Treatment of Combined Hepatocellular and Cholangiocarcinoma

Leoni, Simona; Sansone, Vito; Lorenzo, Stefania De; Ielasi, Luca; Tovoli, Francesco; Renzulli, Matteo; Golfieri, Rita; Spinelli, Daniele; Piscaglia, Fabio

doi:10.3390/cancers12040794

Cited by 34 publications

(31 citation statements)

References 75 publications

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“…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).…”

Section: Discussionmentioning

confidence: 95%

“…Moreover, Kim et al reported that TACE could significantly improve the OS of unresectable cHCC-CC, with a favorable median OS time of 12.3 months 31 . As we know, tumor hypovascularity was the major factor restricting the response of TACE 24 , 31 . Although some studies insisted that cHCC-CC was hypovascular and TACE was not recommended 32 , 33 , the rate of hypervascularity in cHCC-CC in previous study reached about 40.9%-80% 31 , 34 , which enabled a favorable feasibility and effect of applying postoperative TACE for cHCC-CC.…”

Section: Discussionmentioning

confidence: 99%

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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

Tang¹,

Wang²,

Teng³

et al. 2021

Int. J. Med. Sci.

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Background: Clinical characteristics and prognosis among combined hepatocellular carcinoma (HCC) and cholangiocarcinoma (cHCC-CC) with HCC and intrahepatic cholangiocarcinoma (ICC) were inconsistent in previous studies. The aim of this study was to compare postoperative prognosis among cHCC-CC, HCC and ICC, and investigated the prognostic risk factor of cHCC-CC after surgical resection. Methods: A total of 1041 eligible patients with pathological diagnosis of cHCC-CC (n=135), HCC (n=698) and ICC (n=208) were enrolled in this study. Univariate and multivariate Cox analysis were applied for assessing important risk factors. cHCC-CC were further 1:1 matched with HCC and ICC on important clinical risk factors. Survival curves of matched and unmatched cohorts were depicted by Kaplan-Meier method with log-rank test. Results: Patients with cHCC-CC had similar rate of sex, age and cirrhosis with HCC (p<0.05) and comparable incidence of hepatitis B or C with ICC (p=0.197). Patients of cHCC-CC had intermediate prognosis between HCC and ICC, with median overall survival (OS) time of cHCC-CC, HCC and ICC of 20.5 months, 35.7 months and 11.6 months (p<0.001). In matched cohorts, the OS of cHCC-CC were worse than HCC (p<0.001) but comparable with ICC (p=0.06), while the disease-free survival (DFS) of cHCC-CC was worse than HCC but better than ICC (p<0.05). And lymph node infiltration and postoperative transarterial chemoembolization (TACE) were independent risk factors of cHCC-CC associated with prognosis. Conclusion: The long term survival of cHCC-CC was worse than HCC but comparable with ICC when matched on albumin level, tumor size, lymph node infiltration, tumor stage and margin. Presence of lymph node infiltration and no postoperative TACE were associated with poor prognosis of cHCC-CC.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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

Tang¹,

Wang²,

Teng³

et al. 2021

Int. J. Med. Sci.

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“…The intrinsic properties of CHCC-CCA differ from those of HCC and ICC. Moreover, its OS rate has been reported to be even lower than that of ICC (26)(27)(28). As a result, it is critical to separately map prediction models for strong prognostic parameters, including MVI, satellite nodules and LNM.…”

Section: Prognostic Value Of the Predicted MVI Risk Status And Satellite Nodule Statusmentioning

confidence: 99%

A multidimensional nomogram combining imaging features and clinical factors to predict the invasiveness and metastasis of combined hepatocellular cholangiocarcinoma

Wang¹,

Zhou²,

Zhu³

et al. 2021

Ann Transl Med

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Background: Combined hepatocellular cholangiocarcinoma (CHCC-CCA) is a rare type of primary liver cancer having aggressive behavior. Few studies have investigated the prognostic factors of CHCC-CCA.Therefore, this study aimed to establish a nomogram to evaluate the risk of microvascular invasion (MVI) and the presence of satellite nodules and lymph node metastasis (LNM), which are associated with prognosis. Methods: One hundred and seventy-one patients pathologically diagnosed with CHCC-CCA were divided into a training set (n=116) and validation set (n=55). Logistic regression analysis was used to assess the relative value of clinical factors associated with the presence of MVI and satellite nodules. The least absolute shrinkage and selection operator (LASSO) algorithm was used to establish the imaging model of all outcomes, and to build clinical model of LNM. Nomograms were constructed by incorporating clinical risk factors and imaging features. The model performance was evaluated on the training and validation sets to determine its discrimination ability, calibration, and clinical utility. Kaplan Meier analysis and time dependent receiver operating characteristic (ROC) were displayed to evaluate the prognosis value of the predicted nomograms of MVI and satellite nodule. Results: A nomogram comprising the platelet to lymphocyte ratio (PLR), albumin-to-alkaline phosphatase ratio (AAPR) and imaging model was established for the prediction of MVI. Carcinoembryonic antigen (CEA) level and size were combined with the imaging model to establish a nomogram for the prediction of the presence of satellite nodules. Favorable calibration and discrimination were observed in the training and validation sets for the MVI nomogram (C-indexes of 0.857 and 0.795), the nomogram for predicting satellite nodules (C-indexes of 0.919 and 0.883) and the LNM nomogram (C-indexes of 0.872 and 0.666). Decision curve analysis (DCA) further confirmed the clinical utility of the nomograms. The preoperatively predicted MVI and satellite nodules by the combined nomograms achieved satisfactory performance in recurrence-free survival (RFS) and overall survival (OS) prediction. Conclusions:The proposed nomograms incorporating clinical risk factors and imaging features achieved satisfactory performance for individualized preoperative predictions of MVI, the presence of satellite nodules, and LNM. The prediction models were demonstrated to be good indicator for predicting the prognosis of CHCC-CCA, facilitating treatment strategy optimization for patients with CHCC-CCA.

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“…Locoregional treatments have been considered in CHC that is surgically unresectable with no clear guidelines. Inoperability is usually defined as large or multifocal tumors [58]. CHC follows a pathological course as with HCC.…”

Section: Combined Hepatocellular Cholangiocarcinomamentioning

confidence: 99%

Locoregional Treatments in Cholangiocarcinoma and Combined Hepatocellular Cholangiocarcinoma

Renzulli

Ramai

Singh

et al. 2021

Cancers

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Cholangiocarcinoma (CCA) is a primary and aggressive cancer of the biliary tree. Combined hepatocellular cholangiocarcinoma (CHC) is a distinctive primary liver malignancy which has properties of both hepatocytic and cholangiocytic differentiation. CHC appears to have a worse prognosis compared to hepatocellular carcinoma, and similar to that of intrahepatic CCA. While significant advances have been made in understanding the pathophysiology and treatment of these two tumor types, their prognosis remains poor. Currently, liver resection is the primary treatment modality; however, only a minority of patients are eligible for surgery. However, the use of locoregional therapies proves an alternative approach to treating locally advanced disease with the aim of converting to resectability or even transplantation. Locoregional therapies such as transarterial chemoembolization (TACE), selective internal radiation therapy (SIRT), radiofrequency ablation (RFA), and photodynamic therapy (PDT) can provide patients with tumor control and increase the chances of survival. In this review, we appraise the evidence surrounding the use of locoregional therapies in treating patients with CCA and CHC.

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Treatment of Combined Hepatocellular and Cholangiocarcinoma

Cited by 34 publications

References 75 publications

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

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

A multidimensional nomogram combining imaging features and clinical factors to predict the invasiveness and metastasis of combined hepatocellular cholangiocarcinoma

Locoregional Treatments in Cholangiocarcinoma and Combined Hepatocellular Cholangiocarcinoma

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