Aishima Shinichi, Kuroda Yousuke, Asayama Yoshiki, Taguchi Kenichi, Nishihara Yunosuke, Taketomi Akinobu, Tsuneyoshi Masazumi
Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
Hum Pathol. 2006 Mar;37(3):283-91. doi: 10.1016/j.humpath.2005.08.019.
Combined hepatocellular and cholangiocarcinoma (cHC-CC) is a rare type of liver cancer displaying both hepatocellular and cholangiocellular components. The cholangiocellular carcinoma (CC) in these tumors ranges from focal to prominent. Those cHC-CCs with sarcomatous features are reported to have a poor prognosis. To clarify whether the CC and sarcomatous component affects the prognosis, we classified 40 patients with cHC-CCs into 4 groups according to the presence of a sarcomatous component and the extent of the CC component. Seven (17.5%) tumors showed areas with a sarcomatous component. The remaining tumors were divided into a low-CC group (CC occupying <30% of the tumor, n = 12), a middle-CC group (30%-60%, n = 15), and a high-CC group (>60%, n = 6). Vascular invasion was more frequently present in the high-CC and sarcomatous group than in the other groups (P = .0007). No lymph node metastasis occurred in either the low- or the middle-CC groups, but it was detected in 3 (50%) cases of the high-CC group and in 2 (29%) cases of the sarcomatous group (P < .0001). There was a tendency for tumor size to increase from the low- to the middle- to the high-CC group. The Ki-67 labeling index values for the hepatocellular carcinoma, CC, and sarcomatous components were 11.4% +/- 12.9%, 25.4% +/- 18.3%, and 46.0% +/- 23.6%, respectively. The overall survival of patients in the high-CC and sarcomatous group was significantly poorer than that of patients in the low- and middle-CC groups (P = .0048). By multivariate analysis of overall survival, lymph node metastasis, histological subgroup, and vascular invasion were significant independent prognostic factors. A cHC-CC with a large CC component is as aggressive as cHC-CC with sarcomatous features.
肝细胞胆管细胞癌（cHC-CC）是一种罕见的肝癌类型，兼具肝细胞和胆管细胞成分。这些肿瘤中的胆管细胞癌（CC）范围从局灶性到显著。据报道，具有肉瘤样特征的cHC-CC预后较差。为了阐明CC和肉瘤样成分是否影响预后，我们根据肉瘤样成分的存在情况和CC成分的范围将40例cHC-CC患者分为4组。7例（17.5%）肿瘤显示有肉瘤样成分区域。其余肿瘤分为低CC组（CC占肿瘤<30%，n = 12）、中CC组（30%-60%，n = 15）和高CC组（>60%，n = 6）。高CC组和肉瘤样组的血管侵犯比其他组更常见（P = .0007）。低CC组和中CC组均未发生淋巴结转移，但在高CC组的3例（50%）病例和肉瘤样组的2例（29%）病例中检测到淋巴结转移（P < .0001）。肿瘤大小有从低CC组到中CC组再到高CC组逐渐增大的趋势。肝细胞癌、CC和肉瘤样成分的Ki-67标记指数值分别为11.4%±12.9%、25.4%±18.3%和46.0%±23.6%。高CC组和肉瘤样组患者的总生存期明显低于低CC组和中CC组患者（P = .0048）。通过对总生存期的多因素分析，淋巴结转移、组织学亚组和血管侵犯是显著的独立预后因素。具有大CC成分的cHC-CC与具有肉瘤样特征的cHC-CC一样具有侵袭性。
