Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Shanghai , 361006, Fujian, China.
Radiol Med. 2023 Sep;128(9):1047-1060. doi: 10.1007/s11547-023-01682-x. Epub 2023 Jul 20.
To investigate the significance of the predominant component of combined hepatocellular-cholangiocarcinoma (cHCC-CC) in terms of MRI manifestation and its potential prognostic value compared to hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC).
A total of 300 patients with chronic liver disease from two centers were retrospectively enrolled, including 100 surgically proven cases of cHCC-CC, HCC, and ICC each. Univariate and multivariate regression analyses were performed to identify independent predictors for distinguishing HCC-predominant cHCC-CC and ICC-predominant cHCC-CC from HCC and ICC, respectively. Diagnostic models were constructed based on the independent features. Recurrence-free survival (RFS) was estimated and compared between groups.
The predominant component was an independent predictor for RFS in cHCC-CC (hazard ratio = 1.957, P = 0.044). The presence of targetoid appearance (odds ratio(OR) = 10.907, P = 0.001), lack of enhancing capsule (OR = 0.072, P = 0.001) and arterial peritumoral enhancement (OR = 0.091, P = 0.003) were independent predictors suggestive of HCC-predominant cHCC-CC over HCC; their combination yielded an area under the curve of 0.756. No significant differences were observed in RFS between HCC-predominant cHCC-CC and HCC (P = 0.864). Male gender (OR = 4.049, P = 0.015), higher alpha fetoprotein (OR = 16.789, P < 0.001) and normal carbohydrate antigen 19-9 (OR = 0.343, P = 0.036) levels, presence of enhancing capsule (OR = 7.819, P < 0.001) and hemorrhage (OR = 23.526, P = 0.004), and lack of targetoid appearance (OR = 0.129, P = 0.005) and liver surface retraction (OR = 0.190, P = 0.021) were independent predictors suggestive of ICC-predominant cHCC-CC over ICC; their combination yielded an area under the curve value of 0.898. ICC-predominant cHCC-CC exhibited poorer survival with shorter RFS than ICC (P = 0.009).
The predominant histopathological component is closely related to the imaging manifestation of cHCC-CC; and more importantly, it plays a significant prognostic role, which may alter the RFS prognosis of cHCC-CC.
探讨混合型肝细胞癌-胆管细胞癌（cHCC-CC）中主要成分在 MRI 表现方面的意义及其与肝细胞癌（HCC）和肝内胆管细胞癌（ICC）相比的潜在预后价值。
本研究回顾性分析了来自两个中心的 300 例慢性肝病患者，其中包括 100 例经手术证实的 cHCC-CC、HCC 和 ICC 各 100 例。采用单因素和多因素回归分析，确定区分 HCC 为主型 cHCC-CC 和 ICC 为主型 cHCC-CC 与 HCC 和 ICC 的独立预测因素。基于独立特征构建诊断模型。估计并比较各组的无复发生存率（RFS）。
主要成分是 cHCC-CC 中 RFS 的独立预测因素（危险比=1.957，P=0.044）。靶样外观（优势比（OR）=10.907，P=0.001）、缺乏增强包膜（OR=0.072，P=0.001）和动脉肿瘤周强化（OR=0.091，P=0.003）是提示 HCC 为主型 cHCC-CC 与 HCC 相比的独立预测因素；它们的组合获得了 0.756 的曲线下面积。HCC 为主型 cHCC-CC 与 HCC 之间的 RFS 无显著差异（P=0.864）。男性（OR=4.049，P=0.015）、较高的甲胎蛋白（OR=16.789，P<0.001）和正常的碳水化合物抗原 19-9（OR=0.343，P=0.036）水平、增强包膜的存在（OR=7.819，P<0.001）和出血（OR=23.526，P=0.004）、以及缺乏靶样外观（OR=0.129，P=0.005）和肝表面回缩（OR=0.190，P=0.021）是提示 ICC 为主型 cHCC-CC 与 ICC 相比的独立预测因素；它们的组合获得了 0.898 的曲线下面积值。ICC 为主型 cHCC-CC 的 RFS 较短，生存时间较差，无复发生存率（RFS）低于 ICC（P=0.009）。
主要组织病理学成分与 cHCC-CC 的影像学表现密切相关；更重要的是，它具有显著的预后作用，可能改变 cHCC-CC 的 RFS 预后。
