Skip to main content
Log in

Combined Hepatocellular–Cholangiocarcinoma Had Poor Outcomes after Hepatectomy Regardless of Allen and Lisa Class or the Predominance of Intrahepatic Cholangiocarcinoma Cells within the Tumor

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Liver Cancer Study Group of Japan. Seventeenth nationwide survey of primary liver cancer in Japan. Kyoto, 2006.

  2. Allen RA, Lisa JR. Combined liver cell and bile duct carcinoma. Am J Pathol. 1949;25:647–55.

    PubMed  CAS  Google Scholar 

  3. Bosman FT, Carneiro F, Hruban RH, et al. WHO classification of tumours of the digestive system. Lyon: IARC, 2010.

    Google Scholar 

  4. Liver Cancer Study Group of Japan. General rules for the clinical and pathological study of primary liver cancer. 5th ed. Tokyo: Kanehara, 2008.

    Google Scholar 

  5. Goodman ZD, Ishak KG, Langloss JM, et al. Combined hepatocellular–cholangiocarcinoma: a histologic and immunohistochemical study. Cancer. 1985;55:124–35.

    Article  PubMed  CAS  Google Scholar 

  6. Nakamura S, Suzuki S, Sakaguchi T, et al. Surgical treatment of patients with mixed hepatocellular carcinoma and cholangiocarcinoma. Cancer. 1996;78:1671–6.

    Article  PubMed  CAS  Google Scholar 

  7. Taguchi J, Nakashima O, Tanaka M, et al. A clinicopathological study on combined hepatocellular and cholangiocarcinoma. J Gastroenterol Hepatol. 1996;11:758–64.

    Article  PubMed  CAS  Google Scholar 

  8. Ng IO, Shek TW, Nicholls J, et al. Combined hepatocellular cholangiocarcinoma: a clinicopathological study. J Gastroenterol Hepatol. 1998;13:34–40.

    Article  PubMed  CAS  Google Scholar 

  9. Jarnagin WR, Weber S, Tickoo SK, et al. Combined hepatocellular and cholangiocarcinoma: demographic, clinical, and prognostic factors. Cancer. 2002;94:2040–6.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. Liu CL, Fan ST, Lo CM, et al. Hepatic resection for combined hepatocellular and cholangiocarcinoma. Arch Surg. 2003;138:86–90.

    Article  PubMed  Google Scholar 

  12. Cazals-Hatem D, Rebouissou S, Bioulac-Stage P, et al. Clinical and molecular analysis of combined hepatocellular–cholangiocarcinomas. J Hepatol. 2004;41:292–8.

    Article  PubMed  CAS  Google Scholar 

  13. Koh KC, Lee H, Choi MS, et al. Clinicopathologic features and prognosis of combined hepatocellular cholangiocarcinoma. Am J Surg. 2005;189:120–5.

    Article  PubMed  Google Scholar 

  14. Lee WS, Lee KW, Heo JS, et al. Comparison of combined hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Surg Today. 2006;36:892–7.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. Portolani N, Baiocchi GL, Coniglio A, et al. Intrahepatic cholangiocarcinoma and combined hepatocellular–cholangiocarcinoma: a Western experience. Ann Surg Oncol. 2008;15:1880–90.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. Wang J, Wang F, Kessinger A. Outcome of combined hepatocellular and cholangiocarcinoma of the liver. J Oncol. 2010;2010:917356.

    PubMed  Google Scholar 

  22. 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.

    PubMed  Google Scholar 

  23. Aoki K, Takayasu K, Kawano T, et al. Combined hepatocellular carcinoma and cholangiocarcinoma: clinical features and computed tomographic findings. Hepatology. 1993;18:1090–5.

    Article  PubMed  CAS  Google Scholar 

  24. 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.

    Article  PubMed  CAS  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. Terminology Committee of the International Hepato-Pancreato-Biliary Association. The Brisbane 2000 terminology of liver anatomy and resections. HPB. 2000;2:333–9.

    Google Scholar 

  27. Sobin LH, Gospodarowics MK, Wittekind CH; International Union against Cancer. TNM classification of malignant tumours. 7th ed. UK: Wiley-Blackwell, 2009.

    Google Scholar 

  28. 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.

    Article  PubMed  CAS  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. Ghali P, Marotta PJ, Yoshida EM, et al. Liver transplantation for incident cholangiocarcinoma. Liver Transpl. 2005;11:1412–6.

    Article  PubMed  Google Scholar 

  32. 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.

    Article  PubMed  Google Scholar 

  33. Theise ND, Yao JL, Harada K, et al. Hepatic “stem cell” malignancies in adults: four cases. Histopathology. 2003;43:263–71.

    Article  PubMed  CAS  Google Scholar 

  34. 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.

    Article  PubMed  CAS  Google Scholar 

  35. Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO classification of tumours of the digestive system. 4th ed. Switzerland: WHO Press, 2010.

    Google Scholar 

Download references

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

Authors

Corresponding author

Correspondence to Masakazu Yamamoto MD.

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-011-2150-0

Keywords

Navigation