Combined Hepatocellular Carcinoma and Cholangiocarcinoma: Diagnosis and Prognosis After Resection or Transplantation.

Abstract

BACKGROUND:

Primary liver malignancy is the leading cause of cancer death worldwide, with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) representing the majority. Combined HCC-CC, in contrast, accounts for less than 5% of these liver cancers and has not been clearly characterized by imaging, making diagnosis and management difficult.

MATERIALS AND METHODS:

This retrospective study investigated 32 patients with early-stage combined HCC-CC tumor who underwent hepatectomy (n = 24) or liver transplantation (n = 8). Preoperative imaging and pathologic reports were retrospectively reviewed and correlated. Survival and recurrence rates were then analyzed.

RESULTS:

Twelve patients with more than 50% CC component showed typical CC enhancement, whereas 17 patients with less than 50% CC component exhibited typical HCC enhancement. Those with equivocal imaging findings resulted near equal tumor component. The majority demonstrated either heterogeneous or peripheral enhancement. Considering the major tumor component, 66% of the images were consistent with histopathology. The over-all 3-year recurrent rate was 59%, with a mean time to recurrence of about 7 months. The 3-year survival rate of combined tumor after hepatectomy was 76% and after transplant was 75%, regardless of major tumor component. However, patients with more than 50% CC component showed a decrease in 3-year survival rate to 50% when transplantation was performed.

CONCLUSION:

The overall survival rate for combined tumor after either hepatectomy or transplantation seems to be satisfactory but carries a high risk of recurrent when compared to pure HCC. On the other hand, a major CC component tumor after transplantation is associated with poor survival outcome; thus, liver transplantation has no role and is not a good management option.

• Authors: C-H Wu, C-C Yong, E-H Liew, L L-C Tsang, M Lazo, H-W Hsu, H-Y Ou, C-Y Yu, T-Y Chen, T-L Huang, A M Concejero, C-L Chen, Y-F Cheng
• Journal: Transplantation proceedings (Transplant Proc) Vol. 48 Issue 4 Pg. 1100-4 (May 2016) ISSN: 1873-2623 [Electronic] United States
• PMID: 27320566 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Hepatocellular (diagnosis, mortality, surgery)
• Cholangiocarcinoma (diagnosis, mortality, surgery)
• Female
• Hepatectomy
• Humans
• Liver Neoplasms (diagnosis, surgery)
• Liver Transplantation
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Survival Rate