Long-term Prognosis of Combined Hepatocellular and Cholangiocarcinoma After Curative Resection Comparison With Hepatocellular Carcinoma and Cholangiocarcinoma

Lee, Jeong Hoon; Chung, Gyung Ho; Yu, Su Jong; Hwang, Sang Youn; Kim, Joon Suk; Kim, Hwi Young; Yoon, Jung Hwan; Lee, Hyo Suk; Yi, Nam Joon; Suh, Kyung Suk; Lee, Kuhn Uk; Jang, Ja June; Kim, Yoon Jun

doi:10.1097/mcg.0b013e3181ce5dfa

Cited by 136 publications

(122 citation statements)

References 17 publications

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“…The small numbers of patients in the 2 studies preclude us from drawing firm conclusions about the outcomes of these tumor subtypes. In several published studies on liver resection, HCC-CC patients were found to have shorter periods of disease-free survival and poorer prognoses than I-CC patients 2,4,26 and HCC patients. 26 None of the patients in our study experienced lymph node invasion.…”

Section: Discussionmentioning

confidence: 99%

“…In several published studies on liver resection, HCC-CC patients were found to have shorter periods of disease-free survival and poorer prognoses than I-CC patients 2,4,26 and HCC patients. 26 None of the patients in our study experienced lymph node invasion. The poor prognosis of patients with HCC-CC may be due to its inherent aggressiveness, which is linked to the origination of the tumor cells from pluripotent hepatic precursor cells.…”

Section: Discussionmentioning

confidence: 99%

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Mixed hepatocellular cholangiocarcinoma and intrahepatic cholangiocarcinoma in patients undergoing transplantation for hepatocellular carcinoma

et al. 2011

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Mixed hepatocellular cholangiocarcinoma (HCC-CC) and intrahepatic cholangiocarcinoma (I-CC) are increasingly being reported in patients with cirrhosis. The aims of this study were (1) to evaluate the incidence, imaging features, and posttransplant outcomes for patients who underwent transplantation for hepatocellular carcinoma (HCC) and were found to have HCC-CC or I-CC in the explant and (2) to compare the outcomes of these patients with those of controls with HCC who were matched (1:3) by the tumor size and the number of nodules in the explant. In the explant specimens of 10 of 302 patients (3.3%) who underwent liver transplantation (LT) for HCC, mixed HCC-CC or I-CC was identified. There were 4 additional incidental cases of HCC-CC. After a median follow-up period of 32 months, 8 of the 14 patients (57%) suffered from tumor recurrence, and the median disease-free survival time was 8 months. The cumulative risk of tumor recurrence was 40% and 70% at 1 and 5 years, respectively, for these 14 patients. When the 4 incidental cases were excluded, the study group with HCC-CC or I-CC (n ¼ 10) had a significantly lower incidence of well-differentiated tumors (11.1% versus 43.3%, P < 0.02) and a higher rate of recurrence (60% versus 16.7%, P ¼ 0.008) in comparison with the control group of patients with HCC (n ¼ 30). The 1-and 5-year cumulative risks of tumor recurrence were 42% and 65%, respectively, in the study group and 10% and 17%, respectively, in the control group (P < 0.002). The actuarial 1-and 5-year patient survival rates without recurrence were also significantly lower in the study group (79% and 32% in the study group and 90% and 62% in the control group, P < 0.03). Dynamic contrast-enhanced computed tomography or magnetic resonance imaging showed progressive contrast enhancement throughout the arterial and portal venous phases without washout in 8 of the 10 patients. In conclusion, HCC-CC and I-CC are associated with a poor prognosis and a high rate of tumor recurrence after LT, and both tumors exhibit radiographic features that are distinct from those observed with HCC. Liver Transpl 17:934-942,

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mixed hepatocellular cholangiocarcinoma and intrahepatic cholangiocarcinoma in patients undergoing transplantation for hepatocellular carcinoma

et al. 2011

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“…Therefore, in the differentiation of hepatic nodules in high-risk patients, the possibility of ICCs should be ruled out [66]. Differentiating ICCs from HCCs with imaging studies is critical because their respective treatment strategies and prognoses are different [67,68]. On ECCM-enhanced imaging, ICCs typically show peripheral or weak enhancement on the HAP and centripetal or persistent enhancement on the PVP and DP [69,70].…”

Section: Hcc Vs Non-hepatocellular Tumorsmentioning

confidence: 99%

Recent Advances in the Imaging Diagnosis of Hepatocellular Carcinoma: Value of Gadoxetic Acid-Enhanced MRI

Joo

Lee

2015

Liver Cancer

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Magnetic resonance imaging (MRI) using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DPTA), or gadoxetic acid for short, is a hepatocyte-specific contrast agent which is now increasingly used for the detection and characterization of focal hepatic lesions, particularly in patients at high-risk of developing hepatocellular carcinomas (HCC). In fact, several recent guidelines now recognize gadoxetic acid-enhanced MRI (Gd-EOB-MRI) as the primary diagnostic imaging modality for the noninvasive diagnosis of HCC, although it must be noted that several major guidelines still include only extracellular contrast media-enhanced computed tomography and MRI. The primary merits of Gd-EOB-MRI lie in the fact that it can provide not only dynamic imaging, but also hepatobiliary phase (HBP) imaging which can lead to high lesion-to-liver contrast and give additional information regarding hepatocyte uptake via organic anion transporting polypeptides. This, in turn, allows higher sensitivity in detecting small HCCs and helps provide additional information regarding the multistep process of hepatocarcinogenesis. Indeed, many recent studies have investigated the diagnostic value of Gd-EOB-MRI for early HCCs as well as its role as a potential imaging biomarker in predicting outcome. We herein review the recent advances in the imaging diagnosis of HCCs focusing on the applications of Gd-EOB-MRI and the challenging issues that remain.

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“…HCCs with such IRE patterns (IRE-HCCs) were reported in 5-13% of patients undergoing curative resection or radiofrequency ablation [3][4][5]. The IRE pattern is not a typical imaging feature of HCC; it is a finding usually indicative of other hepatic malignancies such as cholangiocarcinoma or combined hepatocellular-cholangiocarcinoma, which generally show worse prognoses than HCC [6,7]. In patients with chronic liver disease, however, a significant proportion of hepatic tumors showing IRE are HCCs, because the incidence of this malignancy is much higher than that of other malignancies with underlying liver diseases [8,9].…”

Section: Introductionmentioning

confidence: 99%

Hepatocellular Carcinoma with Irregular Rim-Like Arterial Phase Hyperenhancement: More Aggressive Pathologic Features

Rhee

An²,

Kim

et al. 2018

Liver Cancer

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Background and Aims: The purpose of our study was to examine the histopathologic characteristics of hepatocellular carcinoma (HCC) with irregular rim-like arterial phase enhancement (IRE), which has been reported to be associated with more aggressive tumor behavior. Methods: We investigated 84 pathologically confirmed HCCs in 84 patients who underwent curative hepatic resection after gadoxetate-enhanced magnetic resonance imaging between January 2008 and February 2013. Two abdominal radiologists independently reviewed these images and classified HCCs into two categories: HCC showing IRE (IRE-HCC) and HCC showing hypoenhancement or diffuse arterial enhancement (non-IRE-HCC). Twenty-two HCCs were classified as IRE-HCCs, and 51 were classified as non-IRE-HCCs concordantly by both reviewers. The remaining 11 HCCs, on whose radiologic classifications the reviewers disagreed, were classified as HCCs with intermediate enhancement patterns. The HCC clinicopathologic characteristics and patient outcomes were then compared. Results: IRE-HCCs showed more frequent microvascular invasion (91 vs. 35%), lower microvascular density (246.5 vs. 426.5/mm²), higher proportions of sinusoid-like microvascular pattern (55 vs. 0%) and macrotrabecular pattern (45 vs. 0%), and larger areas of tumor necrosis (15 vs. 0%) and fibrous stroma (8.3 vs. 2.1%) than non-IRE-HCCs. IRE-HCCs also expressed higher levels of immunomarkers of hypoxia (carbonic anhydrase IX, 64 vs. 8%) and stemness (EpCAM, 50 vs. 20%). p values were < 0.001 for all comparisons except for EpCAM (p = 0.026). HCCs with intermediate enhancement patterns showed mixed/intermediate pathologic features from both IRE- and non-IRE-HCCs. IRE-HCC patients showed poorer 5-year disease-free survival after curative resection than non-IRE-HCC patients (p = 0.005). Conclusions: IRE-HCCs demonstrate aggressive histopathologic features, including more hypoxic and fibrotic tumor microenvironments and increased stemness, compared to non-IRE-HCCs. IRE might therefore serve as a noninvasive imaging biomarker for aggressive HCC.

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Long-term Prognosis of Combined Hepatocellular and Cholangiocarcinoma After Curative Resection Comparison With Hepatocellular Carcinoma and Cholangiocarcinoma

Abstract: The results of this study indicated that cHCC-CC had a significantly poorer prognosis than HCC and CC even after curative resection.

Cited by 136 publications

References 17 publications

Mixed hepatocellular cholangiocarcinoma and intrahepatic cholangiocarcinoma in patients undergoing transplantation for hepatocellular carcinoma

Mixed hepatocellular cholangiocarcinoma and intrahepatic cholangiocarcinoma in patients undergoing transplantation for hepatocellular carcinoma

Recent Advances in the Imaging Diagnosis of Hepatocellular Carcinoma: Value of Gadoxetic Acid-Enhanced MRI

Hepatocellular Carcinoma with Irregular Rim-Like Arterial Phase Hyperenhancement: More Aggressive Pathologic Features

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