Abstract
Background
We evaluated the surgical outcomes of combined hepatocellular–cholangiocarcinoma (CHC) in relation to Allen and Lisa class and the predominance of intrahepatic cholangiocarcinoma (ICC) cells within the tumor.
Methods
We retrospectively studied 44 patients with CHC who underwent hepatectomy between 1987 and 2010. Clinicopathologic characteristics and surgical outcomes were compared in relation to Allen and Lisa class (33 combined type, 11 mixed type) and the predominance of ICC cells within the tumor (cases in which ICC cells accounted for 50% or less of all cells within the tumor, n = 22; cases in which ICC cells accounted for more than 50%, n = 22).
Results
The survival rate for 42 patients with CHC who underwent curative surgery was 24% at 5 years, and median survival was 15.4 months. According to Allen and Lisa class, the number of cases with portal invasion was far higher in patients with the mixed type than in patients with the combined type. The 5-year survival rates of patients with the combined type and mixed type who underwent curative surgery were 27% and 13%, respectively, showing no statistically significant difference. According to the predominance of ICC cells, there was no difference in clinicopathologic findings between the groups. The 5-year survival rates of patients with ≤50% and >50% ICC cells within the tumor who underwent curative surgery were 21% and 26%, respectively, showing no statistically significant difference.
Conclusions
CHC had poor outcomes after hepatectomy regardless of Allen and Lisa class or the predominance of ICC cells within the tumor.
Similar content being viewed by others
References
Liver Cancer Study Group of Japan. Seventeenth nationwide survey of primary liver cancer in Japan. Kyoto, 2006.
Allen RA, Lisa JR. Combined liver cell and bile duct carcinoma. Am J Pathol. 1949;25:647–55.
Bosman FT, Carneiro F, Hruban RH, et al. WHO classification of tumours of the digestive system. Lyon: IARC, 2010.
Liver Cancer Study Group of Japan. General rules for the clinical and pathological study of primary liver cancer. 5th ed. Tokyo: Kanehara, 2008.
Goodman ZD, Ishak KG, Langloss JM, et al. Combined hepatocellular–cholangiocarcinoma: a histologic and immunohistochemical study. Cancer. 1985;55:124–35.
Nakamura S, Suzuki S, Sakaguchi T, et al. Surgical treatment of patients with mixed hepatocellular carcinoma and cholangiocarcinoma. Cancer. 1996;78:1671–6.
Taguchi J, Nakashima O, Tanaka M, et al. A clinicopathological study on combined hepatocellular and cholangiocarcinoma. J Gastroenterol Hepatol. 1996;11:758–64.
Ng IO, Shek TW, Nicholls J, et al. Combined hepatocellular cholangiocarcinoma: a clinicopathological study. J Gastroenterol Hepatol. 1998;13:34–40.
Jarnagin WR, Weber S, Tickoo SK, et al. Combined hepatocellular and cholangiocarcinoma: demographic, clinical, and prognostic factors. Cancer. 2002;94:2040–6.
Yano Y, Yamamoto J, Kosuge T, et al. Combined hepatocellular and cholangiocarcinoma: a clinicopathologic study of 26 resected cases. Jpn J Clin Oncol. 2003;33:283–7.
Liu CL, Fan ST, Lo CM, et al. Hepatic resection for combined hepatocellular and cholangiocarcinoma. Arch Surg. 2003;138:86–90.
Cazals-Hatem D, Rebouissou S, Bioulac-Stage P, et al. Clinical and molecular analysis of combined hepatocellular–cholangiocarcinomas. J Hepatol. 2004;41:292–8.
Koh KC, Lee H, Choi MS, et al. Clinicopathologic features and prognosis of combined hepatocellular cholangiocarcinoma. Am J Surg. 2005;189:120–5.
Lee WS, Lee KW, Heo JS, et al. Comparison of combined hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Surg Today. 2006;36:892–7.
Chantajitr S, Wilasrusmee C, Lertsitichai P, et al. Combined hepatocellular and cholangiocarcinoma;clinical features and prognostic study in a Thai population. J Hepatobiliary Pancreat Surg. 2006;13:537–42.
Zuo HQ, Yan LN, Zeng Y, et al. Clinicopathological characteristics of 15 patients with combined hepatocellular carcinoma and cholangiocarcinoma. Hepatobiliary Pancreat Dis Int. 2007;6:161–5.
Lin G, Toh CH, Wu RC, et al. Combined hepatocellular cholangiocarcinoma: prognostic factors investigated by computed tomography/magnetic resonance imaging. Int J Clin Pract. 2007;62:1199–205.
Portolani N, Baiocchi GL, Coniglio A, et al. Intrahepatic cholangiocarcinoma and combined hepatocellular–cholangiocarcinoma: a Western experience. Ann Surg Oncol. 2008;15:1880–90.
Shin CI, Lee JM, Kim SH, et al. Recurrence pattern of combined hepatocellular–cholangiocarcinoma on enhanced computed tomography. J Comput Assist Tomogr. 2007;31:109–15.
Kim KH, Lee SG, Park EH, et al. Surgical treatments and prognoses of patients with combined hepatocellular carcinoma and cholangiocarcinoma. Ann Surg Oncol. 2009;16:623–9.
Wang J, Wang F, Kessinger A. Outcome of combined hepatocellular and cholangiocarcinoma of the liver. J Oncol. 2010;2010:917356.
Lee JH, Chung GE, Yu SJ, et al. Long-term prognosis of combined hepatocellular and cholangiocarcinoma after curative resection comparison with hepatocellular carcinoma and cholangiocarcinoma. J Clin Gastroenterol. 2011;45:69–75.
Aoki K, Takayasu K, Kawano T, et al. Combined hepatocellular carcinoma and cholangiocarcinoma: clinical features and computed tomographic findings. Hepatology. 1993;18:1090–5.
Fukukura Y, Taguchi J, Nakashima O, et al. Combined hepatocellular and cholangiocarcinoma: correlation between CT findings and clinicopathological features. J Comput Assist Tomogr. 1997;21:52–8.
Sanada Y, Shiozaki S, Aoki H, et al. A clinical study of 11 cases of combined hepatocellular–cholangiocarcinoma. Assessment of enhancement pattern on dynamics computed tomography before resection. Hepatol Res. 2005;32:185–95.
Terminology Committee of the International Hepato-Pancreato-Biliary Association. The Brisbane 2000 terminology of liver anatomy and resections. HPB. 2000;2:333–9.
Sobin LH, Gospodarowics MK, Wittekind CH; International Union against Cancer. TNM classification of malignant tumours. 7th ed. UK: Wiley-Blackwell, 2009.
Panjala C, Senecal DL, Bridges MD, et al. The diagnostic conundrum and liver transplantation outcome for combined hepatocellular–cholangiocarcinoma. Am J Transplant. 2010;10:1263–7.
Maganty K, Levi D, Moon J, et al. Combined hepatocellular carcinoma and intrahepatic cholangiocarcinoma: outcome after liver transplantation. Dig Dis Sci. 2010;55:3597–601.
Sapisochin G, Fidelman N, Roberts JP, et al. Mixed hepatocellular–cholangiocarcinoma (HCC-CC) and intra-hepatic cholangiocarcinoma (I-CC) in patients transplanted for hepatocellular carcinoma. Liver Transpl. 2011;17:934–42.
Ghali P, Marotta PJ, Yoshida EM, et al. Liver transplantation for incident cholangiocarcinoma. Liver Transpl. 2005;11:1412–6.
Kim JH, Yoon HK, Ko GY, et al. Nonresectable combined hepatocellular carcinoma and cholangiocarcinoma: analysis of the response and prognostic factors after transcatheter arterial chemoembolization. Radiology. 2010;255:270–7.
Theise ND, Yao JL, Harada K, et al. Hepatic “stem cell” malignancies in adults: four cases. Histopathology. 2003;43:263–71.
Zhang F, Chen XP, Zhang W, et al. Combined hepatocellular cholangiocarcinoma originating from hepatic progenitor cells: immunohistochemical and double-fluorescence immunostaining evidence. Histopathology. 2008;52:224–32.
Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO classification of tumours of the digestive system. 4th ed. Switzerland: WHO Press, 2010.
Acknowledgment
The authors are indebted to Professor Raoul Breugelmans, Department of International Medical Communications, Tokyo Medical University, for his review.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ariizumi, Si., Kotera, Y., Katagiri, S. et al. Combined Hepatocellular–Cholangiocarcinoma Had Poor Outcomes after Hepatectomy Regardless of Allen and Lisa Class or the Predominance of Intrahepatic Cholangiocarcinoma Cells within the Tumor. Ann Surg Oncol 19, 1628–1636 (2012). https://doi.org/10.1245/s10434-011-2150-0
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-011-2150-0