Patients' prognosis of intrahepatic cholangiocarcinoma and combined hepatocellular‐cholangiocarcinoma after resection

Abstract

Combined hepatocellular‐cholangiocarcinoma (cHCC‐CC) and intrahepatic cholangiocarcinoma (ICC) are classified into one category, but comparison of prognosis of the two carcinomas remains controversial. The aim of the current study was to investigate surgical outcomes for patients with ICC or cHCC‐CC who underwent resection in order to elucidate whether the classification of ICC and cHCC‐CC is justified. Subjects were 61 patients with ICC and 29 patients with cHCC‐CC who underwent liver resection from 2001 to 2017. Clinic‐pathological data from the two groups were compared. Tumor number and vascular invasion were independent risk factors for recurrence‐free survival (RFS) in both groups (P < .001 for both). Of note, for patients with ICC, tumor cut‐off size of 5 cm showed statistical significance in median RFS (>5 cm vs ≤5 cm, 0.5 years vs 4.0 years, P = .003). For patients with cHCC‐CC, tumor cut‐off size of 2 cm showed statistical significance in median RFS (>2 cm vs ≤2 cm, 0.6 years vs 2.6 years, P = .038). The median RFS of patients with cHCC‐CC was 0.9 years (95% confidence interval: 0.3‐1.6), which was poorer than that of patients with ICC (1.3 years, 0.5‐2.1) (P = .028); the rate of RFS at 5 years was 0% and 37.7% respectively. Our study supports the concept of classifying ICC and cHCC‐CC into different categories because of a significant difference in RFS between the two.

Albumin-to-Alkaline Phosphatase Ratio is an Independent Prognostic Indicator in Combined Hepatocellular and Cholangiocarcinoma

“…Some researchers suggested that cHCC-CCA had poorer survival outcome than both HCC and CC [5], whereas other investigations showed a better or similar prognosis of cHCC-CCA compared to CC [6,7]. Several prognostic factors for cHCC-CCA have been identified, including performance status, Child-Pugh (CP) grade, tumor size, tumor number, carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) [7][8][9][10]. However, these findings still remain controversial and need further validations, due to the small sample size and inconsistent pathological diagnostic criteria.…”

Therapy of Primary Liver Cancer

“…The treatment options for cHCC-ICC are similar to those for HCC and ICC and include surgery, radiation, yttrium-90 radioembolization, chemotherapy, combined radiation and chemotherapy, combined surgery and chemotherapy, and triple therapy (surgery, radiation, and chemotherapy). 41 , 66 , 67 , 68 , 69 A recently retrospective analysis from 2001 to 2015 of 623 PLC patients, including 47 cHCC-ICC, 468 HCC, and 108 ICC patients, who underwent resection found that although cHCC-ICC is more poorly differentiated than HCC and ICC, it had a similar 5-year survival rate (49.7%, 54.8%, and 68.7%, respectively) and 3-year recurrence rate (57.9%, 61.5%, 56%, respectively). 70 …”

High C-reactive protein/albumin ratio associated with reduced survival due to advanced stage of intrahepatic cholangiocarcinoma

“…All patients were followed for postoperative recurrence as described previously (26). Briefly, tumor marker levels, including those of carcinoembryonic antigen and carbohydrate antigen 19-9 (CA19-9), were measured, and imaging studies, including computed tomography and ultrasonography, were performed every three months in all patients.…”