Jung Dong-Hwan, Hwang Shin, Song Gi-Won, Ahn Chul-Soo, Moon Deok-Bog, Kim Ki-Hun, Ha Tae-Yong, Park Gil-Chun, Hong Seung-Mo, Kim Wan-Jun, Kang Woo-Hyoung, Kim Seok-Hwan, Yu Eun Sil, Lee Sung-Gyu
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Liver Transpl. 2017 Mar;23(3):330-341. doi: 10.1002/lt.24711.
Combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CC) is a rare disease. We investigated the clinicopathological features of cHCC-CC and compared the longterm outcomes following liver transplantation (LT) and hepatic resection (HR). We identified 32 LT patients with cHCC-CC through an institutional database search. The HR control group (n = 100) was selected through propensity score-matching. The incidence of cHCC-CC among all adult LT patients was 1.0%. Mean patient age was 53.4 ± 6.7 years, and 26 patients were male. Thirty patients had hepatitis B virus infection. All patients of cHCC-CC were diagnosed incidentally in the explanted livers. Mean tumor diameter was 2.5 ± 1.3 cm, and 28 patients had single tumors. Tumor stage was stage I in 23 and II in 9. Concurrent hepatocellular carcinoma (HCC) was detected in 12 patients with stage I in 5 and II in 7. Mean tumor diameter was 1.9 ± 1.2 cm, and 5 had single tumors. Tumor recurrence and survival rates were 15.6% and 84.4% at 1 year and 32.2% and 65.8% at 5 years, respectively. Patients with very early stage cHCC-CC (1 or 2 tumors ≤ 2.0 cm) showed 13.3% tumor recurrence and 93.3% patient survival rates at 5 years, which were significantly improved than those with advanced tumors (P = 0.002). Tumor recurrence and survival rates did not differ significantly between the LT and HR control groups (P = 0.22 and P = 0.91, respectively); however, postrecurrence patient survival did (P = 0.016). In conclusion, cHCC-CC is rarely diagnosed following LT, and one-third of such patients have concurrent HCC. The longterm posttransplant prognosis was similar following LT and HR. Very early cHCC-CC resulted in favorable posttransplant prognosis, thus this selection condition can be prudently considered for LT indication. Liver Transplantation 23 330-341 2017 AASLD.
肝细胞癌-胆管癌合并症（cHCC-CC）是一种罕见疾病。我们研究了cHCC-CC的临床病理特征，并比较了肝移植（LT）和肝切除术（HR）后的长期预后。我们通过机构数据库检索确定了32例接受LT的cHCC-CC患者。通过倾向评分匹配选择HR对照组（n = 100）。所有成年LT患者中cHCC-CC的发生率为1.0%。患者平均年龄为53.4±6.7岁，男性26例。30例患者感染乙肝病毒。所有cHCC-CC患者均在移植肝中偶然诊断。平均肿瘤直径为2.5±1.3 cm，28例患者为单发病灶。肿瘤分期为I期23例，II期9例。12例患者同时存在肝细胞癌（HCC），其中I期5例，II期7例。平均肿瘤直径为1.9±1.2 cm，5例为单发病灶。1年时肿瘤复发率和生存率分别为15.6%和84.4%，5年时分别为32.2%和65.8%。极早期cHCC-CC（1个或2个肿瘤≤2.0 cm）患者5年时肿瘤复发率为13.3%，患者生存率为93.3%，显著优于晚期肿瘤患者（P = 0.002）。LT组和HR对照组之间的肿瘤复发率和生存率无显著差异（分别为P = 0.22和P = 0.91）；然而，复发后患者生存率有差异（P = 0.016）。总之，LT后很少诊断出cHCC-CC，此类患者中有三分之一同时存在HCC。LT和HR后的长期移植后预后相似。极早期cHCC-CC导致良好的移植后预后，因此在LT指征时可谨慎考虑这一选择条件。《肝脏移植》2017年第23卷330 - 341页，美国肝病研究学会
