Post-resection prognosis of combined hepatocellular carcinoma-cholangiocarcinoma cannot be predicted by the 2019 World Health Organization classification

Kim, Minjae; Hwang, Shin; Ahn, Curie; Kim, Ki‐Hun; Moon, Deok‐Bog; Song, Gi‐Won; Jung, Dong‐In; Hong, Seung‐Mo

doi:10.1016/j.asjsur.2021.03.002

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…While subclasses of “stem-cell tumors” were characterized in the 2010 edition of the WHO “Blue Book” [ 81 ], the more recent edition [ 82 ] has eliminated the term as a diagnostic category in all primary liver cancers. Nonetheless, the question of its importance remains uncertain, and it has been recommended that the presence of “stem-cell features” be noted in the pathology report of tumors that contain them [ 83 ].…”

Section: Frequently Asked Questionsmentioning

confidence: 99%

Etiology, Pathogenesis, Diagnosis, and Practical Implications of Hepatocellular Neoplasms

Hytiroglou

Bioulac‐Sage

Theise

et al. 2022

Cancers

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Hepatocellular carcinoma (HCC), a major global contributor of cancer death, usually arises in a background of chronic liver disease, as a result of molecular changes that deregulate important signal transduction pathways. Recent studies have shown that certain molecular changes of hepatocarcinogenesis are associated with clinicopathologic features and prognosis, suggesting that subclassification of HCC is practically useful. On the other hand, subclassification of hepatocellular adenomas (HCAs), a heterogenous group of neoplasms, has been well established on the basis of genotype–phenotype correlations. Histologic examination, aided by immunohistochemistry, is the gold standard for the diagnosis and subclassification of HCA and HCC, while clinicopathologic correlation is essential for best patient management. Advances in clinico-radio-pathologic correlation have introduced a new approach for the diagnostic assessment of lesions arising in advanced chronic liver disease by imaging (LI-RADS). The rapid expansion of knowledge concerning the molecular pathogenesis of HCC is now starting to produce new therapeutic approaches through precision oncology. This review summarizes the etiology and pathogenesis of HCA and HCC, provides practical information for their histologic diagnosis (including an algorithmic approach), and addresses a variety of frequently asked questions regarding the diagnosis and practical implications of these neoplasms.

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Section: Frequently Asked Questionsmentioning

confidence: 99%

Etiology, Pathogenesis, Diagnosis, and Practical Implications of Hepatocellular Neoplasms

Hytiroglou

Bioulac‐Sage

Theise

et al. 2022

Cancers

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“…Currently, there is no definite tool to assess tumor prognosis after liver resections. Kim et al (66) found that the 2019 World Health Organization classification was not associated with post-resection prognosis of combined HCC and CCA. Nevertheless, clinical assessment and strict follow-up aid in clinical decision and prognosis assessment.…”

Section: Important Considerationsmentioning

confidence: 99%

Surgical approach to achieve R0 resections in primary and metastatic liver tumors: a literature review

Vargas¹,

Dar²,

Fernandes³

et al. 2023

J Gastrointest Oncol

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Background and Objective: Primary and metastatic liver tumors are a significant cause of mortality worldwide. Regardless of the etiology of the tumor, macro-and microscopically clear margins (R0) while preserving adequate function of the remaining organ are the main goals after liver resections. However, technically challenging procedures are required to achieve R0 resection. Currently, there is no consensus of which should be the ideal minimal safety margin for liver tumor resections, with contrasting reports in regards of safety, tumor recurrence and overall outcomes following R0. Therefore, we aim to review current worldwide surgical practices to achieve R0 resections for primary and metastatic liver tumors in challenging surgical techniques and their reported outcomes.Methods: PubMed database, Google Scholar, and OVID Medline were searched for peer-reviewed original articles related to surgical techniques performed to achieve R0 resections in the setting of primary and/or metastatic liver tumors. An up-to-date review of English-language articles published between 2015 to July 2022 was performed.

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“…The prognosis of patients who undergo resection for cHCC-CCA has been reported to vary across different studies, as shown in Table 1 . 16 , 45 – 53 Prognostic factors after cHCC-CCA resection include tumor diameter >5 cm, intrahepatic metastases, lymph node metastases, multifocality, vascular invasion, high levels of CA 19-9, incomplete capsule formation, and a resection margin of <2 cm. 15 , 54…”

Section: Treatment and Prognosismentioning

confidence: 99%

“…The prognosis of patients who undergo resection for cHCC-CCA has been reported to vary across different studies, as shown in Table 1. 16,[45][46][47][48][49][50][51][52][53] Prognostic factors after cHCC-CCA resection include tumor diameter >5 cm, intrahepatic metastases, lymph node metastases, multifocality, vascular invasion, high levels of CA 19-9, incomplete capsule formation, and a resection margin of <2 cm. 15,54 One study conducted using data from the Surveillance, Epidemiology, and End Results Program (SEER) database found that liver transplantation (LT) did not provide any survival benefit compared with minor or major hepatectomy in 465 patients with cHCC-CCA.…”

Section: Treatment and Prognosismentioning

confidence: 99%

Update on the Diagnosis and Treatment of Combined Hepatocellular Cholangiocarcinoma

Chu,

Kawaguchi,

Wang

et al. 2023

J Clin Transl Hepatol

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Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a unique type of liver tumor that contains both hepatocellular carcinoma and cholangiocarcinoma components within a single tumor. The fifth edition of the World Health Organization classification provides a definition and diagnostic criteria for cHCC-CCA. However, the heterogeneous histomorphology and presentation resulting from variation of the proportion of each component poses challenges for clinical diagnosis and treatment. A diagnosis of cHCC-CCA may be suggested by the synchronous elevation of serum tumor markers for hepatocellular carcinoma and cholangiocarcinoma, a mixed enhancement pattern on imaging, and a discrepancy between the elevation of tumor marker and the imaging enhancement pattern. Histopathological examination using hematoxylin and eosin staining is considered the gold standard for diagnosing cHCC-CCA, and comprehensive examination of resection or biopsy specimens is crucial for an accurate diagnosis. Currently, there is no standard treatment for cHCC-CCA, and surgery is the mainstay. Anatomic hepatectomy with lymphadenectomy is among the recommended surgical procedures. The role of liver transplantation in the management of cHCC-CCA is still uncertain. Transarterial chemoembolization may be effective for unresectable cHCC-CCA, particularly for hypervascular tumors. However, the available evidence does not support systemic therapy for advanced cHCC-CCA. The prognosis of cHCC-CCA is generally poor, and there is no established staging system. Further research is needed to better understand the histogenesis and clinical management of cHCC-CCA. This review provides an overview of the current literature on cHCC-CCA with a focus on its clinical characteristics, pathological diagnosis, and management.

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Post-resection prognosis of combined hepatocellular carcinoma-cholangiocarcinoma cannot be predicted by the 2019 World Health Organization classification

Cited by 5 publications

References 18 publications

Etiology, Pathogenesis, Diagnosis, and Practical Implications of Hepatocellular Neoplasms

Etiology, Pathogenesis, Diagnosis, and Practical Implications of Hepatocellular Neoplasms

Surgical approach to achieve R0 resections in primary and metastatic liver tumors: a literature review

Update on the Diagnosis and Treatment of Combined Hepatocellular Cholangiocarcinoma

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