Copyright
©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Prognostic analysis of patients with combined hepatocellular-cholangiocarcinoma after radical resection: A retrospective multicenter cohort study
Ge Zhang, Bo-Wen Chen, Xiao-Bo Yang, Huai-Yuan Wang, Xu Yang, Fu-Cun Xie, Xiang-Qi Chen, Ling-Xiang Yu, Jie Shi, Yin-Ying Lu, Hai-Tao Zhao
Ge Zhang, Xiao-Bo Yang, Huai-Yuan Wang, Xu Yang, Fu-Cun Xie, Xiang-Qi Chen, Hai-Tao Zhao, Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Bo-Wen Chen, Yin-Ying Lu, 302 Clinical Medical School, Peking University, Beijing 100039, China
Bo-Wen Chen, Ling-Xiang Yu, Yin-Ying Lu, Senior Department of Hepatology, The 5th Medical Center of the PLA General Hospital, Beijing 100039, China
Jie Shi, Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Yin-Ying Lu, Guangdong Key Laboratory of Epigenetics, College of Life Sciences and Oceanography, Shenzhen University, Shenzhen 518055, Guangdong Province, China
Author contributions: Zhao HT, Lu YY, and Shi J led the entire project, and all authors participated in the discussion and interpretation of the data and results; Zhang G, Chen BW, and Yang XB performed the data collection, main analysis, and wrote the original manuscript; Wang HY, Xie FC, and Yu LX were participated in data collection and generation of figures and tables; Yang X and Shi J were involved in pathology review.
Supported by the CAMS Innovation Fund for Medical Sciences (CIFMS), No. 2021-I2M-1-061 and No. 2021-1-I2M-003; CSCO-hengrui Cancer Research Fund, No. Y-HR2019-0239; and CSCO-MSD Cancer Research Fund, No. Y-MSDZD2021-0213.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Peking Union Medical College Hospital (Approval No. JS-3390); and The 5th Medical Center of the PLA General Hospital (Approval No. KY-2022-4-23-1).
Informed consent statement: Patients were not required to give informed consent to the study because the study used identifiable human body materials or data that cannot be found, and the research project does not involve personal privacy and commercial interests.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at
zhaoht@pumch.cn. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hai-Tao Zhao, MD, Professor, Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuai-Fu-Yuan, Wang-Fu-Jing, Beijing 100730, China.
zhaoht@pumch.cn
Received: August 19, 2022
Peer-review started: August 19, 2022
First decision: September 12, 2022
Revised: September 24, 2022
Accepted: October 13, 2022
Article in press: October 13, 2022
Published online: November 7, 2022
Processing time: 76 Days and 19.4 Hours
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.
Core Tip: Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a relatively rare type of primary liver cancer. Hepatectomy combined with lymph node dissection is the only possible cure. In our study, we found that the prognosis for this group of patients is poor, with a 2-year survival rate of approximately 50% after radical resection. Preoperative CA19-9 Level, tumor number, tumor size and whether or not to receive tumor size and transarterial chemoembolization (TACE) after surgery were independent factors affecting overall survival. Therefore, we recommend that patients with cHCC-CCA actively receive adjuvant TACE therapy after surgery.
