Yano Yoshiko, Yamamoto Junji, Kosuge Tomoo, Sakamoto Yoshihiro, Yamasaki Susumu, Shimada Kazuaki, Ojima Hidenori, Sakamoto Michiie, Takayama Tadatoshi, Makuuchi Masatoshi
Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
Jpn J Clin Oncol. 2003 Jun;33(6):283-7. doi: 10.1093/jjco/hyg056.
Combined hepatocellular and cholangiocarcinoma (cHCC-CC) is an uncommon subtype of primary liver cancer, the clinicopathological features of which have rarely been reported in detail. The aim of this study was to clarify the characteristics of cHCC-CC in comparison with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC).
The clinicopathological features of 26 cHCC-CC patients, who were surgically treated, were reviewed by comparing them with the features of patients suffering from ordinary hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC).
The cHCC-CC patients showed greater similarity with HCC patients than with CC patients with regard to male/female ratio, status of hepatitis viral infection, serum alpha-fetoprotein (AFP) level, and non-tumor liver histology. The disease stage of the cHCC-CC patients was more advanced than that of either the HCC or CC patients. The cHCC-CC tumors were significantly more invasive to the portal vein than the HCC tumors and were comparable to the CC tumors. The overall 3-, 5-, and 10-year survival rates and the median survival times (95% confidence interval) were 34.6%, 23.1%, 11.5% and 1.8 (0.7-3.0) years for cHCC-CC patients, 86.7%, 66.2%, 46.8% and 4.6 (4.3-5.0) years for HCC patients, and 68.5%, 32.3%, 23.9% and 1.9 (1.1-2.7) years for CC patients, respectively. Survival of patients with cHCC-CC was significantly poorer than that of HCC or CC patients. Among the 26 patients, six survived for >5 years.
In most cases, cHCC-CC seems to be a variant of ordinary HCC with cholangiocellular features, rather than a true intermediate disease entity between HCC and CC. The surgical approach is recommended for selected patients with cHCC-CC.
肝内胆管癌合并肝细胞癌（cHCC-CC）是原发性肝癌的一种罕见亚型，其临床病理特征鲜有详细报道。本研究旨在阐明cHCC-CC相较于肝细胞癌（HCC）和胆管癌（CC）的特征。
回顾性分析26例接受手术治疗的cHCC-CC患者的临床病理特征，并与普通肝细胞癌（HCC）和胆管癌（CC）患者的特征进行比较。
在男女比例、肝炎病毒感染状况、血清甲胎蛋白（AFP）水平及非肿瘤肝脏组织学方面，cHCC-CC患者与HCC患者的相似性高于与CC患者的相似性。cHCC-CC患者的疾病分期比HCC或CC患者更晚。cHCC-CC肿瘤对门静脉的侵犯明显高于HCC肿瘤，与CC肿瘤相当。cHCC-CC患者的3年、5年和10年总生存率及中位生存时间（95%置信区间）分别为34.6%、23.1%、11.5%和1.8（0.7 - 3.0）年，HCC患者分别为86.7%、66.2%、46.8%和4.6（4.3 - 5.0）年，CC患者分别为68.5%、32.3%、23.9%和1.9（1.1 - 2.7）年。cHCC-CC患者的生存率显著低于HCC或CC患者。26例患者中，6例存活超过5年。
在大多数情况下，cHCC-CC似乎是具有胆管细胞特征的普通HCC的一种变体，而非HCC与CC之间真正的中间疾病实体。建议对选定的cHCC-CC患者采取手术治疗方法。
