Combined hepatocellular and cholangiocarcinoma: a clinicopathologic study of 26 resected cases.
BACKGROUND
Combined hepatocellular and cholangiocarcinoma (cHCC-CC) is an uncommon subtype of primary liver cancer, the clinicopathological features of which have rarely been reported in detail. The aim of this study was to clarify the characteristics of cHCC-CC in comparison with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC).


METHODS
The clinicopathological features of 26 cHCC-CC patients, who were surgically treated, were reviewed by comparing them with the features of patients suffering from ordinary hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC).


RESULTS
The cHCC-CC patients showed greater similarity with HCC patients than with CC patients with regard to male/female ratio, status of hepatitis viral infection, serum alpha-fetoprotein (AFP) level, and non-tumor liver histology. The disease stage of the cHCC-CC patients was more advanced than that of either the HCC or CC patients. The cHCC-CC tumors were significantly more invasive to the portal vein than the HCC tumors and were comparable to the CC tumors. The overall 3-, 5-, and 10-year survival rates and the median survival times (95% confidence interval) were 34.6%, 23.1%, 11.5% and 1.8 (0.7-3.0) years for cHCC-CC patients, 86.7%, 66.2%, 46.8% and 4.6 (4.3-5.0) years for HCC patients, and 68.5%, 32.3%, 23.9% and 1.9 (1.1-2.7) years for CC patients, respectively. Survival of patients with cHCC-CC was significantly poorer than that of HCC or CC patients. Among the 26 patients, six survived for >5 years.


CONCLUSIONS
In most cases, cHCC-CC seems to be a variant of ordinary HCC with cholangiocellular features, rather than a true intermediate disease entity between HCC and CC. The surgical approach is recommended for selected patients with cHCC-CC.
Yano
Yoshiko
Y
Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
Yamamoto
Junji
J
Kosuge
Tomoo
T
Sakamoto
Yoshihiro
Y
Yamasaki
Susumu
S
Shimada
Kazuaki
K
Ojima
Hidenori
H
Sakamoto
Michiie
M
Takayama
Tadatoshi
T
Makuuchi
Masatoshi
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology*; D001653:Bile Ducts, Intrahepatic; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology*; D005260:Female; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000401:mortality / Q000473:pathology*; D015996:Survival Rate