Clinicopathologic and MRI features of combined hepatocellular‐cholangiocarcinoma in patients with or without cirrhosis

Yoon, Jongjin; Hwang, Jeong Ah; Lee, Sun Young; Lee, Ji Eun; Ha, Sang Yun; Park, Young Nyun

doi:10.1111/liv.14798

Cited by 9 publications

(15 citation statements)

References 27 publications

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“…Some researchers remarked on the predictive significance of LNM [ 23 , 37 , 39 , 42 ]. Nevertheless, the same finding was not obtained in our study, supported by several previous studies [ 14 , 50 , 51 ]. Possible reasons that can explain this contradiction are shown as follows: Firstly, due to the highly heterogeneous nature, the predominance of HCC or ICC component may affect the biological behavior of the tumor [ 41 , 52 ].…”

Section: Discussionsupporting

confidence: 91%

Morbidity, Prognostic Factors, and Competing Risk Nomogram for Combined Hepatocellular-Cholangiocarcinoma

Chen

Shi

et al. 2021

Journal of Oncology

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Background. Combined hepatocellular-cholangiocarcinoma (CHC) is a rare and heterogeneous histological subtype of primary liver cancer, which is still poorly understood. This study aimed to describe the epidemiological and clinical features, investigate the prognostic indicators, and develop a competing risk nomogram for CHC. Methods. The study cohort was taken from the Surveillance, Epidemiology, and End Results database. The annual percent change (APC) in incidence was calculated using the joinpoint regression. The nomogram was developed based on multivariate competing risk survival analyses and validated by calibration curves. Akaike information criterion, Bayesian information criterion, Harrell’s C-index, and area under the receiver operating characteristic curves were obtained to compare prognostic performance. Decision curve analysis was introduced to examine the clinical value of the models. Results. The overall incidence of CHC was 0.062 per 100,000 individuals in 2004 and 0.081 per 100,000 individuals in 2018, with an APC of 1.0% ( P > 0.05 ). CHC displayed intermediate clinicopathological features of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Race, tumor size, vascular invasion, extrahepatic invasion, distant metastasis, grade, surgery, and Metavir stage were confirmed as the independent predictors of cancer-specific survival. The constructed nomogram was well calibrated, which showed better discrimination power and higher net benefits than the current American Joint Committee on Cancer staging system. Patients with liver transplantation had better survival than those with hepatectomy, especially patients within the Milan Criteria ( P = 0.022 and P = 0.015 ). There was no survival difference between liver transplantation and hepatectomy in patients beyond the Milan Criteria ( P = 0.340 ). Conclusion. The morbidity of CHC remained stable between 2004 and 2018. The constructed nomogram could predict the prognosis with good performance, which was meaningful to individual treatment strategies optimization. CHC patients should also be considered as potential liver transplantation recipients, especially those within the Milan Criteria, but the finding still needs more evidence to be further confirmed.

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Section: Discussionsupporting

confidence: 91%

Morbidity, Prognostic Factors, and Competing Risk Nomogram for Combined Hepatocellular-Cholangiocarcinoma

Chen

Shi

et al. 2021

Journal of Oncology

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“…Our results had better sensitivity in the LR-5 category at the cost of reduced specificity than that of the previous studies (6,12,18,19), which showed a range of sensitivity between 55.2 and 74%.…”

Section: Lrcategorycontrasting

confidence: 74%

“…According to the previous study by Wang et al (23) with the 2010 WHO classification, more cHCC-CCAs were misclassified 19) with cHCC-CCA in patients with cirrhosis, the rate classified as LR-M in cHCC-CCAs was decreased (58.8% vs 53%). The rate classified as LR-M in cHCC-CCAs was also even lower than that of recent studies (14,19,23) in patients at risk. That could explain why LI-RADS v2018 showed decreased specificity in the diagnosis of HCCs than recent reports with LI-RADS v2014 (21) and v2017 (4).…”

Section: Lrcategorycontrasting

confidence: 72%

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Diagnostic Performance of LI-RADS Version 2018 for Primary Liver Cancer in Patients With Liver Cirrhosis on Enhanced MRI

Liu

et al. 2022

Front. Oncol.

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PurposeThe study evaluated the diagnostic performance of the Liver Imaging Reporting and Data System (LI-RADS) version 2018 for differentiating hepatocellular carcinoma (HCC) from primary liver cancer in patients with liver cirrhosis based on the updated 2019 WHO classification.Materials and MethodsFrom 2016 to 2021, 300 patients with surgically confirmed primary liver cancer (PLC) and liver cirrhosis based on the updated 2019 WHO classification were eligible for this retrospective study (100 cases in each of three groups including HCC, ICC, and cHCC-CCA). Two radiologists were blinded to the final diagnosis and independently assigned an LI-RADS category to each liver nodule. The diagnostic performances of the LR-5 category (definitely HCC), and the LR-M category (probably or definitely malignant, but not specific for HCC) were calculated in overall and small observations (<20 mm). Comparisons between groups of categorical variables were performed by one-way analysis of variance and the Chi-squared or Fisher’s exact test.ResultsThe mean age of 300 patients (226 men and 74 women) was 57.40 ± 11.05 years. The sensitivity and specificity of the LR-5 category for differentiating HCCs from other primary liver cancers were 81% (81 of 100) and 82% (164 of 200), respectively. The LR-M category had a sensitivity of 63% (126 of 200) for diagnosing non-HCCs (ICCs and cHCC-CCAs), with a specificity of 90% (90 of 100). The LR-5 category had a sensitivity of 82.5% (33 of 40) for diagnosing HCCs in small observations (<20 mm) with a specificity of 76.6% (59 of 77). On the contrary, LR-M demonstrated slightly higher specificity (93.8%) and sensitivity (73.8%) for diagnosing non-HCCs with tumor size <20 mm.ConclusionThe LR-5 category as well as the LR-M category of Liver Imaging Reporting and Data System (LI-RADS) version 2018 can effectively distinguish hepatocellular carcinoma from other primary hepatic malignancies in patients with liver cirrhosis, especially for small observations (<20 mm).

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“…18,19 In previous studies of surgically resected cHCC-CCAs, patients with cHCC-CCA categorized as LR-M had a worse prognosis than those categorized as LR-4 or 5. 20,21 Our results, using iCCA with curative surgery, also showed that patients with iCCA categorized as LR-M had significantly worse RFS than those categorized as LR-4 or 5. Additionally, the LR-M category was an independent factor for postsurgical outcomes of HCC, cHCC-CCA, and iCCA in each study, including the present study.…”

Section: Discussionsupporting

confidence: 54%

LI‐RADS Category on MRI Is Associated With Recurrence of Intrahepatic Cholangiocarcinoma After Surgery: A Multicenter Study

Hwang

Lee

et al. 2022

Magnetic Resonance Imaging

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Background The Liver Imaging Reporting and Data System (LI‐RADS) is a comprehensive system for standardizing the terminology and interpretation of liver imaging. The association between the LI‐RADS category and tumor recurrence in patients with intrahepatic cholangiocarcinomas (iCCAs) has not yet been evaluated in a multicenter study. Purpose To retrospectively investigate the preoperative clinical and imaging features associated with recurrence‐free survival (RFS) after curative resection of iCCAs and to identify the role of the LI‐RADS category in at‐risk patients. Study Type Retrospective, multicenter. Subjects A total of 113 patients (mean age: 61.1 years; 74 men, 39 women) who underwent preoperative contrast‐enhanced MRI and curative surgical resection for a single treatment‐naive iCCA between 2008 and 2021. Filed Strength/Sequence A 3 T dual gradient‐echo T1WI with in‐ and opposed‐phase, turbo spin‐echo T2WI, diffusion‐weighted echo‐planar images, and three‐dimensional gradient‐echo T1WI before and after administration of contrast agent. Assessment MR imaging features were evaluated and assigned for each lesion using LI‐RADS version 2018. RFS was calculated from the date of surgery to tumor recurrence or the last imaging date without evidence of recurrence. Factors affecting RFS were evaluated using clinical and imaging features. Statistical Tests Cox proportional hazards model, Kaplan–Meier method, and log‐rank test. A P‐value of <0.05 was considered statistically significant. Results A total of 93 (82.3%) were categorized as LR‐M and 20 (17.7%) were categorized as LR‐4 or 5. In the multivariable analysis, LR‐M category (hazard ratio [HR], 8.035; 95% confidence interval [CI], 1.096–58.931) and a tumor size >3 cm on MRI (HR, 2.690; 95% CI, 1.319–5.487) were independent factors for poor RFS. The 5‐year RFS rate was significantly higher in patients with iCCA categorized as LR‐4 or 5 than in those categorized as LR‐M (94.4% vs. 51.9%, respectively). Data Conclusion Patients with iCCA categorized as LR‐4 or 5 may have a better RFS than those categorized as LR‐M. Evidence Level 3 Technical Efficacy Stage 2

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Clinicopathologic and MRI features of combined hepatocellular‐cholangiocarcinoma in patients with or without cirrhosis

Cited by 9 publications

References 27 publications

Morbidity, Prognostic Factors, and Competing Risk Nomogram for Combined Hepatocellular-Cholangiocarcinoma

Morbidity, Prognostic Factors, and Competing Risk Nomogram for Combined Hepatocellular-Cholangiocarcinoma

Diagnostic Performance of LI-RADS Version 2018 for Primary Liver Cancer in Patients With Liver Cirrhosis on Enhanced MRI

LI‐RADS Category on MRI Is Associated With Recurrence of Intrahepatic Cholangiocarcinoma After Surgery: A Multicenter Study

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