title: Surgical treatments and prognoses of patients with combined hepatocellular carcinoma and cholangiocarcinoma.
abstract: 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.
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea. khkim620@amc.seoul.kr
authors.forename: Ki Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Sung Gyu
authors.initials: SG
authors.lastname: Lee
authors.forename: Eun Hwa
authors.initials: EH
authors.lastname: Park
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Chul Soo
authors.initials: CS
authors.lastname: Ahn
authors.forename: Deok Bog
authors.initials: DB
authors.lastname: Moon
authors.forename: Tae Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Gi Won
authors.initials: GW
authors.lastname: Song
authors.forename: Dong Hwan
authors.initials: DH
authors.lastname: Jung
authors.forename: Kang Mo
authors.initials: KM
authors.lastname: Kim
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Lim
authors.forename: Han Chu
authors.initials: HC
authors.lastname: Lee
authors.forename: Young Hwa
authors.initials: YH
authors.lastname: Chung
authors.forename: Yung Sang
authors.initials: YS
authors.lastname: Lee
authors.forename: Dong Jin
authors.initials: DJ
authors.lastname: Suh
mesh_terms: 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