Surgical treatments and prognoses of patients with combined hepatocellular carcinoma and cholangiocarcinoma.
BACKGROUND
Combined hepatocellular carcinoma and cholangiocarcinoma is a very rare form of primary liver cancer containing components of both tumor types. We evaluated the effectiveness of surgical treatment and factors related to survival and recurrence.


METHODS
Of the 2427 patients who underwent hepatectomy or liver transplantation because of a primary hepatic malignancy from January 1989 to July 2006 at the Asan Medical Center, Seoul, Korea, 29 had hepatocellular carcinoma and cholangiocarcinoma as a single mixed or transitional tumor. Their medical records were retrospectively reviewed.


RESULTS
Disease-free survival rates at 6 months, 1 year, and 3 years were 51.1%, 38.3%, and 25.6%, respectively. Univariate analysis showed that CA 19-9 above 37 U/ml was predictive of low overall survival (P= .03) and that TNM stage was significantly associated with disease-free survival (P= .04).


CONCLUSIONS
Patients with combined hepatocellular carcinoma and cholangiocarcinoma had poor postoperative survival rates. High CA 19-9 level was associated with poorer survival, suggesting that the cholangiocarcinoma portion may be a major determining factor for patient prognosis. Aggressive surgical treatment, including lymph node dissection, may improve survival in patients suspected of or diagnosed with these tumors.
Kim
Ki Hun
KH
Department of Hepatobiliary Surgery and Liver Transplantation, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea. khkim620@amc.seoul.kr
Lee
Sung Gyu
SG
Park
Eun Hwa
EH
Hwang
Shin
S
Ahn
Chul Soo
CS
Moon
Deok Bog
DB
Ha
Tae Yong
TY
Song
Gi Won
GW
Jung
Dong Hwan
DH
Kim
Kang Mo
KM
Lim
Young Suk
YS
Lee
Han Chu
HC
Chung
Young Hwa
YH
Lee
Yung Sang
YS
Suh
Dong Jin
DJ
D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome