Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Liver Int. 2021 Jul;41(7):1641-1651. doi: 10.1111/liv.14798. Epub 2021 Feb 13.
Differences in combined hepatocellular-cholangiocarcinomas (cHCC-CCAs) arising in high-risk patients with or without liver cirrhosis have not been elucidated. This study aimed to compare the clinicopathologic and imaging characteristics of cHCC-CCAs in patients with or without cirrhosis and to determine the prognostic factors for recurrence-free survival (RFS) after curative resections of single cHCC-CCAs.
This retrospective study included 113 patients with surgically resected single cHCC-CCAs who underwent preoperative magnetic resonance imaging from January 2008 to December 2019 at two tertiary referral centres. Clinical, pathologic and imaging features of tumours were compared in high-risk patients with or without cirrhosis. Imaging features were assessed using the Liver Imaging Reporting and Data System (LI-RADS) version 2018. RFS and associated factors were evaluated using Cox proportional hazards regression analysis, Kaplan-Meier analysis and log-rank test.
cHCC-CCAs arising from cirrhotic livers had a smaller mean tumour size (2.9 cm vs. 4.5 cm; P < .001) and were more frequently categorized as LR-5 or 4 (41.2% vs. 20.0%; P = .024) than those arising from non-cirrhotic livers. In multivariable analysis, a tumour size of > 3 cm (hazard ratio [HR], 2.081; 95% confidence interval [CI], 1.180-3.668; P = .011) and the LR-M category (HR, 2.302; 95% CI, 1.198-4.424; P = .012) were independent predictors associated with worse RFS.
The tumour size and distribution of LI-RADS categories of cHCC-CCAs differed in high-risk patients with or without cirrhosis. And LR-M category was a worse prognosis predictor after curative resections than LR-5 or 4 category.
在伴有或不伴有肝硬化的高危患者中，发生的混合性肝细胞癌-胆管细胞癌（cHCC-CCAs）之间的差异尚未阐明。本研究旨在比较伴有或不伴有肝硬化的 cHCC-CCAs 的临床病理和影像学特征，并确定单个 cHCC-CCAs 根治性切除术后无复发生存（RFS）的预后因素。
本回顾性研究纳入了 2008 年 1 月至 2019 年 12 月期间在两家三级转诊中心接受术前磁共振成像的 113 例接受手术切除的单发 cHCC-CCAs 患者。比较了高危伴或不伴肝硬化患者的肿瘤临床、病理和影像学特征。采用 2018 年版肝脏成像报告和数据系统（LI-RADS）评估影像学特征。采用 Cox 比例风险回归分析、Kaplan-Meier 分析和对数秩检验评估 RFS 及相关因素。
来自肝硬化肝脏的 cHCC-CCAs 的平均肿瘤大小较小（2.9cm 比 4.5cm；P<0.001），并且更常被归类为 LR-5 或 4（41.2%比 20.0%；P=0.024）。多变量分析显示，肿瘤直径>3cm（危险比[HR]，2.081；95%置信区间[CI]，1.180-3.668；P=0.011）和 LR-M 类别（HR，2.302；95%CI，1.198-4.424；P=0.012）是与 RFS 较差相关的独立预测因素。
在伴有或不伴有肝硬化的高危患者中，cHCC-CCAs 的肿瘤大小和 LI-RADS 分类分布不同。LR-M 类别是根治性切除术后比 LR-5 或 4 类别更差的预后预测因素。
