Analysis of Clinicopathological Characteristics and Prognostic Factors of 31 Patients with Combined Hepatocellular and Cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANGJie , XIONGXian-ze ,  CHENGNan-sheng

Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding?author：

CHENGNan-sheng, Email: nscheng2002@163.com

Keywords：

Combined hepatocellular and cholangiocarcinoma; Liver resection; Prognosis

DOI：

10.7507/1007-9424.20140105

Video：

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Objective To explore the clinicopathological characteristics of combined hepatocellular and cholangiocarcinoma (cHCC-CC), and the prognostic factors associated with survival. Methodes The clinical features of 31 patients with cHCC-CC from 1995 to 2010 in West China Hospital of Sichuan University underwent liver resection were analyzed retrospectively. The prognostic factors were analyzed by using univariate and multivariate analysis. Results Of these 31 patients, 25 men and 6 women, with a median age of 58 years, underwent liver resection for cHCC-CC. Twentythree cases (74.2%) showed positive of hepatitis B surface antigen (HBsAg), 13 cases (41.9%) had elevated AFP≥20μg/L, 18 cases (58.1%) with liver cirrhosis, 8 cases (25.8%) showed presence of lymph node metastases. The 1-, 3-, and 5-year overall survival rates of these patients were 61.3%, 32.3%, and 12.9%, respectively. Univariate analysis showed that invasion of portal vein, microscopic tumor thrombi, positive resection margins, and lymph node involvement were significant prognostic factors. Multiple analysis revealed the positive resection margins and lymph node involvement were independent prognostic factors for overall survival. Conclusions The prognosis of patients with cHCC-CC is poor. R0 resection is the only available treatment in curing these patients.

Citation： ZHANGJie, XIONGXian-ze, CHENGNan-sheng. Analysis of Clinicopathological Characteristics and Prognostic Factors of 31 Patients with Combined Hepatocellular and Cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(4): 432-436. doi: 10.7507/1007-9424.20140105 Copy

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9.	Maeda T, Adachi E, Kajiyama K, et al. Combined hepatoce-llular and cholangiocarcinoma:proposed criteria according to cytokeratin expression and analysis of clinicopathologic features[J]. Human Pathol, 1995, 26(9):956-964.
10.	Taguchi J, Nakashima O, Tanaka M, et al. A clinicopathological study on combined hepatocellular and cholangiocarcinoma[J]. J Gastroenterol Hepatol, 1996, 11(8):758-764.
11.	Yano Y, Yamamoto J, Kosuge T, et al. Combined hepatocellular and cholangiocarcinoma:a clinicopathologic study of 26 resected cases[J]. Jpn J Clin Oncol, 2003, 33(6):283-287.
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14.	Park H, Choi KH, Choi SB, et al. Clinicopathological characteristics in combined hepatocellular-cholangiocarcinoma:a single center study in Korea[J]. Yonsei Med J, 2011, 52(5):753-760.
15.	Lin G, Toh CH, Wu RC, et al. Combined hepatocellular cholang-iocarcinoma:prognostic factors investigated by computed tomography/magnetic resonance imaging[J]. Int J Clin Pract, 2008, 62(8):1199-1205.
16.	Panjala C, Senecal DL, Bridges MD, et al. The diagnostic conu-ndrum and liver transplantation outcome for combined hepatocellular-cholangiocarcinoma[J]. Am J Transplant, 2010, 10(5):1263-1267.
17.	夏振中, 林小軍, 勞向明, 等. 27例混合型肝癌臨床特點分析[J].中國腫瘤臨床, 2008, 35(14):801-807.
18.	Kassahun WT, Hauss J. Management of Combined Hepatocellular and Cholangiocarcinoma[J]. Int J Clin Pract, 2008, 62(8):1271-1278.
19.	Zuo HQ, Yan LN, Zeng Y, et al. Clinicopathological characteristics of 15 patients with combined hepatocellular carcinoma and cholangiocarcinoma[J]. Hepatobiliary Pancreat Dis Int, 2007, 6(2):161-165.
20.	Lee JH, Chung GE, Yu SJ, et al. Long-term prognosis of comb-ined hepatocellular and cholangiocarcinoma after curative resection comparison with hepatocellular carcinom a and cholangiocarcinoma[J]. J Clin Gastroentero, 2011, 45(1):69-75.
21.	Liu CL, Fan ST, Lo CM, et al. Hepatic resection for combined hepatocellular and cholangiocarcinoma[J]. Arch Surg, 2003, 138(1):86-90.
22.	Jarnagin WR, Weber S, Tickoo SK, et al. Combined hepatoce-llular and cholangiocarcinoma:demographic, clinical, and prognostic factors[J]. Cancer, 2002, 94(7):2040-2046.
23.	Kim KH, Lee SG, Park EH, et al. Surgical treatments and prog-noses of patients with combined hepatocellular carcinoma and chol-angiocarcinoma[J]. Ann Surg Oncol, 2009, 16(3):623-629.
24.	Vauthey JN, Pawlik TM, Abdalla EK, et al. Is extended hepatec tomy for hepatobiliary malignancy justified?[J]. Ann Surg, 2004, 239(5):722-732.
25.	Chou FF, Sheen-Chen SM, Chen CL, et al. Prognostic factors of resectable intrahepatic cholangiocarcinoma[J]. J Surg Oncol, 1995, 59(1):40-44.

1. Hamilton SR, Aaltonen IA. WHO Classification of Tumours. Pathology and Genetics of Tumours of the Digestive System[M]. Lyon:IARC Press, 2000:179-180.
2. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors[M]. 7^th ed. Hoboken:John Wiley & Sons, 2009:241-249.
3. Lee CC, Wu CY, Chen JT, et al. Comparing combined hepatocellularcholangiocarcinoma and cholangiocarcinoma:a clinicopathological study[J]. Hepatogastroenterology, 2002, 49(48):1487-1490.
4. Goodman ZD, Ishak KG, Langloss JM, et al. Combined hepato-cellular cholangiocarcinoma. A histologic and immunohistochemical study[J]. Cancer, 1985, 55(1):124-135.
5. Wachtel MS, Zhang Y, Xu T, et al. Combined hepatocellular cholangiocarcinomas; analysis of a large database[J]. Clin Med Pathol, 2008, l(1):43-47.
6. Ng IO, Shek TW, Nicholls J, et al. Combined Hepatocellular-cholangiocarcinoma:a clinicopathological study[J]. J Gastroenterol Hepatol, 1998, 13(1):34-40.
7. Allen RA, Lisa JR. Combined liver cell and bile duct carcinoma[J]. Am J Pathol, 1949, 25(4):647-655.
8. 殷欣, 張博恒, 陳曉泓, 等. 115例混合型肝癌臨床病理特征及預后分析[J].中華消化雜志, 2011, 31(2):73-76.
9. Maeda T, Adachi E, Kajiyama K, et al. Combined hepatoce-llular and cholangiocarcinoma:proposed criteria according to cytokeratin expression and analysis of clinicopathologic features[J]. Human Pathol, 1995, 26(9):956-964.
10. Taguchi J, Nakashima O, Tanaka M, et al. A clinicopathological study on combined hepatocellular and cholangiocarcinoma[J]. J Gastroenterol Hepatol, 1996, 11(8):758-764.
11. Yano Y, Yamamoto J, Kosuge T, et al. Combined hepatocellular and cholangiocarcinoma:a clinicopathologic study of 26 resected cases[J]. Jpn J Clin Oncol, 2003, 33(6):283-287.
12. Zhang F, Chen XP, Zhang W, et al. Combined hepatocellular cholangiocarcinoma originating from hepatic progenitor cells:immunohistochemical and double-fluorescence immunostaining evidence[J]. Histopathology, 2008, 52(2):224-232.
13. Tickoo SK, Zee SY, Obiekwe S, et al. Combined hepatocellular cholangiocarcinoma:A histopathologic, immunohistochemical, and in situ hybridization study[J]. Am J Surg Pathol, 2002, 26(8):989-997.
14. Park H, Choi KH, Choi SB, et al. Clinicopathological characteristics in combined hepatocellular-cholangiocarcinoma:a single center study in Korea[J]. Yonsei Med J, 2011, 52(5):753-760.
15. Lin G, Toh CH, Wu RC, et al. Combined hepatocellular cholang-iocarcinoma:prognostic factors investigated by computed tomography/magnetic resonance imaging[J]. Int J Clin Pract, 2008, 62(8):1199-1205.
16. Panjala C, Senecal DL, Bridges MD, et al. The diagnostic conu-ndrum and liver transplantation outcome for combined hepatocellular-cholangiocarcinoma[J]. Am J Transplant, 2010, 10(5):1263-1267.
17. 夏振中, 林小軍, 勞向明, 等. 27例混合型肝癌臨床特點分析[J].中國腫瘤臨床, 2008, 35(14):801-807.
18. Kassahun WT, Hauss J. Management of Combined Hepatocellular and Cholangiocarcinoma[J]. Int J Clin Pract, 2008, 62(8):1271-1278.
19. Zuo HQ, Yan LN, Zeng Y, et al. Clinicopathological characteristics of 15 patients with combined hepatocellular carcinoma and cholangiocarcinoma[J]. Hepatobiliary Pancreat Dis Int, 2007, 6(2):161-165.
20. Lee JH, Chung GE, Yu SJ, et al. Long-term prognosis of comb-ined hepatocellular and cholangiocarcinoma after curative resection comparison with hepatocellular carcinom a and cholangiocarcinoma[J]. J Clin Gastroentero, 2011, 45(1):69-75.
21. Liu CL, Fan ST, Lo CM, et al. Hepatic resection for combined hepatocellular and cholangiocarcinoma[J]. Arch Surg, 2003, 138(1):86-90.
22. Jarnagin WR, Weber S, Tickoo SK, et al. Combined hepatoce-llular and cholangiocarcinoma:demographic, clinical, and prognostic factors[J]. Cancer, 2002, 94(7):2040-2046.
23. Kim KH, Lee SG, Park EH, et al. Surgical treatments and prog-noses of patients with combined hepatocellular carcinoma and chol-angiocarcinoma[J]. Ann Surg Oncol, 2009, 16(3):623-629.
24. Vauthey JN, Pawlik TM, Abdalla EK, et al. Is extended hepatec tomy for hepatobiliary malignancy justified?[J]. Ann Surg, 2004, 239(5):722-732.
25. Chou FF, Sheen-Chen SM, Chen CL, et al. Prognostic factors of resectable intrahepatic cholangiocarcinoma[J]. J Surg Oncol, 1995, 59(1):40-44.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of Clinicopathological Characteristics and Prognostic Factors of 31 Patients with Combined Hepatocellular and Cholangiocarcinoma

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