title: Clinical and pathological analysis of 27 patients with combined hepatocellular-cholangiocarcinoma in an Asian center.
abstract: BACKGROUND
  Our purpose was to assess the clinicopathological features and surgical outcomes of combined hepatocellular-cholangiocarcinoma (HCC-CC) in an Asian center.
  
  
  METHODS
  Between 1998 and 2009, 27 patients were diagnosed with combined HCC-CC at our hospital. Their medical records were reviewed and clinicopathological data retrospectively analyzed.
  
  
  RESULTS
  The 27 patients included 24 (88.9%) males and 3 (11.1%) females with a mean age of 58.26 ± 11.18 years. Cirrhosis was present in 10 patients (37.0%), and 12 patients had hepatitis C or hepatitis B virus infection. Serum alpha fetoprotein was >20 ng/ml in 7 of the 19 patients in whom it was measured (36.8%). Twenty-five patients underwent hepatic resections and 2 received liver transplantations. Five (18.5%) patients had separate HCC and CC within the same liver (type I), 21 (77.8%) had tumors with mixed components (type II), and 1 patient had a type III tumor (3.7%). Of 22 patients with immunohistochemical data, 19 (86.4%) were cytokeratin (CK) 7-positive, 20 (90.9%) were CK19-positive, and 4 (18.2%) were CK20-positive. Mean follow-up was 25.8 months. The 1- and 2-year survival rates were 72.5 and 49.4%, respectively. The 1- and 2-year disease-free survival rates were 54.2 and 41.3%, respectively. Symptoms at the time of diagnosis, and regional lymph node metastases, were associated with higher mortality and recurrence.
  
  
  CONCLUSIONS
  Lymph node metastasis and positive resection margins are important factors affecting HCC-CC surgical outcomes.
authors: General Surgical Department, Ruijin Hospital Affiliated to Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai 200025, China.
authors: Qian
authors: Q
authors: Zhan
authors: Bai-Yong
authors: BY
authors: Shen
authors: Xia-Xing
authors: XX
authors: Deng
authors: Zhe-Cheng
authors: ZC
authors: Zhu
authors: Hao
authors: H
authors: Chen
authors: Chen-Hong
authors: CH
authors: Peng
authors: Hong-Wei
authors: HW
authors: Li
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms; D001653:Bile Ducts, Intrahepatic; D006528:Carcinoma, Hepatocellular / Q000378:metabolism / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018281:Cholangiocarcinoma; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D007633:Keratins / Q000378:metabolism; D008113:Liver Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000378:metabolism / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D007633:Keratins