Management and outcomes among patients with mixed hepatocholangiocellular carcinoma: A population‐based analysis

Abstract

Background We sought to define the management of mixed hepatocellular carcinoma‐intrahepatic cholangiocarcinoma (HCC‐ICC) as well as characterize short‐ and long‐term outcomes of patients with mixed HCC‐ICC. Methods Patients diagnosed with HCC‐ICC, HCC, or ICC between 2004 and 2015 were identified from the National Cancer Data Base using the International Classification of Diseases for Oncology codes. Short‐ and long‐term outcomes were assessed using univariate and multivariate analyses. Results Among 174 454 patients, 86.8% had HCC, 12.1% ICC, and 1.1% HCC‐ICC. The incidence of lymphadenectomy was 55.6% among ICC patients vs 15.1% and 34.2% for HCC and HCC‐ICC patients, respectively (P < 0.001). A 90‐day mortality was comparable among patients with HCC (9.1%), ICC (8.8%), and HCC‐ICC (10.5%) (all P > 0.2). While 42.0% of ICC patients received adjuvant chemotherapy, adjuvant chemotherapy among HCC and HCC‐ICC patients was 13.1% and 27.4%, respectively (P < 0.001). A 5‐year survival was 43.5% (95% CI, 42.5‐44.5), 33.3% (95% CI, 31.4‐35.3), 34.4% (95% CI, 29.1‐39.8) for HCC, ICC, and HCC‐ICC patients, respectively. Conclusion Patients who underwent resection of mixed HCC‐ICC had a prognosis that was comparable to ICC, yet worse than HCC. Utilization of lymphadenectomy and adjuvant therapy were low. HCC‐ICC remains a rare disease with a guarded prognosis that should be treated in a multidisciplinary setting.

The clinical characteristics and prognostic factors of combined Hepatocellular Carcinoma and Cholangiocarcinoma, Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma after Surgical Resection: A propensity score matching analysis

“…Lymph node infiltration was associated with poor survival of cHCC-CC after surgery [15,24]. In the present study, the incidence of lymph node infiltration in cHCC-CC was 13.3% and patients with positive LN infiltration survived significant poor prognosis than those negative (median overall survival time, positive vs. negative, 22.1 months vs. 12.9 months, p=0.019).…”

“…In further, cHCC-CC patients with positive LN infiltration suffered an unfavorable average overall survival time of 7.8 months than those of 20.2 months in negative LN [13]. Another population-based study suggested that lymph node status of cHCC-CC were strongly associated with overall survival, with a remarkable increased risk of death in positive LN patients [15]. A recent systematic review of cHCC-CC revealed that LN metastasis was strongly associated with decreased overall survival after surgical resection, with a hazards ratio of 2.84, p<0.0001 [26].…”

“…This can be demonstrated by previous study which reported the prognosis of cHCC-CC was worse than HCC, however, comparable with ICC, with median overall survival time of 6.0 months, 17.4 months, and 4.4 months in cHCC-CC, HCC and ICC, respectively [12]. Another population-based study suggested that the 5-year OS rate of cHCC-CC, HCC and ICC was 34.4%, 43.5% and 33.3%, respectively [15]. The clinical characteristics and prognosis of cHCC-CC were different from HCC and ICC, suggesting that cHCC-CC was a distinct entity of primary liver malignancy and should be treated individually.…”

“…cHCC-CC is a distinct entity of primary liver tumor, with a proportion of about 0.8-6.5% in primary liver malignancy [2,6,15,17,18]. However, the results of previous studies regarding to outcomes of cHCC-CC were inconsistent.…”

“…Albeit the clinical characteristics and prognosis of among cHCC-CC, HCC and ICC had been widely discussed for years, the results yielded in their studies were still inconsistent [2,4,6,[11][12][13][14]. Most of the previous studies found that cHCC-CC had worse prognosis than HCC [2, 4-6, 12, 15-19], while some of them suggest the prognosis of cHCC-CC was better than ICC [2,4,6], and others insisted opposite conclusion [5,12,[15][16][17][18][19]. In the literature review, large-scale studies regarding to the long-term outcome among cHCC-CC, HCC and ICC were limited and a recently western series which comprised 623 patients found that no significant difference of 5-year survival rate of cHCC-CC, HCC as well as ICC after surgical resection [11].…”