Abstract
BackgroundCombined hepatocellular-cholangiocarcinoma (cHCC-CC) can present as a hypervascular or peripherally enhancing tumor in dynamic imaging. We evaluated the effect of transarterial chemoembolization (TACE) on prognosis according to post-operative recurrence imaging patterns.MethodsWe retrospectively analyzed 42 cHCC-CC and 59 hepatocellular carcinoma (HCC-control) patients at the Asan Medical Center. We classified recurrent cHCC-CC according to enhancement pattern (globally enhancing: GE cHCC-CC, peripherally enhancing: PE cHCC-CC) and evaluated tumor response, time-to-local progression (TTPlocal), and overall survival (OS).ResultsThe GE cHCC-CC group had a significantly higher best objective response rate (complete remission + partial response) than the PE cHCC-CC group (36% vs 0%, P = 0.005), and it was comparable to that of the HCC-control group (35.6%, P = 0.97). TTPlocal in the GE cHCC-CC group was significantly shorter than in the HCC-control group (6.6 vs 27.1 months, P < 0.001), and was not significantly different from that in the PE cHCC-CC group (5.3 months, P = 0.12). OS was 12.4 months, 52.8 months, and 67.5 months in the PE cHCC-CC, GE cHCC-CC, and HCC-control groups, respectively (Ps < 0.05). The adjusted hazard ratios (HRs) for TTPlocal and OS revealed an independent association with enhancement pattern of recurrent cHCC-CC (TTPlocal: HR 2.46; 95% CI 1.10–5.46; P = 0.03; OS: HR 5.97; 95% CI 2.38–14.96; P < 0.001).ConclusionsThe GE cHCC-CC group showed better response and prognosis after TACE than the PE cHCC-CC group, but poorer response and prognosis than the HCC-control group. Enhancement patterns at recurrence were crucially associated with tumor response and overall survival.
Highlights
Combined hepatocellular-cholangiocarcinoma accounts for 0.4%–14.2% of primary liver malignancies [1, 2], and contains pathological components of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) [3]
Enhancement patterns at recurrence were crucially associated with tumor response and overall survival
Recurrences occurred in 135 patients, and 93 patients were excluded for the following reasons: 11 patients had concurrent other malignancies; 3 patients were lost to followup; and 79 patients received treatments other than transarterial chemoembolization (TACE) for the first recurrence
Summary
Combined hepatocellular-cholangiocarcinoma (cHCC-CC) accounts for 0.4%–14.2% of primary liver malignancies [1, 2], and contains pathological components of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) [3]. Pre-operative diagnosis of cHCC-CC is sometimes challenging due to its heterogeneous imaging characteristics with overlapping features of both HCC and CC [4,5,6,7]. It can present predominantly as a hypervascular lesion resembling HCC or a peripherally enhancing lesion resembling CC, according to the predominant histologic component within the tumor. The prognosis after liver transplantation for cHCC-CC is poorer than that of HCC and confers a survival rate similar to that of selected patients with CC [14, 15]. We evaluated the effect of transarterial chemoembolization (TACE) on prognosis according to post-operative recurrence imaging patterns.
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