联合肝细胞癌和胆管细胞癌与肝细胞癌和胆管细胞癌患者术后临床特征和结局的比较：倾向评分匹配分析。
Clinical features and outcomes of combined hepatocellular carcinoma and cholangiocarcinoma versus hepatocellular carcinoma versus cholangiocarcinoma after surgical resection: a propensity score matching analysis.
机构信息
Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan.
Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
出版信息
BMC Gastroenterol. 2021 Jan 7;21(1):20. doi: 10.1186/s12876-020-01586-4.
BACKGROUND
Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is an infrequent type of primary liver cancer that comprises hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). This study investigated the clinicopathological features and prognosis among cHCC-CC, HCC, and CC groups.
METHODS
We prospectively collected the data of 608 patients who underwent surgical resection for liver cancer between 2011 and 2018 at E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. Overall, 505 patients with cHCC-CC, HCC, and CC were included, and their clinicopathological features, overall survival (OS), and recurrence were recorded. OS and recurrence rates were analyzed using the Kaplan-Meier analysis.
RESULTS
In the entire cohort, the median age was 61 years and 80% were men. Thirty-five (7.0%) had cHCC-CC, 419 (82.9%) had HCC, and 51 (10.1%) had CC. The clinicopathological features of the cHCC-CC group were more identical to those of the HCC group than the CC group. OS was significantly lower in the cHCC-CC group than in the HCC group but was not significantly higher in the cHCC-CC group than in the CC group. The median OS of cHCC-CC, HCC, and CC groups was 50.1 months [95% confidence interval (CI): 38.7-61.2], 62.3 months (CI: 42.1-72.9), and 36.2 months (CI: 15.4-56.5), respectively. Cumulative OS rates at 1, 3, and 5 years in cHCC-CC, HCC, and CC groups were 88.5%, 62.2%, and 44.0%; 91.2%, 76.1%, and 68.0%; and 72.0%, 48.1%, and 34.5%, respectively. After propensity score matching (PSM), OS in the cHCC-CC group was not significantly different from that in the HCC or CC group. However, OS was significantly higher in the HCC group than in the CC group before and after PSM. Furthermore, the disease-free survival was not significantly different among cHCC-CC, HCC, and CC groups before and after PSM.
CONCLUSION
The clinicopathological features of the cHCC-CC group were more identical to those of the HCC group than the CC group. The OS rate was significantly lower in the cHCC-CC group than the HCC group. However, after PSM, OS and disease-free survival in the cHCC-CC group were not significantly different from those in the HCC or CC group.
背景
肝细胞癌合并胆管细胞癌（cHCC-CC）是一种罕见的原发性肝癌，由肝细胞癌（HCC）和胆管细胞癌（CC）组成。本研究旨在探讨 cHCC-CC、HCC 和 CC 三组患者的临床病理特征和预后。
方法
我们前瞻性收集了 2011 年至 2018 年在台湾高雄义大医院接受肝癌手术切除的 608 例患者的数据。共纳入 505 例 cHCC-CC、HCC 和 CC 患者，记录其临床病理特征、总生存期（OS）和复发情况。采用 Kaplan-Meier 分析评估 OS 和复发率。
结果
在整个队列中，中位年龄为 61 岁，80%为男性。35 例（7.0%）为 cHCC-CC，419 例（82.9%）为 HCC，51 例（10.1%）为 CC。cHCC-CC 组的临床病理特征与 HCC 组更为相似，而与 CC 组则差异较大。cHCC-CC 组的 OS 明显低于 HCC 组，但与 CC 组无显著差异。cHCC-CC、HCC 和 CC 组的中位 OS 分别为 50.1 个月（95%CI：38.7-61.2）、62.3 个月（CI：42.1-72.9）和 36.2 个月（CI：15.4-56.5）。cHCC-CC、HCC 和 CC 组的累积 OS 率在 1、3 和 5 年时分别为 88.5%、62.2%和 44.0%、91.2%、76.1%和 68.0%、72.0%、48.1%和 34.5%。经倾向评分匹配（PSM）后，cHCC-CC 组的 OS 与 HCC 或 CC 组无显著差异。然而，PSM 前后 HCC 组的 OS 均显著高于 CC 组。此外，PSM 前后 cHCC-CC、HCC 和 CC 组的无病生存率无显著差异。
结论
cHCC-CC 组的临床病理特征与 HCC 组更为相似，而与 CC 组差异较大。cHCC-CC 组的 OS 率明显低于 HCC 组。然而，PSM 后 cHCC-CC 组的 OS 和无病生存率与 HCC 或 CC 组无显著差异。
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