Adhoute Xavier, Pietri Olivia, Pénaranda Guillaume, Wolf Thomas, Beaurain Patrick, Monnet Olivier, Laquière Arthur, Bonomini Justine, Neumann Frédéric, Levrel Olivier, Buono Jean-Pascal, Hanna Xavier, Castellani Paul, Perrier Hervé, Bourliere Marc, Anty Rodolphe
Department of Gastroenterology and Hepatology, Hôpital Saint-Joseph, Marseille, France.
Department of Biostatistics, AlphaBio-Biogroup Laboratory, Marseille, France.
J Clin Transl Hepatol. 2023 Oct 28;11(5):1106-1117. doi: 10.14218/JCTH.2022.00141. Epub 2023 May 16.
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) have common features and differences. This real-life study investigated their characteristics, treatment modalities, and prognoses.
This retrospective comparative study was performed in 1,075 patients seen at one tertiary center between January 2008 and December 2020. Overall survival (OS) was estimated by the Kaplan-Meier method. Subclassification of iCCAs after histological and radiological review, and molecular profiling was performed.
HCCs patients were more likely to have early-stage disease than iCCA patients. iCCA patients were more likely to be female, especially those patients without cirrhosis (43% vs. 17%). Cirrhosis was prominent among HCC patients (89% vs. 34%), but no difference in underlying liver disease among cirrhotic patients was found. OS of HCC patients was 18.4 (95% CI: 6.4, 48.3) months, that of iCCA patients was 7.0 (95% CI: 3.4, 20.1) months. OS of Barcelona Clinic Liver Cancer C HCC patients was 7.8 (95% CI: 4.3, 14.2) months, that of advanced/metastatic iCCA patients was 8.5 (95% CI: 5.7, 12.3) months. In patients treated with sorafenib, OS was longer in HCC patients who received subsequent tyrosine kinase inhibitor therapies. No significant OS difference was found between iCCA patients with and without cirrhosis or according to histological subtype. A targetable molecular alteration was detected in 50% of the iCCA patients.
In this French series, cirrhosis was common in iCCA, which showed etiological factors comparable to those of HCC, implying a distinct oncogenic pathway. Both entities had a dismal prognosis at advanced stages. However, systemic therapies sequencing in HCC and molecular profiling in iCCA offer new insights.
肝细胞癌（HCC）和肝内胆管癌（iCCA）有共同特征和差异。这项真实世界研究调查了它们的特征、治疗方式和预后。
这项回顾性比较研究纳入了2008年1月至2020年12月期间在一家三级中心就诊的1075例患者。采用Kaplan-Meier法估计总生存期（OS）。在组织学和放射学检查以及分子分析后对iCCA进行亚分类。
与iCCA患者相比，HCC患者更易患早期疾病。iCCA患者女性居多，尤其是无肝硬化的患者（43%对17%）。肝硬化在HCC患者中更为突出（89%对34%），但肝硬化患者的潜在肝脏疾病无差异。HCC患者的OS为18.4（95%CI：6.4，48.3）个月，iCCA患者为7.0（95%CI：3.4，20.1）个月。巴塞罗那临床肝癌C期HCC患者的OS为7.8（95%CI：4.3，14.2）个月，晚期/转移性iCCA患者为8.5（95%CI：5.7，12.3）个月。在接受索拉非尼治疗的患者中，接受后续酪氨酸激酶抑制剂治疗的HCC患者OS更长。iCCA患者中，有肝硬化和无肝硬化患者之间或根据组织学亚型划分，OS无显著差异。50%的iCCA患者检测到可靶向的分子改变。
在这个法国队列中，肝硬化在iCCA中很常见，其显示出与HCC相当的病因学因素，这意味着存在不同的致癌途径。这两种实体在晚期预后均不佳。然而，HCC的系统治疗序贯和iCCA的分子分析提供了新的见解。
