title: Clinicopathological features and prognosis of combined hepatocellular carcinoma and cholangiocarcinoma after surgery.
abstract: BACKGROUND
  Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is a rare subtype of primary liver cancer consisting of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). Because of the rarity of this tumor, its feature is poorly understood. The present study aimed to evaluate the clinicopathological features and long-term prognosis of patients with cHCC-CC after surgery and to compare with those of the patients with stage-matched HCC and CC.
  
  
  METHODS
  The clinicopathological features of the patients who underwent surgery for cHCC-CC at our center during the period of 2001-2010 were retrospectively analyzed and compared with those of stage-matched HCC and CC patients. Cancer staging was performed according to the AJCC Cancer Staging Manual (6th ed.). Overall survival and disease-free survival were compared among the groups and prognostic factors of cHCC-CC were evaluated.
  
  
  RESULTS
  Significant differences were observed in clinicopathological features among 42 patients with cHCC-CC, 90 patients with HCC and 45 patients with CC. Similar to HCC patients, cHCC-CC patients had frequent hepatitis B virus antigen positivity, microscopic vessel invasion, cirrhosis and high level of serum alpha-fetoprotein. Similar to CC patients, cHCC-CC patients showed increased bile duct invasion and decreased capsule. The 1-, 3-, and 5-year overall survival and disease-free survival of patients with cHCC-CC were not significantly different from those with stage-matched patients with CC; but significantly poorer than those with HCC. In subanalysis of patients with stage II, the overall survival in patients with cHCC-CC or CC was significantly poorer than that in patients with HCC. We did not find the difference in patients with other stages. Univariate analysis of overall and disease-free survival of patients with cHCC-CC showed that the vascular invasion and intrahepatic metastasis were the significant predictive factors.
  
  
  CONCLUSIONS
  Patients with cHCC-CC showed similar clinicopathological features as those with HCC or CC, and patients with cHCC-CC or CC had a poorer prognosis compared with those with HCC, especially at matched stage II.
authors.affiliation: Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea. spark@ncc.re.kr.
authors.forename: Seung Duk
authors.initials: SD
authors.lastname: Lee
authors.forename: Sang-Jae
authors.initials: SJ
authors.lastname: Park
authors.forename: Sung-Sik
authors.initials: SS
authors.lastname: Han
authors.forename: Seong Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Young-Kyu
authors.initials: YK
authors.lastname: Kim
authors.forename: Soon-Ae
authors.initials: SA
authors.lastname: Lee
authors.forename: Young Hwan
authors.initials: YH
authors.lastname: Ko
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D001652:Bile Ducts / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000556:secondary / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000150:complications / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006511:Hepatitis B Antigens / Q000097:blood; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D008297:Male; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D006511:Hepatitis B Antigens; D000509:alpha-Fetoproteins