Liver Cancer Institute, Zhong Shan Hospital, Fudan University, Key Laboratory for Carcinogenesis & Cancer Invasion, Chinese Ministry of Education, Shanghai, People's Republic of China.
Ann Surg Oncol. 2012 Sep;19(9):2869-76. doi: 10.1245/s10434-012-2328-0. Epub 2012 Mar 27.
Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is an uncommon subtype of primary liver cancer that has rarely been reported in large-scale clinical studies. The aim of this study was to clarify the clinical features, treatment modalities, and prognosis of cHCC-CC.
Included in this study were 113 patients who were histologically diagnosed as having Allen type C cHCC-CC, 103 of whom received liver resection, 6 transarterial chemoembolization treatment, 3 radiofrequency ablation, and 1 palliative supportive treatment. Clinicopathologic features and prognosis of 103 cHCC-CC patients after liver resection were compared with those of 6,679 patients with hepatocellular carcinoma (HCC) and 386 patients with intrahepatic cholangiocarcinoma (ICC) who underwent liver resection during the same period.
The proportion of cHCC-CC in primary liver cancers was 1.5 %. The 103 cases of cHCC-CC were characterized by male predominance, infection with hepatitis virus or presence of liver cirrhosis, and elevated alfa-fetoprotein-findings similar to HCC. However, serum CA19-9 elevation, incomplete capsules, and lymph node involvement were similar to ICC. The 1-, 3-, and 5-year overall survival rates after liver resection were 73.9, 41.4, and 36.4 %, respectively, for patients with cHCC-CC versus 77.5, 53.3, and 41.4 % for HCC patients, and 58.0, 29.1, and 22.3 % for ICC patients (χ(2) = 137.5, P < 0.001). Tumor, node, metastasis system stage (hazard ratio 1.27, 95 % confidence interval 1.08-1.49, P = 0.003) and radical liver resection (hazard ratio 0.31, 95 % confidence interval 0.14-0.68, P = 0.004) were independent prognostic factors for overall survival.
cHCC-CC has biological behavior and prognosis that are intermediate between HCC and ICC. Radical liver resection can provide a better outcome for this uncommon malignancy.
肝细胞癌-胆管细胞癌（cHCC-CC）是一种罕见的原发性肝癌亚型，在大规模临床研究中鲜有报道。本研究旨在阐明 cHCC-CC 的临床特征、治疗方式和预后。
本研究纳入了 113 例经组织学诊断为 Allen 分型 C 型 cHCC-CC 的患者，其中 103 例行肝切除术，6 例行经肝动脉化疗栓塞术（TACE）治疗，3 例行射频消融术，1 例行姑息性支持治疗。比较了 103 例 cHCC-CC 患者肝切除术后的临床病理特征和预后与同期接受肝切除术的 6679 例肝细胞癌（HCC）患者和 386 例肝内胆管细胞癌（ICC）患者的预后。
cHCC-CC 在原发性肝癌中的比例为 1.5%。103 例 cHCC-CC 患者以男性为主，感染肝炎病毒或存在肝硬化，甲胎蛋白升高，与 HCC 的表现相似。然而，血清 CA19-9 升高、包膜不完整和淋巴结受累与 ICC 相似。cHCC-CC 患者肝切除术后 1、3 和 5 年总生存率分别为 73.9%、41.4%和 36.4%，HCC 患者分别为 77.5%、53.3%和 41.4%，ICC 患者分别为 58.0%、29.1%和 22.3%（χ(2) = 137.5，P < 0.001）。肿瘤、淋巴结、转移系统分期（危险比 1.27，95%置信区间 1.08-1.49，P = 0.003）和根治性肝切除术（危险比 0.31，95%置信区间 0.14-0.68，P = 0.004）是影响总生存率的独立预后因素。
cHCC-CC 的生物学行为和预后介于 HCC 和 ICC 之间。根治性肝切除术可为这种罕见的恶性肿瘤提供更好的疗效。
