Department of Surgery and Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Asian J Surg. 2021 Nov;44(11):1389-1395. doi: 10.1016/j.asjsur.2021.03.002. Epub 2021 Mar 22.
Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CCA) has wide histologic diversity. This study investigated the prognostic impacts of cHCC-CCA histology according to the 2019 World Health Organization (WHO) classification.
This retrospective observational study included 153 patients who underwent surgical resection for cHCC-CCA at Asan Medical Center between August 2012 and July 2019.
During the study period, 153 patients, 112 (73.2%) men and 41 (26.8%) women with a mean age of 56.4 ± 10.8 years, underwent R0 resection for cHCC-CCA. Mean tumor diameter was 4.2 ± 2.6 cm, and 147 (96.1%) patients had solitary tumors. According to 2019 WHO classification, 111 (72.5%) patients had cHCC-CCA alone, and 29 of them (26.1%) showed stem cell features. cHCC-CCA-intermediate cell carcinoma and cHCC-CCA-cholangiolocellular carcinoma were identified in 27 (17.6%) and 15 (9.8%), respectively. The 1-, 3-, and 5-year tumor recurrence and patient survival rates were 31.8% and 92.1%, 49.8% and 70.9%, and 59.0% and 61.7%, respectively. Univariate analyses revealed that significant prognostic factors were tumor size >5 cm, microscopic and macroscopic vascular invasion, lymph node metastasis, 8th American Joint Committee on Cancer (AJCC) tumor stage, and status of stem cell features. Multivariate analysis revealed 8th AJCC tumor stage and status of stem cell features as independent prognostic factors. 2019 WHO classification was not associated with post-resection prognosis.
2019 WHO classification was not associated with post-resection prognosis, thus was considered as simplified histologic classification requiring prognostic validation. We suggest that stem cell features should be included as an essential component of the pathology report for cHCC-CCA.
混合型肝细胞癌和胆管细胞癌（cHCC-CCA）具有广泛的组织学多样性。本研究根据 2019 年世界卫生组织（WHO）分类，探讨了 cHCC-CCA 组织学的预后影响。
本回顾性观察研究纳入了 2012 年 8 月至 2019 年 7 月期间在 Asan 医疗中心接受 cHCC-CCA 手术切除的 153 例患者。
在研究期间，153 例患者（112 例男性，41 例女性）接受了 R0 切除术，平均年龄为 56.4±10.8 岁。肿瘤平均直径为 4.2±2.6cm，147 例（96.1%）患者为单发肿瘤。根据 2019 年 WHO 分类，111 例（72.5%）患者为单纯 cHCC-CCA，其中 29 例（26.1%）具有干细胞特征。cHCC-CCA-间充质细胞癌和 cHCC-CCA-胆管细胞癌分别为 27 例（17.6%）和 15 例（9.8%）。1、3 和 5 年肿瘤复发率和患者生存率分别为 31.8%和 92.1%、49.8%和 70.9%以及 59.0%和 61.7%。单因素分析显示，肿瘤大小>5cm、镜下和肉眼血管侵犯、淋巴结转移、第 8 版美国癌症联合委员会（AJCC）肿瘤分期和干细胞特征状态是显著的预后因素。多因素分析显示，第 8 版 AJCC 肿瘤分期和干细胞特征状态是独立的预后因素。2019 年 WHO 分类与术后预后无关。
2019 年 WHO 分类与术后预后无关，因此被认为是简化的组织学分类，需要进行预后验证。我们建议将干细胞特征作为 cHCC-CCA 病理报告的一个重要组成部分。
