Prognostic analysis of patients with combined hepatocellular-cholangiocarcinoma after radical resection: A retrospective multicenter cohort study

Abstract

BACKGROUND Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a form of rare primary liver cancer that combines intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma. AIM To investigate overall survival (OS) and recurrence-free survival (RFS) after radical resection in patients with cHCC-CCA, and the clinicopathological factors affecting prognosis in two center hospitals of China. METHODS We reviewed consecutive patients with cHCC-CCA who received radical resection between January 2005 and September 2021 at Peking Union Medical College and the 5th Medical Center of the PLA General Hospital retrospectively. Regular follow-up and clinicopathological characteristics were systematic collected for baseline and prognostic analysis. RESULTS Our study included 95 patients who received radical resection. The majority of these patients were male and 82.7% of these patients were infected with HBV. The mean tumor size was 4.5 cm, and approximately 40% of patients had more than one lesion. The median OS was 26.8 (95%CI: 18.5-43.0) mo, and the median RFS was 7.27 (95%CI: 5.83-10.3) mo. Independent predictors of OS were CA19-9 ≥ 37 U/mL (HR = 8.68, P = 0.002), Child-Pugh score > 5 (HR = 5.52, P = 0.027), tumor number > 1 (HR = 30.85, P = 0.002), tumor size and transarterial chemoembolization (TACE) after surgery (HR = 0.2, P = 0.005). CONCLUSION The overall postoperative survival of cHCC-CCA patients is poor, and most patients experience relapse within a short period of time after surgery. Preoperative tumor biomarker (CA19-9, alpha-fetoprotein) levels, tumor size, and Child-Pugh score can significantly affect OS. Adjuvant TACE after surgery prolongs RFS, suggesting that TACE is a possible option for postoperative adjuvant therapy in patients with cHCC-CCA.

Clinical Implications of Naples Prognostic Score for Patients with Resected Cholangiocarcinoma: A Real-World Experience

“…To address this, the Nomogram incorporating multiple risk factors was developed to provide improved risk stratification and survival prediction. 25 , 26 In this study, risk factors included in the Nomogram were identified by multivariate analysis. All the factors included in the Nomogram are clinical variables, facilitating its further adoption in clinical practice.…”

Update on the Diagnosis and Treatment of Combined Hepatocellular Cholangiocarcinoma

“…The prognosis of patients who undergo resection for cHCC-CCA has been reported to vary across different studies, as shown in Table 1. 16,[45][46][47][48][49][50][51][52][53] Prognostic factors after cHCC-CCA resection include tumor diameter >5 cm, intrahepatic metastases, lymph node metastases, multifocality, vascular invasion, high levels of CA 19-9, incomplete capsule formation, and a resection margin of <2 cm. 15,54 One study conducted using data from the Surveillance, Epidemiology, and End Results Program (SEER) database found that liver transplantation (LT) did not provide any survival benefit compared with minor or major hepatectomy in 465 patients with cHCC-CCA.…”

Management of Locally Advanced or Metastatic Combined Hepatocellular Cholangiocarcinoma

“…While surgical treatment is crucial to improving long-term prognosis of the aggressive malignancy, approximately half of the patients will experience early disease recurrence [47,48], thus reflecting a high demand for further treatment development.…”