Abstract
Background/Purpose
Combined hepatocellular and cholangiocarcinoma (HCC-CC) is an uncommon subtype of primary liver cancer, the clinicopathological features of which have rarely been reported in detail. Some authors believe that HCC-CC behaves like HCC, but biliary differentiation may be associated with poorer prognosis. Moreover, CC has more frequent lymph node metastases. In this study, we aimed to determine the clinical course and survival outcome of HCC-CC patients in a Thai population by comparing them with patients with ordinary HCC.
Methods
The clinicopathological features of patients who were diagnosed with HCC-CC at Ramathibodi Hospital during 2000–2004 were retrospectively studied by comparing them with the features of patients suffering from ordinary HCC. Twenty-five patients who were diagnosed with HCC-CC were included in this study, and subsequently 50 patients with HCC who had tissues taken during the same period were selected randomly from among 148 HCC patients. Statistical analysis was done by using SPSS version 10.0. The Kaplan-Meier method was used to assess the survival rate. Multiple logistic regression analysis was performed to assess correlations. A value of P < 0.05 was considered statistically significant.
Results
There were no significant differences in etiologic risk factors between HCC-CC and HCC patients: cirrhosis (50% vs 44%), chronic alcohol abuse (36% vs 43%), presence of hepatitis B surface antigen (HBsAg; 66% vs 78%) and presence of hepatitis C virus (HCV) antibody (13% vs 3%). The serum alpha-fetoprotein (AFP) value in the HCC-CC group was lower than that in the HCC group (5.87 vs 41.46 ng/ml). No differences in tumor characteristics or liver status (tumor size, presence of multinodular lesions, portal vein thrombosis, intrahepatic bile duct dilatation, intraabdominal lymphadenopathy, extrahepatic metastasis, liver cirrhosis, portal hypertension, and ascites) between these two groups were found. The overall median survival of HCC-CC patients was 38 weeks while that of HCC patients was 54 weeks. Multivariate analysis showed that elevated carbohydrate antigen (CA)19-9 (≥80 U/ml) and the presence of intrahepatic bile duct dilatation were independent risk factors for worse survival.
Conclusions
The demographic and clinical features of patients with combined HCC-CC were similar to those of patients with HCC. The presence of cholangiocellular differentiation appeared to worsen the prognosis when compared with pure HCC, although this difference did not reach statistical significance. An increased CA19-9 level and intrahepatic bile duct dilatation in patients with HCC-CC were considered to be independent factors that suggested poor prognosis.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
J Taguchi O Nakashima M Tanaka T Hisaka T Takazawa M Kojiro (1996) ArticleTitleA clinicopathological study on combined hepatocellular and cholangiocarcinoma J Gastroenterol Hepatol 11 758–64 Occurrence Handle8872774 Occurrence Handle1:STN:280:DyaK2s%2Fis1GqtA%3D%3D
Y Yano J Yamamoto T Kosuge Y Sakamoto S Yamasaki K Shimada et al. (2003) ArticleTitleCombined hepatocellular and cholangiocarcinoma: a clinicopathologic sutyd of 26 resected cases Jpn J Clin Oncol 33 283–7 Occurrence Handle12913082 Occurrence Handle10.1093/jjco/hyg056
CL Liu ST Fan CM Lo IO Ng CM Lam RT Poon et al. (2003) ArticleTitleHepatic resection for combined hepatocellular and cholangiocarcinoma Arch Surg 138 86–90 Occurrence Handle12511158 Occurrence Handle10.1001/archsurg.138.1.86
K Okuda (2002) ArticleTitleNatural history of hepatocellular carcinoma including fibrolamellan and hepato-cholangiocarcinoma variants J Gastroenterol Hepatol 17 401–5 Occurrence Handle11982719 Occurrence Handle10.1046/j.1440-1746.2002.02734.x
KC Koh H Lee MS Choi JH Lee SW Paik BC Yoo et al. (2005) ArticleTitleClinicopathologic features and prognosis of combined hepatocellular cholangiocarcinoma Am J Surg 189 120–5 Occurrence Handle15701504 Occurrence Handle10.1016/j.amjsurg.2004.03.018
WR Jarnagin S Weber SK Tickoo JB Koea S Obiekwe Y Fong et al. (2002) ArticleTitleCombined hepatocellular and cholangiocarcinoma: demographic, clinical, and prognostic factors Cancer 94 2040–6 Occurrence Handle11932907 Occurrence Handle10.1002/cncr.10392
IO Ng TW Shek J Nicholls LT Ma (1998) ArticleTitleCombined hepatocellular-cholangiocarcinoma: a clinicopathological study J Gastroenterol Hepatol 13 34–40 Occurrence Handle9737569 Occurrence Handle1:STN:280:DyaK1cvgslGrtQ%3D%3D
S Bunyaratvej V Meenakanit T Tantachamrun P Srinawat P Susilaworn N Chongchitnan (1981) ArticleTitleNationwide survey of major liver diseases in Thailand. Analysis of 3305 biopsies as to year-end 1978 J Med Assoc Thai 64 432–9 Occurrence Handle7299296 Occurrence Handle1:STN:280:DyaL38%2FlsVGgtA%3D%3D
RA Allen JR Lisa (1949) ArticleTitleCombined liver and bile duct carcinoma Am J Pathol 25 647–55 Occurrence Handle1:STN:280:DyaH1M%2FlsVCgtQ%3D%3D Occurrence Handle18152860
ZD Goodman KG Ishak JM Langloss IA Sesterhenn L Rabin (1985) ArticleTitleCombined hepatocellular cholangiocarcinoma. A histologic and immunohistochemical study Cancer 55 124–35 Occurrence Handle2578078 Occurrence Handle1:STN:280:DyaL2M%2Fntl2mtA%3D%3D Occurrence Handle10.1002/1097-0142(19850101)55:1<124::AID-CNCR2820550120>3.0.CO;2-Z
A Maeda T Edate K Matsunaga H Kanemoto E Bando S Yamaguchi et al. (2005) ArticleTitlePrimary liver cancer with bidirectional differentiation into hepatocytes and biliary epithelium J Hepatobiliary Pancreat Surg 12 484–7 Occurrence Handle16365824 Occurrence Handle10.1007/s00534-005-1010-3
T Tsushimi T Enoki E Harada M Orita S Noshima M Masuda et al. (2005) ArticleTitleEctopic hepatocellular carcinoma arising in the bile duct J Hepatobiliary Pancreat Surg 12 266–8 Occurrence Handle15995818 Occurrence Handle10.1007/s00534-004-0963-y
T Maeda E Adachi K Kajiyama K Sugimachi M Tsuneyoshi (1995) ArticleTitleCombined hepatocellular and cholangiocarcinoma: proposed criteria according to cytokeratin expression and analysis of clinicopathologic features Hum Pathol 26 956–64 Occurrence Handle7545644 Occurrence Handle1:STN:280:DyaK2Mvgt12msQ%3D%3D Occurrence Handle10.1016/0046-8177(95)90084-5
InstitutionalAuthorNameLiver Cancer Study Group of Japan (1990) ArticleTitlePrimary liver cancer in Japan. Clinicopathologic features and results of surgical treatment Ann Surg 211 277–87
Author information
Authors and Affiliations
About this article
Cite this article
Chantajitr, S., Wilasrusmee, C., Lertsitichai, P. et al. Combined hepatocellular and cholangiocarcinoma: clinical features and prognostic study in a Thai population. J Hepatobiliary Pancreat Surg 13, 537–542 (2006). https://doi.org/10.1007/s00534-006-1117-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00534-006-1117-1