title: Biphenotypic Primary Liver Carcinomas: Assessing Outcomes of Hepatic Directed Therapy.
abstract: BACKGROUND
  Primary liver carcinomas with hepatocellular and cholangiocellular differentiation (b[HB]-PLC) are rare. Surgery offers the best prognosis, but there is a paucity of literature to guide therapy for patients with advanced or unresectable disease. This study aimed to evaluate outcomes of hepatic-directed therapy compared with those of systemic chemotherapy and surgery.
  
  
  METHODS
  A retrospective evaluation of patients with b(HB)-PLC from 1 January 2008 to 1 September 2014 was conducted. The patients were divided into the following four groups: transplantation (TX) group, surgical resection (SX) group, hepatic directed (HD) group, and systemic chemotherapy alone (SC) group. Overall and progression-free survival, treatment response, and clinicopathologic data were analyzed.
  
  
  RESULTS
  The study included 79 patients (37 females) with an average age of 62 years. The number of patients in each group were as follows: TX group (n = 6), SX group (n = 27), HD group (n = 18), and SC group (n = 28). The mean follow-up periods were 33 months for the TX group, 17 months for the SX group, 14 months for the HD group, and 7 months for the SX group. Overall, 28 % of the patients had cirrhosis and 35 % had viral hepatitis. The candidates for surgery comprised 42 % of the patients. The HD group (n = 18) had a significantly greater objective response than the SC group (n = 28) (47 vs. 6 %; p = 0.02). Two patients who underwent hepatic arterial infusion pump treatment were downstaged to resection. A trend toward improved OS/PFS was observed in the HD group versus the SC group, although statistically significant. The SX group had significantly improved survival (p < 0.001) as did the transplanted patients.
  
  
  CONCLUSIONS
  Although surgery offers the best survival for b(HB)-PLC patients, only a minority are candidates for surgery. Because HD therapy showed a superior objective response over SC therapy, it may offer a survival advantage and may downstage patients for surgical resection or transplantation.
authors: Department of Radiology, Washington University, St. Louis, MO, USA. fowlerk@mir.wustl.edu.
authors: Kathryn
authors: K
authors: Fowler
authors: Department of Radiology, Washington University, St. Louis, MO, USA.
authors: Nael E
authors: NE
authors: Saad
authors: Department of Immunology and Pathology, Washington University, St. Louis, MO, USA.
authors: Elizabeth
authors: E
authors: Brunt
authors: Department of Surgery, Washington University, St. Louis, MO, USA.
authors: M B Majella
authors: MB
authors: Doyle
authors: Department of Internal Medicine and Oncology, Washington University, St. Louis, MO, USA.
authors: Manik
authors: M
authors: Amin
authors: Department of Surgery, Washington University, St. Louis, MO, USA.
authors: Neeta
authors: N
authors: Vachharajani
authors: Department of Internal Medicine and Oncology, Washington University, St. Louis, MO, USA.
authors: Benjamin
authors: B
authors: Tan
authors: Department of Surgery, Washington University, St. Louis, MO, USA.
authors: William C
authors: WC
authors: Chapman
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate