Abstract:
Objective : To analyze the origin, clinical and pathological characteristics, diagnosis, treatment and prognosis of combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC).
Methods : Data from 27 patients who underwent hepatectomy and were pathologically confirmed as having cHCC-CC in Cancer Centerof Sun Yet-sen University from February 1988 to August 2003 were collected. We retrospectively analyzed theclinical pathological characteristics, diagnosis, treatments and prognosis in addition to indices including sex,age, hepatitis B virus infection, AFP, diameter of tumor, disseminated nodules, thrombosis, invasion of adjacent organs, lymph node metastasis and metastasis to other organs. The 1-, 3-, and 5-year overall survivalrates were analyzed by Kaplan-Meier method.
Results : None of the 27 cases of cHCC-CC was accurately diagnosed. The average age of the patients was 49 years (27-76 years). The percent of female patients was70.4%. HBV infection was present in 63.6% of all cases. AFP expression was found in 48.1% of the patients (>25 ng/mL). The cases with a tumor diameter less than 5 cm accounted for 11.1% of the total cases. The cases with a tumor diameter between 5.1 cm and 10 cm accounted for 66.7% of the total cases. The cases with atumor diameter larger than 10 cm accounted for 16.2% of the total cases. Disseminated nodules were foundin 30.8% of the patients. Macroscopic tumor thrombosis was found in 15.4% of the patients. Adjacent organ invasion was observed in 22.2% of the patients. Lymph node metastases were found in 19.2% of the patients.Metastases to other organs were found in 7.7% of the patients. The 1-, 3-, and 5-year overall survival rates ofthe 16 cases that were followed up were 31.3%, 18.8% and 6.3%, respectively.
Conclusion : cHCC-CC is difficult to diagnose preoperatively. In most patients, the tumor is found at an advanced stage during the initial diagnosis. The diagnosis depends on pathological examination. Surgical resection is the main treatment. Theprognosis of cHCC-CC is worse than that of HCC.