Combined hepatocellular and cholangiocarcinoma
Open Access
- 28 March 2002
- Vol. 94 (7), 2040-2046
- https://doi.org/10.1002/cncr.10392
Abstract
BACKGROUND Tumors with combined hepatocellular and cholangiocellular features are well known histopathologically but their clinical behavior is poorly understood. The objectives of the current study were to define the demographic profile of the patients in whom these uncommon tumors occur and to evaluate treatment outcome in comparison with that in patients with either hepatocellular carcinoma (HCC) or peripheral cholangiocarcinoma (CC) alone. METHODS Twenty‐seven patients with combined tumors were identified from a prospective database. Pathologic specimens were analyzed to confirm the diagnosis. Demographics, clinical data, and survival were analyzed. Outcome after resection was compared with that of patients with CC and with a matched group of patients with HCC. RESULTS The gender distribution of the combined tumors (52% men and 48% women) was intermediate between HCC (67% men and 33% women) and CC (30% men and 70% women) (P = 0.03). The incidence of positive hepatitis B or C serology and cirrhosis was similar in patients with combined tumors and those with CC (15% and 0% vs. 13% and 4%, respectively); similarly, patients of Asian heritage constituted 7% and 9%, respectively, of the patients with these tumors. By contrast, cirrhosis (41%) and positive hepatitis serology (56%) were far more common in patients with HCC, and 19% of these patients were of Asian heritage. Twenty‐one of 27 patients with combined tumors (78%) underwent resection. All 6 patients with combined tumors that were not amenable to resection died of disease within 18 months. After resection, the 5‐year survival was lowest in patients with combined tumors (24%) but was not significantly different from that in patients with CC (33%) or HCC (37%). The liver was the most common site of recurrence in all three groups. CONCLUSIONS The demographic and clinical features of patients with combined tumors were most similar to those of patients with CC. Most important, combined tumors were not found to be associated with chronic liver disease; consequently, the resectability rate was higher for these tumors than typically is reported for HCC. Resection was associated with long‐term survival in some patients, but recurrent hepatic disease was common. The presence of cholangiocellular differentiation appeared to worsen the prognosis when compared with pure HCC, although this difference did not reach statistical significance. Cancer 2002;94:2040–6. © 2002 American Cancer Society. DOI 10.1002/cncr.10392Keywords
This publication has 16 references indexed in Scilit:
- Intrahepatic Cholangiocarcinoma: Resectability, Recurrence Pattern, and OutcomesJournal of the American College of Surgeons, 2001
- An Analysis of 412 Cases of Hepatocellular Carcinoma at a Western CenterAnnals of Surgery, 1999
- Surgical treatment of 32 patients with peripheral intrahepatic cholangiocarcinomaBritish Journal of Surgery, 1998
- A Clinicopathological study on combined hepatocellular and cholangiocarcinomaJournal of Gastroenterology and Hepatology, 1996
- Histogenesis of primary liver carcinomas: Strengths and weaknesses of cytokeratin profile and albumin mRNA detectionHuman Pathology, 1996
- Combined hepatocellular and cholangiocarcinoma: Proposed criteria according to cytokeratin expression and analysis of clinicopathologic featuresHuman Pathology, 1995
- Combined Hepatocellular-Cholangiocarcinoma with Variabl Sarcomatous TransformationAmerican Journal of Clinical Pathology, 1988
- Experience with Portacaval Shunt for Portal HypertensionThe New England Journal of Medicine, 1961
- Nonparametric Estimation from Incomplete ObservationsJournal of the American Statistical Association, 1958
- PRIMARY CARCINOMA OF THE LIVERThe American Journal of the Medical Sciences, 1903