Annals of Surgical Oncology

, Volume 22, Issue 13, pp 4130–4137 | Cite as

Biphenotypic Primary Liver Carcinomas: Assessing Outcomes of Hepatic Directed Therapy

  • Kathryn Fowler
  • Nael E. Saad
  • Elizabeth Brunt
  • M. B. Majella Doyle
  • Manik Amin
  • Neeta Vachharajani
  • Benjamin Tan
  • William C. Chapman
Hepatobiliary Tumors



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.


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.


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.


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.


Overall Survival Gemcitabine Sorafenib Tace Systemic Chemotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors acknowledge the support of the Biostastics Core, the Siteman Cancer Center, and NCI Cancer Center Support Grant P30 CA091842.

Conflict of interest

Nael E. Saad is proctor for Sirtex Radiopharamaceuticals.


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Kathryn Fowler
    • 1
  • Nael E. Saad
    • 1
  • Elizabeth Brunt
    • 2
  • M. B. Majella Doyle
    • 3
  • Manik Amin
    • 4
  • Neeta Vachharajani
    • 3
  • Benjamin Tan
    • 4
  • William C. Chapman
    • 3
  1. 1.Department of RadiologyWashington UniversitySt. LouisUSA
  2. 2.Department of Immunology and PathologyWashington UniversitySt. LouisUSA
  3. 3.Department of SurgeryWashington UniversitySt. LouisUSA
  4. 4.Department of Internal Medicine and OncologyWashington UniversitySt. LouisUSA

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