title: Comparing combined hepatocellular-cholangiocarcinoma and cholangiocarcinoma: a clinicopathological study.
abstract: OBJECTIVE
  Combined hepatocellular-cholangiocarcinoma is a rare subtype of primary liver cancer. To clarify the significance of this tumor, we conducted the present study to investigate the clinicopathological characteristics. As well, a comparison between this tumor and cholangiocarcinoma was made to determine whether these two types of liver cancers are closely related.
  
  
  METHODS
  Seventeen cases of combined hepatocellular-cholangiocarcinoma and 104 cases of cholangiocarcinoma were included. Patients were evaluated on the basis of age, gender, viral hepatitis markers, tumor markers, laboratory data, indocyanine green test, tumor location, histological differentiation, lymph node involvement, and organ metastasis. In addition, the presenting symptoms at admission were also recorded. Data was analyzed using the chi 2 test and Student's t test and differences between the curves were tested using the two-tailed log-rank test.
  
  
  RESULTS
  Combined hepatocellular-cholangiocarcinoma was found to be more prevalent in males. In addition, the combined hepatocellular-cholangiocarcinoma patients had lower serum bilirubin, ALP levels (p < 0.05), and more poor differentiation (p < 0.05). Also, the presenting symptoms of combined hepatocellular-cholangiocarcinoma patients were different from those of cholangiocarcinoma patients with the former a lower incidence of fever, chills, jaundice and a higher incidence of fatigue and weakness.
  
  
  CONCLUSIONS
  The clinicopathological features of combined hepatocellular-cholangiocarcinoma were different from those of cholangiocarcinoma with more advanced histological differentiation, more prevalent in males, and lower levels of serum bilirubin and ALP. These characteristic features may help us in diagnosing combined hepatocellular-cholangiocarcinoma in patients with suspected cholangiocarcinoma.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 160, Section 3, Taichung-Kang Road, Taichung, 407, Taiwan.
authors.forename: Cheng-Chi
authors.initials: CC
authors.lastname: Lee
authors.forename: Chun-Ying
authors.initials: CY
authors.lastname: Wu
authors.forename: Jung-Ta
authors.initials: JT
authors.lastname: Chen
authors.forename: Gran-Hum
authors.initials: GH
authors.lastname: Chen
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence
chemical_list: D000469:Alkaline Phosphatase; D001663:Bilirubin