Combined hepatocholangiocarcinoma: case-series and review of literature.
OBJECTIVE
Combined hepatocholangiocarcinoma (CHCC) is an infrequent primary hepatic malignancy with no clearly defined diagnostic criteria, poorly studied natural history, and no guidelines regarding therapy. In this study we attempted to address this need and review our experience.


RESULTS
We performed a retrospective review of all CHCC cases at our institute over the last 10 yr. Eight cases were identified; histological and immunohistochemical criteria used for diagnosis were defined. Patients characteristics were: median age 65 yr (range 47-80); five females; risk factors-cholelithiasis (n = 4) and cirrhosis due to chronic viral hepatitis B and C (n = 1). Abdominal pain (n = 6), hepatomegaly (n = 4), and elevated CA 19-9 >40 U/mL (n = 4/5) were frequent. Early TNM stage (I and II) compared with advanced disease (III and IV) correlated with higher overall survival on univariate analyses [37 and 6 mo respectively (p = 0.011)]. Median overall survival was significantly higher in patients who underwent potentially curative resection (23 mo, range 4-48+) compared with patients who underwent non-surgical therapies such as transcatheter arterial chemoembolization and chemotherapy (2 mo, range 1-8) (p = 0.0357, one-sided exact log-rank test).


CONCLUSIONS
Chronic inflammation and cirrhosis may play a role in pathogenesis of CHCC. Surgical resection and early stage at diagnosis predict longer survival.
Bhagat
Vishal
V
Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
Javle
Milind
M
Yu
Jihnhee
J
Agrawal
Aarti
A
Gibbs
John F
JF
Kuvshinoff
Boris
B
Nava
Enriquetta
E
Iyer
Renuka
R
D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000473:pathology; D018281:Cholangiocarcinoma / Q000150:complications* / Q000473:pathology; D002769:Cholelithiasis / Q000453:epidemiology; D005260:Female; D019694:Hepatitis B, Chronic / Q000453:epidemiology; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
D018395:CA-19-9 Antigen