Factors associated with 5-year survival of combined hepatocellular and cholangiocarcinoma

Table 1 Baseline characteristics, n (%)

	Overall	5-year survivor	Non-5-year survivor	P value
Median age (IQR)	62 (56-69)	57 (51.25-63.75)	62 (56-70)	< 0.01
Sex (%Male)	348 (70.0)	36 (78.3)	312 (69.2)	0.27
Race				0.23
Whites	276 (55.5)	23 (50.0)	253 (56.1)
Blacks	53 (10.7)	2 (4.3)	51 (11.3)
Hispanics	77 (15.5)	8 (17.4)	69 (15.3)
API	84 (16.9)	13 (28.3)	71 (15.7)
Others	7 (1.4)	0 (0)	7 (1.6)
AJCC stages				< 0.01
I	116 (23.3)	19 (41.3)	97 (21.5)
II	90 (18.1)	19 (41.3)	71 (15.7)
III	78 (15.7)	5 (10.9)	73 (16.2)
IV	139 (28.0)	1 (2.2)	138 (30.6)
Unknown	74 (14.9)	2 (4.3)	72 (16.0)
Metastasis	128 (25.8)	1 (2.2)	127 (28.2)	< 0.01
Tumor size < 50 mm	177 (35.6)	34 (91.9)	143 (56.5)	< 0.01
Treatment
LRT	24 (4.8)	2 (4.3)	22 (4.9)	1.00
Resection	119 (23.9)	21 (45.7)	98 (21.8)	< 0.01
Transplant	50 (10.6)	20 (43.5)	30 (6.7)	< 0.01
Median survival months (IQR)	6 (1-22)	96.5 (83.25-129.5)	5 (1-16)	< 0.01

IQR: Interquartile range; API: Asians and Pacific Islanders; AJCC: American Joint Committee on Cancer; LRT: Locoregional therapy.

Table 2 Univariate and multivariate logistic regression for 5-year survival

	Univariate analysis		Multivariate analysis
	OR [95%CI]	P value	OR [95%CI]	P value
Age > 60 yr old	0.372 [0.195-0.708]1	< 0.01	0.502 [0.231-1.088]	0.08
Sex (Male)	1.604 [0.774-3.323]	0.20	1.264 [0.537-2.975]	0.59
Race		0.13		0.07
Black	0.432 [0.099-1.888]		0.483 [0.095-2.444]
Hispanic	1.275 [0.547-2.976]		2.043 [0.744-5.613]
API	2.014 [0.971-4.176]		2.793 [1.120-6.967]1
AJCC stages				0.41
Stage I/II vs unknown	8.143 [1.913-34.660]1	< 0.01	1.048 [0.185-5.935]
Stage III/IV vs unknown	1.024 [0.202-5.186]	0.06	0.498 [0.074-3.328]
Stage I /II vs III/IV	7.954 [3.284-19.264]1	< 0.01
Metastasis	0.057 [0.008-0.416]1	< 0.01	0.602 [0.059-6.165]	0.67
Tumor size < 50 mm	6.098 [3.067-12.200]1	< 0.01	2.415 [1.010-5.780]1	0.05
LRT	0.884 [0.201-3.886]	0.87	4.622 [0.671-31.856]	0.12
Resection	3.017 [1.620-5.620]1	< 0.01	12.849 [3.359-49.142]1	< 0.01
Transplant	10.769 [5.398-21.485]1	< 0.01	28.129 [6.639-119.187]1	< 0.01

¹Significant confidence interval.

White as a comparison group for race. AJCC: American Joint Committee on Cancer; API: Asians and Pacific Islanders; LRT: Locoregional therapy; OR: Odds ratio.

Table 3 Multivariate Cox proportional hazard regression for 5-year survival

	Hazard ratio	95%CI	P value
Age > 60 years old	0.862	0.708-1.050	0.14
Sex (Male)	1.071	0.863-1.328	0.54
Race			0.07
API vs black	0.654	0.452-0.9481
API vs Hispanic	0.838	0.595-1.180
API vs white	0.727	0.555-0.9521
Black vs Hispanic	1.280	0.884-1.852
Black vs white	1.111	0.819-1.506
Hispanic vs white	0.868	0.660-1.140
AJCC stages			< 0.01
Stage I/II vs unknown	0.547	0.390-0.7681
Stage III/IV vs unknown	0.709	0.509-0.9881
Stage I/II vs III/IV	0.772	0.571-1.042
Metastasis	1.229	0.918-1.645	0.17
Tumor size < 50 mm	0.704	0.545-0.9081	< 0.01
LRT	1.782	1.134-2.8011	0.01
Resection	2.770	2.137-3.5901	< 0.01
Transplant	4.247	2.809-6.5421	< 0.01

¹Significant confidence interval. AJCC: American Joint Committee on Cancer; API: Asians and Pacific Islanders; LRT: Locoregional therapy.

Table 4 Summary of previous studies

Ref.	Country	Number of HCC/CC patients	1-year survival (%)	3-year survival (%)	Factors predictive of survival
Park et al[32], 2013	South Korea	Hepatic resection (n = 10)	20	20	Age, sex, TACE and T stage by univariate analysis, but none multivariate analysis
Antwi et al[33], 2018	United States	Liver transplant (n = 19)	84	74	Response to neoadjuvant LRT
Groeschl et al[31], 2013	United States	Hepatic resection (n = 35); Liver transplant (n = 19)	Resection: 71; Transplant: 89	Resection: 46; Transplant: 48	NA
Itoh et al[29], 2015	Japan	Living donor transplant (n = 8)	87.5	72.9	NA
Li et al[30], 2018	Meta-analysis	Hepatic resection (n = 1390); Liver transplant (n = 301)	Resection: 79; Transplant: 85	Resection: 63; Transplant: 63	Vascular invasion, lymph node involvement, tumor size > 5 cm and advanced stage

HCC/CC: Combined hepatocellular and cholangiocarcinoma; TACE: Transarterial chemoembolization; LRT: Locoregional therapy; NA: Not available.