Clinical characteristics and prognostic factors of 41 cases of combined hepatocellular cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Hao ,  YU Xiaojiong

Department of Hepatobiliary Surgery, Sichuan Provincial People’s Hospital & Affiliated Hospital of University of Electronic Science and Technology of China, Chengdu 610072, P. R. China;

Corresponding author：

YU Xiaojiong, Email: Xjytao2006@126.com

Keywords：

combined hepatocellular cholangiocarcinoma; clinical feature; prognosis

DOI：

10.7507/1007-9424.201710030

Video：

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Objective To study the data of combined hepatocellular cholangiocarcinoma (CHCC) and to explore its clinical characteristics and prognostic factors. Methods Clinical data of 41 patients with radical resection of CHCC were retrospectively analyzed, and the prognostic factors were analyzed by univariate and multivariate analysis. Results In 36.6% cases of 41 patients with CHCC, the elevated levels of both AFP and CA19-9 were detected. And 78.0% cases got the elevated levels of CK7 and (or) CK19 and Glypcian-3 and (or) hepatocyte. Multiple analysis revealed lymph node involvement was independent prognostic factor for overall survival. Conclusions CHCC is a special type of primary liver cancer and shows some intermediated characteristics between hepatocellular carcinoma and cholangiocarcinoma. The long-term survival of the patients should be affected by the residual of metastasis lymph nodes, and the surgical treatment should be individualized at the present stage.

Citation： ZHANG Hao, YU Xiaojiong. Clinical characteristics and prognostic factors of 41 cases of combined hepatocellular cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(3): 301-306. doi: 10.7507/1007-9424.201710030 Copy

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2.	Park HS, Bae JS, Jang KY, et al. Clinicopathologic study on combined hepatocellular carcinoma and cholangiocarcinoma: with emphasis on the intermediate cell morphology. J Korean Med Sci, 2011, 26(8): 1023-1030.
3.	Cai X, Zhai J, Kaplan DE, et al. Background progenitor activation is associated with recurrence after hepatectomy of combined hepatocellular-cholangiocarcinoma. Hepatology, 2012, 56(5): 1804-1816.
4.	Goodman ZD, Ishak KG, Langloss JM, et al. Combined hepatocellular-cholangiocarcinoma. A histologic and immunohistochemical study. Cancer, 1985, 55(1): 124-135.
5.	Libbrecht L. Hepatic progenitor cells in human liver tumor development. World J Gastroenterol, 2006, 12(39): 6261-6265.
6.	Bosman FT, Hruban RH, Theise ND. WHO classification of tumours of the digestive system. 4^th ed. Lyon: International Agency for Research on Cancer, 2010: 225-227.
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8.	Green FL, Balch CM, Fleming ID, et al. AJCC Cancer Staging Manual: TNM classification of Malignant Tumors (6^th ed.). New York: Springer, 2002: 131-138.
9.	Wang J, Wang F, Kessinger A. Outcome of combined hepatocellular and cholangiocarcinoma of the liver. J Oncol, 2010, 2010. pii: 917356.
10.	Jarnagin WR, Weber S, Tickoo SK, et al. Combined hepatocellular and cholangiocarcinoma: demographic, clinical, and prognostic factors. Cancer, 2002, 94(7): 2040-2046.
11.	Akiba J, Nakashima O, Hattori S, et al. Clinicopathologic analysis of combined hepatocellular-cholangiocarcinoma according to the latest WHO classification. Am J Surg Pathol, 2013, 37(4): 496-505.
12.	Park H, Choi KH, Choi SB, et al. Clinicopathological characteristics in combined hepatocellular-cholangiocarcinoma: a single center study in Korea. Yonsei Med J, 2011, 52(5): 753-760.
13.	储开建, 陆崇德, 姚晓平. 肝细胞-胆管细胞混合型肝癌的诊治进展. 中华肝胆外科杂志, 2012, (7): 561-563.
14.	Lee SD, Park SJ, Han SS, et al. Clinicopathological features and prognosis of combined hepatocellular carcinoma and cholangiocarcinoma after surgery. Hepatobiliary Pancreat Dis Int, 2014, 13(6): 594-601.
15.	O’Connor K, Walsh JC, Schaeffer DF. Combined hepatocellular-cholangiocarcinoma (cHCC-CC): a distinct entity. Ann Hepatol, 2014, 13(3): 317-322.
16.	Connell LC, Harding JJ, Shia J, et al. Combined intrahepatic cholangiocarcinoma and hepatocellular carcinoma. Chin Clin Oncol, 2016, 5(5): 66.
17.	Panjala C, Senecal DL, Bridges MD, et al. The diagnostic conundrum and liver transplantation outcome for combined hepatocellular-cholangiocarcinoma. Am J Transplant, 2010, 10(5): 1263-1267.
18.	Lee CH, Hsieh SY, Chang CJ, et al. Comparison of clinical characteristics of combined hepatocellular-cholangiocarcinoma and other primary liver cancers. J Gastroenterol Hepatol, 2013, 28(1): 122-127.
19.	Zhan Q, Shen BY, Deng XX, et al. Clinical and pathological analysis of 27 patients with combined hepatocellular-cholangiocarcinoma in an Asian center. J Hepatobiliary Pancreat Sci, 2012, 19(4): 361-369.
20.	张捷, 熊先泽, 程南生. 31 例混合型肝癌的临床病理特点与预后因素分析. 中国普外基础与临床杂志, 2014, 21(4): 432-436.
21.	Lee JH, Chung GE, Yu SJ, et al. Long-term prognosis of combined hepatocellular and cholangiocarcinoma after curative resection comparison with hepatocellular carcinoma and cholangiocarcinoma. J Clin Gastroenterol, 2011, 45(1): 69-75.
22.	Ijichi H, Shirabe K, Taketomi A, et al. Clinical usefulness of (18) F-fluorodeoxyglucose positron emission tomography/computed tomography for patients with primary liver cancer with special reference to rare histological types, hepatocellular carcinoma with sarcomatous change and combined hepatocellular and cholangiocarcinoma. Hepatol Res, 2013, 43(5): 481-487.
23.	Fowler KJ, Sheybani A, Parker RA 3rd, et al. Combined hepatocellular and cholangiocarcinoma (biphenotypic) tumors: imaging features and diagnostic accuracy of contrast-enhanced CT and MRI. AJR Am J Roentgenol, 2013, 201(2): 332-339.
24.	Ariizumi S, Kotera Y, Katagiri S, et al. Combined hepatocellular-cholangiocarcinoma had poor outcomes after hepatectomy regardless of Allen and Lisa class or the predominance of intrahepatic cholangiocarcinoma cells within the tumor. Ann Surg Oncol, 2012, 19(5): 1628-1636.
25.	Magistri P, Tarantino G, Serra V, et al. Liver transplantation and combined hepatocellular-cholangiocarcinoma: Feasibility and outcomes. Dig Liver Dis, 2017, 49(5): 467-470.

1. Allen RA, Lisa JR. Combined liver cell and bile duct carcinoma. Am J Pathol, 1949, 25(4): 647-655.
2. Park HS, Bae JS, Jang KY, et al. Clinicopathologic study on combined hepatocellular carcinoma and cholangiocarcinoma: with emphasis on the intermediate cell morphology. J Korean Med Sci, 2011, 26(8): 1023-1030.
3. Cai X, Zhai J, Kaplan DE, et al. Background progenitor activation is associated with recurrence after hepatectomy of combined hepatocellular-cholangiocarcinoma. Hepatology, 2012, 56(5): 1804-1816.
4. Goodman ZD, Ishak KG, Langloss JM, et al. Combined hepatocellular-cholangiocarcinoma. A histologic and immunohistochemical study. Cancer, 1985, 55(1): 124-135.
5. Libbrecht L. Hepatic progenitor cells in human liver tumor development. World J Gastroenterol, 2006, 12(39): 6261-6265.
6. Bosman FT, Hruban RH, Theise ND. WHO classification of tumours of the digestive system. 4^th ed. Lyon: International Agency for Research on Cancer, 2010: 225-227.
7. Garancini M, Goffredo P, Pagni F, et al. Combined hepatocellular-cholangiocarcinoma: a population-level analysis of an uncommon primary liver tumor. Liver Transpl, 2014, 20(8): 952-959.
8. Green FL, Balch CM, Fleming ID, et al. AJCC Cancer Staging Manual: TNM classification of Malignant Tumors (6^th ed.). New York: Springer, 2002: 131-138.
9. Wang J, Wang F, Kessinger A. Outcome of combined hepatocellular and cholangiocarcinoma of the liver. J Oncol, 2010, 2010. pii: 917356.
10. Jarnagin WR, Weber S, Tickoo SK, et al. Combined hepatocellular and cholangiocarcinoma: demographic, clinical, and prognostic factors. Cancer, 2002, 94(7): 2040-2046.
11. Akiba J, Nakashima O, Hattori S, et al. Clinicopathologic analysis of combined hepatocellular-cholangiocarcinoma according to the latest WHO classification. Am J Surg Pathol, 2013, 37(4): 496-505.
12. Park H, Choi KH, Choi SB, et al. Clinicopathological characteristics in combined hepatocellular-cholangiocarcinoma: a single center study in Korea. Yonsei Med J, 2011, 52(5): 753-760.
13. 储开建, 陆崇德, 姚晓平. 肝细胞-胆管细胞混合型肝癌的诊治进展. 中华肝胆外科杂志, 2012, (7): 561-563.
14. Lee SD, Park SJ, Han SS, et al. Clinicopathological features and prognosis of combined hepatocellular carcinoma and cholangiocarcinoma after surgery. Hepatobiliary Pancreat Dis Int, 2014, 13(6): 594-601.
15. O’Connor K, Walsh JC, Schaeffer DF. Combined hepatocellular-cholangiocarcinoma (cHCC-CC): a distinct entity. Ann Hepatol, 2014, 13(3): 317-322.
16. Connell LC, Harding JJ, Shia J, et al. Combined intrahepatic cholangiocarcinoma and hepatocellular carcinoma. Chin Clin Oncol, 2016, 5(5): 66.
17. Panjala C, Senecal DL, Bridges MD, et al. The diagnostic conundrum and liver transplantation outcome for combined hepatocellular-cholangiocarcinoma. Am J Transplant, 2010, 10(5): 1263-1267.
18. Lee CH, Hsieh SY, Chang CJ, et al. Comparison of clinical characteristics of combined hepatocellular-cholangiocarcinoma and other primary liver cancers. J Gastroenterol Hepatol, 2013, 28(1): 122-127.
19. Zhan Q, Shen BY, Deng XX, et al. Clinical and pathological analysis of 27 patients with combined hepatocellular-cholangiocarcinoma in an Asian center. J Hepatobiliary Pancreat Sci, 2012, 19(4): 361-369.
20. 张捷, 熊先泽, 程南生. 31 例混合型肝癌的临床病理特点与预后因素分析. 中国普外基础与临床杂志, 2014, 21(4): 432-436.
21. Lee JH, Chung GE, Yu SJ, et al. Long-term prognosis of combined hepatocellular and cholangiocarcinoma after curative resection comparison with hepatocellular carcinoma and cholangiocarcinoma. J Clin Gastroenterol, 2011, 45(1): 69-75.
22. Ijichi H, Shirabe K, Taketomi A, et al. Clinical usefulness of (18) F-fluorodeoxyglucose positron emission tomography/computed tomography for patients with primary liver cancer with special reference to rare histological types, hepatocellular carcinoma with sarcomatous change and combined hepatocellular and cholangiocarcinoma. Hepatol Res, 2013, 43(5): 481-487.
23. Fowler KJ, Sheybani A, Parker RA 3rd, et al. Combined hepatocellular and cholangiocarcinoma (biphenotypic) tumors: imaging features and diagnostic accuracy of contrast-enhanced CT and MRI. AJR Am J Roentgenol, 2013, 201(2): 332-339.
24. Ariizumi S, Kotera Y, Katagiri S, et al. Combined hepatocellular-cholangiocarcinoma had poor outcomes after hepatectomy regardless of Allen and Lisa class or the predominance of intrahepatic cholangiocarcinoma cells within the tumor. Ann Surg Oncol, 2012, 19(5): 1628-1636.
25. Magistri P, Tarantino G, Serra V, et al. Liver transplantation and combined hepatocellular-cholangiocarcinoma: Feasibility and outcomes. Dig Liver Dis, 2017, 49(5): 467-470.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical characteristics and prognostic factors of 41 cases of combined hepatocellular cholangiocarcinoma

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