Clinical features and outcomes of combined hepatocellular carcinoma and cholangiocarcinoma versus hepatocellular carcinoma versus cholangiocarcinoma after surgical resection: a propensity score matching analysis

Abstract

Background Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is an infrequent type of primary liver cancer that comprises hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). This study investigated the clinicopathological features and prognosis among cHCC-CC, HCC, and CC groups. Methods We prospectively collected the data of 608 patients who underwent surgical resection for liver cancer between 2011 and 2018 at E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. Overall, 505 patients with cHCC-CC, HCC, and CC were included, and their clinicopathological features, overall survival (OS), and recurrence were recorded. OS and recurrence rates were analyzed using the Kaplan–Meier analysis. Results In the entire cohort, the median age was 61 years and 80% were men. Thirty-five (7.0%) had cHCC-CC, 419 (82.9%) had HCC, and 51 (10.1%) had CC. The clinicopathological features of the cHCC-CC group were more identical to those of the HCC group than the CC group. OS was significantly lower in the cHCC-CC group than in the HCC group but was not significantly higher in the cHCC-CC group than in the CC group. The median OS of cHCC-CC, HCC, and CC groups was 50.1 months [95% confidence interval (CI): 38.7–61.2], 62.3 months (CI: 42.1–72.9), and 36.2 months (CI: 15.4–56.5), respectively. Cumulative OS rates at 1, 3, and 5 years in cHCC-CC, HCC, and CC groups were 88.5%, 62.2%, and 44.0%; 91.2%, 76.1%, and 68.0%; and 72.0%, 48.1%, and 34.5%, respectively. After propensity score matching (PSM), OS in the cHCC-CC group was not significantly different from that in the HCC or CC group. However, OS was significantly higher in the HCC group than in the CC group before and after PSM. Furthermore, the disease-free survival was not significantly different among cHCC-CC, HCC, and CC groups before and after PSM. Conclusion The clinicopathological features of the cHCC-CC group were more identical to those of the HCC group than the CC group. The OS rate was significantly lower in the cHCC-CC group than the HCC group. However, after PSM, OS and disease-free survival in the cHCC-CC group were not significantly different from those in the HCC or CC group.

Anatomical liver resection improves surgical outcomes for combined hepatocellular-cholangiocarcinoma: A propensity score matched study

“…In our study, the clinicopathological features of cHCC-CCA were more similar to those of patients suffering from HCC infected with HBV (hepatitis B virus), both of which are associated with elevated AFP levels in most patients. The results of this study are consistent with those of previous studies ( 15 , 21 ). In clinical settings, cHCC-CCA is often misdiagnosed as either HCC or iCCA via imaging or hematology tests due to non-specific clinical manifestations, and a confirmed diagnosis of cHCC-CCA usually requires surgical resection ( 22 ).…”

“…Since preoperative biopsy is not routinely used to diagnose cHCC-CCA (as large sampling areas are required and have low sensitivity of detection), some studies have explored the use of other risk factors to differentiate between cHCC-CCA and HCC or iCCA. Some of these factors include sex (men are more likely to develop cHCC-CCA than women), and the presence of chronic liver damage, cirrhosis, hepatitis infection, familial history of liver cancer, alcoholism, and diabetes ( 21 , 23 ). Although both CA199 and AFP levels are expected to be higher than normal in cHCC-CCA patients, in this study, we found that elevated AFP levels were more common than elevated CA199 levels.…”

Histological Heterogeneity of Primary Liver Cancers: Clinical Relevance, Diagnostic Pitfalls and the Pathologist’s Role

“…With regard to prognosis, the overall survival rate is significantly better in HCC compared to iCCA and cHCC-CCA. When comparing iCCA and cHCC-CCA, cHCC-CCA tends to show better outcome compared to iCCA, but without statistical value [48,49]. Table 1 summarizes the histological subtypes of PLCs and their prognosis.…”

The Value of Contrast-Enhanced Magnetic Resonance Imaging Enhancement in the Differential Diagnosis of Hepatocellular Carcinoma and Combined Hepatocellular Cholangiocarinoma

“…It was found that there was no statistical significance in other aspects except the ratio of single focus to multiple lesions and the probability of mass complications with liver cirrhosis through the study of the clinical date of the two groups of patients. Lin et al [ 24 ] found that the incidence of cHCC-CC in men is higher. However, in this study, these two types of liver cancer are not statistically significant in terms of gender and age.…”