Abstract
Combined hepatocellular‐cholangiocarcinoma (cHCC‐CC) and intrahepatic cholangiocarcinoma (ICC) are classified into one category, but comparison of prognosis of the two carcinomas remains controversial. The aim of the current study was to investigate surgical outcomes for patients with ICC or cHCC‐CC who underwent resection in order to elucidate whether the classification of ICC and cHCC‐CC is justified. Subjects were 61 patients with ICC and 29 patients with cHCC‐CC who underwent liver resection from 2001 to 2017. Clinic‐pathological data from the two groups were compared. Tumor number and vascular invasion were independent risk factors for recurrence‐free survival (RFS) in both groups (P < .001 for both). Of note, for patients with ICC, tumor cut‐off size of 5 cm showed statistical significance in median RFS (>5 cm vs ≤5 cm, 0.5 years vs 4.0 years, P = .003). For patients with cHCC‐CC, tumor cut‐off size of 2 cm showed statistical significance in median RFS (>2 cm vs ≤2 cm, 0.6 years vs 2.6 years, P = .038). The median RFS of patients with cHCC‐CC was 0.9 years (95% confidence interval: 0.3‐1.6), which was poorer than that of patients with ICC (1.3 years, 0.5‐2.1) (P = .028); the rate of RFS at 5 years was 0% and 37.7% respectively. Our study supports the concept of classifying ICC and cHCC‐CC into different categories because of a significant difference in RFS between the two.
Highlights
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver tumor following hepatocellular carcinoma (HCC) and accounts for 5‐15% of cases of primary liver cancer.[1]
In order to elucidate whether classifying ICC and cHCC‐ CC into one category is justified, the current study investigated the clinical features of and prognosis for the two types of liver cancer
The current study revealed that patients with Combined hepatocellular‐cholangiocarcinoma (cHCC‐CC) had a poorer prognosis than those with ICC and that the prognosis differed significantly when cHCC‐CC was stratified by a tumor cut‐off size of 2 cm and when ICC was stratified by a tumor cut‐off size of 5 cm
Summary
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver tumor following hepatocellular carcinoma (HCC) and accounts for 5‐15% of cases of primary liver cancer.[1] Combined hepatocellular‐cholangiocarcinoma (cHCC‐CC) originates from cells that have the histological features of HCC and CC, with an incidence rate from 0.4% to 14.2% in different regions.[2,3,4,5,6]. Patients with cHCC‐CC are most often diagnosed based on pathological findings, and after surgery in particular. The 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging[7,8] and International Union for Cancer Control (UICC) tumor‐nodes‐metastasis staging[9,10] classify cHCC‐CC. ICC into one category, but there is debate over the clinical features of cHCC‐CC in comparison to those of ICC and assessment of their prognosis. Liver transplantation cannot contribute to better prognosis of patients with cHCC‐CC compared to those with HCC, but may improve surgical outcomes than ICC patients.[15]
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