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Japanese Journal of Clinical Oncology 33:283-287 (2003)
© 2003 Foundation for Promotion of Cancer Research

Combined Hepatocellular and Cholangiocarcinoma: a Clinicopathologic Study of 26 Resected Cases

Yoshiko Yano1, Junji Yamamoto2, Tomoo Kosuge1, Yoshihiro Sakamoto2, Susumu Yamasaki1, Kazuaki Shimada1, Hidenori Ojima3, Michiie Sakamoto3, Tadatoshi Takayama4 and Masatoshi Makuuchi4,+

1 Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, 2 Department of Surgery, Cancer Institute Hospital, Tokyo, 3 Pathology Division, National Cancer Center Research Institute, Tokyo and 4 Hepatobiliary Pancreatic Surgery Division, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

Background: Combined hepatocellular and cholangiocarcinoma (cHCC-CC) is an uncommon subtype of primary liver cancer, the clinicopathological features of which have rarely been reported in detail. The aim of this study was to clarify the characteristics of cHCC-CC in comparison with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC).

Methods: The clinicopathological features of 26 cHCC-CC patients, who were surgically treated, were reviewed by comparing them with the features of patients suffering from ordinary hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC).

Results: The cHCC-CC patients showed greater similarity with HCC patients than with CC patients with regard to male/female ratio, status of hepatitis viral infection, serum alpha-fetoprotein (AFP) level, and non-tumor liver histology. The disease stage of the cHCC-CC patients was more advanced than that of either the HCC or CC patients. The cHCC-CC tumors were significantly more invasive to the portal vein than the HCC tumors and were comparable to the CC tumors. The overall 3-, 5-, and 10-year survival rates and the median survival times (95% confidence interval) were 34.6%, 23.1%, 11.5% and 1.8 (0.7–3.0) years for cHCC-CC patients, 86.7%, 66.2%, 46.8% and 4.6 (4.3–5.0) years for HCC patients, and 68.5%, 32.3%, 23.9% and 1.9 (1.1–2.7) years for CC patients, respectively. Survival of patients with cHCC-CC was significantly poorer than that of HCC or CC patients. Among the 26 patients, six survived for >5 years.

Conclusions: In most cases, cHCC-CC seems to be a variant of ordinary HCC with cholangiocellular features, rather than a true intermediate disease entity between HCC and CC. The surgical approach is recommended for selected patients with cHCC-CC.

+ For reprints and all correspondence: Junji Yamamoto, 1–37–1 Kami-Ikebukuro, Toshima-ku, Tokyo 170-8455, Japan. E-mail: jyamamoto{at}jfcr.or.jp


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