Kim Won, Lee Jeong Hoon, Kim Yoon Jun, Yoon Jung Hwan, Suh Kyung Suk, Lee Kuhn Uk, Jang Ja June, Lee Hyo Suk
Department of Internal Medicine, Seoul National University College of Medicine, National University Hospital, 29 Yeongeon-dong, Jong-no-gu, Seoul, Korea.
Korean J Gastroenterol. 2007 Mar;49(3):158-65.
BACKGROUND/AIMS: Combined hepatocellular and cholangiocarcinoma (HCC-CC) is a rare form of primary liver carcinoma which contains characteristics of both hepatocellular carcinoma and cholangiocarcinoma. The aim of this study was to evaluate the prognostic factors of combined HCC-CC after curative resection.
Between January 1987 and December 2005, pathologically confirmed combined HCC-CC patients who underwent curative resection at Seoul National University Hospital were evaluated. We reviewed the medical records and evaluated the time-to-recurrence (TTR), overall survival (OS) and prognostic factors of combined HCC-CC.
A total of 31 patients were evaluated (M:F=27:4; median age, 61 years). According to the American Joint Committee on Cancer system, patients with stage I, II, III(A), III(B) and III(C) at the time of resection were 4, 16, 7, 2 and 2, respectively. Twenty six patients (83.9%) had tumor recurrence during the follow-up period and their median TTR was 5.7 months. Twenty one patients received additional treatment while 5 patients did not. As a result, median OS was 21.6 months and 3 year survival rate was 15.4%. In multivariate analysis, stage III than stage I or II at resection was an independent prognostic factor associated with shortened TTR (p<0.01). Older age (p=0.03), stage III(C) rather than stage I, II, III(A) at time of resection (p=0.02), and Child-Pugh B rather than A (p<0.01) were independent prognostic factors associated with shortened OS.
Even after curative resections, patients with combined HCC-CC show poor prognosis with early recurrence and poor survival. However, surgical treatment should be warranted for relatively young patients in early stage with well preserved liver function.
背景/目的：肝细胞胆管细胞癌（HCC-CC）是原发性肝癌的一种罕见形式，兼具肝细胞癌和胆管癌的特征。本研究旨在评估根治性切除术后HCC-CC的预后因素。
对1987年1月至2005年12月在首尔国立大学医院接受根治性切除的经病理确诊的HCC-CC患者进行评估。我们回顾了病历，并评估了HCC-CC的复发时间（TTR）、总生存期（OS）和预后因素。
共评估了31例患者（男:女=27:4；中位年龄61岁）。根据美国癌症联合委员会系统，切除时处于I期、II期、III（A）期、III（B）期和III（C）期的患者分别为4例、16例、7例、2例和2例。26例患者（83.9%）在随访期间出现肿瘤复发，其TTR中位数为5.7个月。21例患者接受了额外治疗，5例未接受。结果，OS中位数为21.6个月，3年生存率为15.4%。多因素分析显示，切除时III期比I期或II期是与TTR缩短相关的独立预后因素（p<0.01）。年龄较大（p=0.03）、切除时为III（C）期而非I期、II期、III（A）期（p=0.02）以及Child-Pugh B级而非A级（p<0.01）是与OS缩短相关的独立预后因素。
即使在根治性切除术后，HCC-CC患者的预后仍较差，复发早且生存率低。然而，对于肝功能良好的相对年轻的早期患者，手术治疗仍是必要的。
