Combined hepatocellular‐cholangiocarcinoma – More questions than answers

Reeves, Helen L.; Edeline, Julien

doi:10.1111/liv.14894

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…Combined hepatocellular-cholangiocarcinoma (CHC) is a rare histological subtype of primary liver cancer (PLC), accounting for 0.4-14.2% of all PLCs (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). According to the World Health Organization (WHO) classification of tumors of the digestive system (5 th edition), CHC is defined as PLC with both hepatocellular and cholangiocytic differentiation in the same tumor, which is consistent with the type 3 tumor proposed by Allen and Lisa (11) and the type 2 tumor described by Goodman et al (12).…”

Section: Introductionmentioning

confidence: 99%

Promising role of liver transplantation in patients with combined hepatocellular-cholangiocarcinoma: a propensity score matching analysis

Chen¹,

Sun²,

Lu³

et al. 2022

Ann Transl Med

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Background: Combined hepatocellular-cholangiocarcinoma (CHC) is a rare but vital heterogeneous histological subtype of primary liver cancer (PLC) with no standardized treatment strategy. This study aimed to preliminarily investigate the role of liver transplantation (LT) in CHC and develop a novel risk scoring model (RSM) to evaluate the benefits of transplantation. Methods:The study cohort was taken from the Surveillance, Epidemiology, and End Results database.The annual percent change (APC) in incidence or ratio was calculated utilizing the Joinpoint regression.Propensity score matching (PSM) was introduced to reduce the selection bias between groups. A novel RSM was developed based on the independent prognostic factors identified by the Cox regression model.The predictive performance of the RSM was compared with the Milan Criteria and the UCSF Criteria, respectively.Results: A total of 223 CHC patients were enrolled, and 60 (26.9%) of them received LT. The incidencebased mortality did not decrease between 2004 and 2015 (APC =1.7%, P=0.195). Although LT was considered an independent protective predictor for CHC, it showed a declining ratio from 33.3% in 2004 to 15.4% in 2015 (APC =−8.9%, P=0.012). The LT recipients had better outcomes than others who underwent hepatectomy or local destruction (P<0.05). Compared with other subtypes of PLC, the posttransplantation prognoses of CHC patients were similar to those with hepatocellular carcinoma (P>0.05) but significantly better than those with intrahepatic cholangiocarcinoma (ICC) (P<0.05). Based on the RSM (vascular invasion: 1 point; tumor size >2 cm: 1 point; multiple tumors: 2 points), patients were stratified into two prognostic subgroups: the low-risk (scoring ≤2) and the high-risk (scoring >2 or extrahepatic metastasis) groups. Patients in the low-risk group were more likely to benefit from LT. The predictive performance of the RSM outperformed the Milan and UCSF Criteria in both the training and validation sets.Conclusions: Therapeutic strategies for CHC should be further improved. Patients with CHC should also be considered potential LT candidates. The novel RSM could be helpful to stratify patients and assist clinical decision-making.

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Section: Introductionmentioning

confidence: 99%

Promising role of liver transplantation in patients with combined hepatocellular-cholangiocarcinoma: a propensity score matching analysis

Chen¹,

Sun²,

Lu³

et al. 2022

Ann Transl Med

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“…Treatment decisions for these patients are frequently based on treatments for HCC and ICC. 68 A study by Kim et al . 69 suggested that HCC- and ICC-oriented treatment strategies yielded similar outcomes for patients with cHCC-CCA.…”

Section: Treatment and Prognosismentioning

confidence: 99%

“…Treatment decisions for these patients are frequently based on treatments for HCC and ICC. 68 A study by Kim et al 69 suggested that HCC-and ICC-oriented treatment strategies yielded similar outcomes for patients with cHCC-CCA. Sorafenib, a commonly used targeted therapy for advanced HCC, and gemcitabine and cisplatin, an effective for ICC, have been found to be ineffective for cHCC-CCA.…”

Section: Treatment and Prognosismentioning

confidence: 99%

Update on the Diagnosis and Treatment of Combined Hepatocellular Cholangiocarcinoma

Chu,

Kawaguchi,

Wang

et al. 2023

J Clin Transl Hepatol

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Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a unique type of liver tumor that contains both hepatocellular carcinoma and cholangiocarcinoma components within a single tumor. The fifth edition of the World Health Organization classification provides a definition and diagnostic criteria for cHCC-CCA. However, the heterogeneous histomorphology and presentation resulting from variation of the proportion of each component poses challenges for clinical diagnosis and treatment. A diagnosis of cHCC-CCA may be suggested by the synchronous elevation of serum tumor markers for hepatocellular carcinoma and cholangiocarcinoma, a mixed enhancement pattern on imaging, and a discrepancy between the elevation of tumor marker and the imaging enhancement pattern. Histopathological examination using hematoxylin and eosin staining is considered the gold standard for diagnosing cHCC-CCA, and comprehensive examination of resection or biopsy specimens is crucial for an accurate diagnosis. Currently, there is no standard treatment for cHCC-CCA, and surgery is the mainstay. Anatomic hepatectomy with lymphadenectomy is among the recommended surgical procedures. The role of liver transplantation in the management of cHCC-CCA is still uncertain. Transarterial chemoembolization may be effective for unresectable cHCC-CCA, particularly for hypervascular tumors. However, the available evidence does not support systemic therapy for advanced cHCC-CCA. The prognosis of cHCC-CCA is generally poor, and there is no established staging system. Further research is needed to better understand the histogenesis and clinical management of cHCC-CCA. This review provides an overview of the current literature on cHCC-CCA with a focus on its clinical characteristics, pathological diagnosis, and management.

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