Clinicopathological Features and Post-resection Prognosis of Double Primary Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma.

Abstract

Simultaneous double primary hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) (dpHCC-ICC) is very rare. This study investigated the clinicopathological features and post-resection prognosis of dpHCC-ICC. We identified 10 patients with dpHCC-ICC through an institutional database search. Three control groups with HCC, ICC and combined HCC-cholangiocarcinoma (cHCC-CC) were selected (each n=120) using propensity score matching. The incidence of dpHCC-ICC was 0.23%. The mean age was 57.4±11.7years, and 8 were male. Hepatitis B virus infection was associated with 8 patients. All dpHCC-ICC were diagnosed incidentally from surgical specimens. Only two patients demonstrated simultaneous elevation of alpha-fetoprotein/des-γ-carboxy prothrombin and carbohydrate antigen 19-9. All patients underwent macroscopic curative resection. The HCC component was classified as stage I in 7 and stage II in 3, and ICC component was classified as stage I in 5, stage II in 2 and stage IV in 3. Tumor recurrence and patient survival rates were 30.0 and 90.0% at 1year and 52.0 and 77.1% at 3years, respectively. Tumor recurrence rates were not different between the dpHCC-ICC and the three control groups (p=0.505). The overall and post-recurrence patient survival rates were similar between the dpHCC-ICC and cHCC-CC groups (p>0.2); however, these were inferior to those in the HCC group but comparable with those in the ICC group. The post-resection prognosis of dpHCC-ICC was more dependent on the tumor stage of the ICC component than that of the HCC component. Therefore, they can be clinically regarded as ICC with concurrent HCC.