Jung Dong-Hwan, Hwang Shin, Hong Seung-Mo, Chung Yong-Kyu, Song Gi-Won, Lee Young-Joo, Kim Ki-Hun, Ahn Chul-Soo, Moon Deok-Bog, Ha Tae-Yong, Park Gil-Chun, Lee Han Chu, Lim Young-Suk, Yu Eun Sil, Lee Sung-Gyu
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
World J Surg. 2017 May;41(5):1347-1357. doi: 10.1007/s00268-016-3837-y.
Combined hepatocellular carcinoma and cholangiocarcinoma (cHC) has wide histological diversity. We intended to investigate the prognostic influence of tumor types of cHC.
We analyzed the clinical and pathological features of cHC along 2010 WHO classification. Study group was 100 cHC patients who underwent primary resection. Control group comprised 200 propensity score-matched patients with intrahepatic cholangiocarcinoma (ICC).
In cHC group, tumor diameter was 4.4 ± 2.8 cm and 95 patients had single tumor. They were classified as classical type in 46 and subtypes with stem cell (SC) features in 54. Subtypes with SC features included typical in 16, intermediate cell in 22, and cholangiolocellular in 16. Their 1- and 3-year tumor recurrence rates were 31.7 and 59.8%; and 1- and 3-year patient survival rates were 92.5 and 77.3%, respectively. Tumor recurrence (p = 0.008) and patient survival (p = 0.005) rates were different according to tumor types. Further stratification by subtypes with SC features resulted in prognostic stratification in tumor recurrence (p = 0.045) and patient survival (p = 0.042). However, tumor stage was the only independent risk factor for tumor recurrence and patient survival. Comparing with ICC control group, cHC group showed no significant difference in rates of tumor recurrence (p = 0.523), but better survival outcomes (p = 0.008). Median post-recurrence patient survival period was 20 months in cHC patients and 6 months in ICC patients (p = 0.001).
Our results indicated that there would be close relationship between the post-resection prognosis and histological types according to the 2010 WHO classification, but these histological types did not become an independent prognostic factor.
肝细胞癌合并胆管癌（cHC）具有广泛的组织学多样性。我们旨在研究cHC肿瘤类型对预后的影响。
我们根据2010年世界卫生组织分类分析了cHC的临床和病理特征。研究组为100例行初次切除的cHC患者。对照组包括200例倾向评分匹配的肝内胆管癌（ICC）患者。
在cHC组中，肿瘤直径为4.4±2.8 cm，95例患者为单发肿瘤。其中46例为经典型，54例为具有干细胞（SC）特征的亚型。具有SC特征的亚型包括典型型16例、中间细胞型22例和胆管细胞型16例。其1年和3年肿瘤复发率分别为31.7%和59.8%；1年和3年患者生存率分别为92.5%和77.3%。根据肿瘤类型，肿瘤复发率（p = 0.008）和患者生存率（p = 0.005）有所不同。按具有SC特征的亚型进一步分层导致肿瘤复发（p = 0.045）和患者生存（p = 0.042）的预后分层。然而，肿瘤分期是肿瘤复发和患者生存的唯一独立危险因素。与ICC对照组相比，cHC组肿瘤复发率无显著差异（p = 0.523），但生存结局更好（p = 0.008）。cHC患者复发后中位生存时间为20个月，ICC患者为6个月（p = 0.001）。
我们的结果表明，根据2010年世界卫生组织分类，切除术后预后与组织学类型之间存在密切关系，但这些组织学类型并未成为独立的预后因素。
