Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, No. 37 GuoXue Alley, Chengdu 610041, P.R. China.
Department of Obstetrics and Gynecology Nursing, Key Laboratory of Birth Defects and Related Disease of Women and Children, West China Second University Hospital, Sichuan University, No. 20 South Renmin Road, Chengdu 610041, P.R. China.
Int J Med Sci. 2021 Jan 1;18(1):187-198. doi: 10.7150/ijms.50883. eCollection 2021.
Clinical characteristics and prognosis among combined hepatocellular carcinoma (HCC) and cholangiocarcinoma (cHCC-CC) with HCC and intrahepatic cholangiocarcinoma (ICC) were inconsistent in previous studies. The aim of this study was to compare postoperative prognosis among cHCC-CC, HCC and ICC, and investigated the prognostic risk factor of cHCC-CC after surgical resection. A total of 1041 eligible patients with pathological diagnosis of cHCC-CC (n=135), HCC (n=698) and ICC (n=208) were enrolled in this study. Univariate and multivariate Cox analysis were applied for assessing important risk factors. cHCC-CC were further 1:1 matched with HCC and ICC on important clinical risk factors. Survival curves of matched and unmatched cohorts were depicted by Kaplan-Meier method with log-rank test. Patients with cHCC-CC had similar rate of sex, age and cirrhosis with HCC (0.05) and comparable incidence of hepatitis B or C with ICC (0.197). Patients of cHCC-CC had intermediate prognosis between HCC and ICC, with median overall survival (OS) time of cHCC-CC, HCC and ICC of 20.5 months, 35.7 months and 11.6 months (0.001). In matched cohorts, the OS of cHCC-CC were worse than HCC (0.001) but comparable with ICC (0.06), while the disease-free survival (DFS) of cHCC-CC was worse than HCC but better than ICC (0.05). And lymph node infiltration and postoperative transarterial chemoembolization (TACE) were independent risk factors of cHCC-CC associated with prognosis. The long term survival of cHCC-CC was worse than HCC but comparable with ICC when matched on albumin level, tumor size, lymph node infiltration, tumor stage and margin. Presence of lymph node infiltration and no postoperative TACE were associated with poor prognosis of cHCC-CC.
先前的研究中，混合型肝细胞癌（HCC）和胆管细胞癌（cHCC-CC）与单纯 HCC 和肝内胆管细胞癌（ICC）的临床特征和预后不一致。本研究旨在比较 cHCC-CC、HCC 和 ICC 患者手术后的预后，并探讨手术切除后 cHCC-CC 的预后危险因素。
共纳入 1041 例经病理诊断为 cHCC-CC（n=135）、HCC（n=698）和 ICC（n=208）的患者。采用单因素和多因素 Cox 分析评估重要的危险因素。cHCC-CC 根据重要的临床危险因素与 HCC 和 ICC 进行 1:1 匹配。采用 Kaplan-Meier 法和对数秩检验描绘匹配和未匹配队列的生存曲线。
cHCC-CC 患者的性别、年龄和肝硬化与 HCC 相似（0.05），与 ICC 的乙型肝炎或丙型肝炎发病率相似（0.197）。cHCC-CC 患者的预后处于 HCC 和 ICC 之间，cHCC-CC、HCC 和 ICC 的中位总生存期（OS）分别为 20.5 个月、35.7 个月和 11.6 个月（0.001）。在匹配队列中，cHCC-CC 的 OS 差于 HCC（0.001），但与 ICC 相当（0.06），而 DFS 差于 HCC 但好于 ICC（0.05）。淋巴结浸润和术后经动脉化疗栓塞（TACE）是与预后相关的 cHCC-CC 的独立危险因素。
当根据白蛋白水平、肿瘤大小、淋巴结浸润、肿瘤分期和切缘匹配时，cHCC-CC 的长期生存状况比 HCC 差，但与 ICC 相当。存在淋巴结浸润和无术后 TACE 与 cHCC-CC 的不良预后相关。
