplantation to those with pCCA in the UK, especially in the setting of PSC.

I hope that more treatment options become available for those with cholangiocarcinoma, hopefully improving outcomes for those suffering from this rare cancer.”

Why did you choose this project?

“I chose to complete this project due to my interest in both surgical oncology and hepatopancreaticobiliary surgery, a career path I am to pursue. This aim has only been strengthened following the completion of this project and being honoured with this prize.

Additionally, one of the reasons I was inspired to complete this project was my interest in liver surgery. Survival rates for many types of liver cancer are sadly extremely low, yet conversely, surgery has the potential to extend life expectancy for at least some patients.”