title: Prognostic impact of cholangiocellular and sarcomatous components in combined hepatocellular and cholangiocarcinoma.
abstract: Combined hepatocellular and cholangiocarcinoma (cHC-CC) is a rare type of liver cancer displaying both hepatocellular and cholangiocellular components. The cholangiocellular carcinoma (CC) in these tumors ranges from focal to prominent. Those cHC-CCs with sarcomatous features are reported to have a poor prognosis. To clarify whether the CC and sarcomatous component affects the prognosis, we classified 40 patients with cHC-CCs into 4 groups according to the presence of a sarcomatous component and the extent of the CC component. Seven (17.5%) tumors showed areas with a sarcomatous component. The remaining tumors were divided into a low-CC group (CC occupying <30% of the tumor, n = 12), a middle-CC group (30%-60%, n = 15), and a high-CC group (>60%, n = 6). Vascular invasion was more frequently present in the high-CC and sarcomatous group than in the other groups (P = .0007). No lymph node metastasis occurred in either the low- or the middle-CC groups, but it was detected in 3 (50%) cases of the high-CC group and in 2 (29%) cases of the sarcomatous group (P < .0001). There was a tendency for tumor size to increase from the low- to the middle- to the high-CC group. The Ki-67 labeling index values for the hepatocellular carcinoma, CC, and sarcomatous components were 11.4% +/- 12.9%, 25.4% +/- 18.3%, and 46.0% +/- 23.6%, respectively. The overall survival of patients in the high-CC and sarcomatous group was significantly poorer than that of patients in the low- and middle-CC groups (P = .0048). By multivariate analysis of overall survival, lymph node metastasis, histological subgroup, and vascular invasion were significant independent prognostic factors. A cHC-CC with a large CC component is as aggressive as cHC-CC with sarcomatous features.
authors.affiliation: Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. saishima@surgpath.med.kyushu-u.ac.jp
authors.forename: Shinichi
authors.initials: S
authors.lastname: Aishima
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Kuroda
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Asayama
authors.forename: Kenichi
authors.initials: K
authors.lastname: Taguchi
authors.forename: Yunosuke
authors.initials: Y
authors.lastname: Nishihara
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
authors.forename: Masazumi
authors.initials: M
authors.lastname: Tsuneyoshi
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology*; D001653:Bile Ducts, Intrahepatic / Q000737:chemistry / Q000473:pathology*; D014408:Biomarkers, Tumor / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000145:classification / Q000401:mortality / Q000556:secondary*; D018281:Cholangiocarcinoma / Q000145:classification / Q000401:mortality / Q000556:secondary*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D008113:Liver Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary; D011379:Prognosis; D012509:Sarcoma / Q000737:chemistry / Q000145:classification / Q000556:secondary*; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor