Elsevier

HPB

Volume 18, Issue 11, November 2016, Pages 886-892
HPB

Original article
Mixed hepatocellular and cholangiocarcinoma: a rare tumor with a mix of parent phenotypic characteristics

https://doi.org/10.1016/j.hpb.2016.07.006Get rights and content
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Abstract

Background

Intrahepatic lesions of mixed hepatocellular (HCC) and intrahepatic cholangiocellular carcinoma (ICC) histology are rare. The aim was to describe the natural history of these tumors relative to monomorphic ICC or HCC utilizing the National Cancer Data Base (NCDB).

Methods

Patients with ICC, HCC, and mixed histology (cHCC-CCA) were identified in the NCDB (2004–2012). Inter-group comparisons were made. Kaplan–Meier and multivariable Cox Proportional Hazards analyzed overall survival.

Results

The query identified 90,499 patients with HCC; 14,463 with ICC; and 1141 with cHCC-CCA histology. Patients with cHCC-CCA histology were relatively young (61 vs. 62 (HCC, p = 0.877) and 67 (ICC, p < 0.001) years) and more likely to have poorly differentiated tumor (29.2% vs. 10.3% (HCC) and 17.2% (ICC) p < 0.001). Median overall survival for cHCC-CCA was 7.9 months vs. 10.8 (HCC) and 8.2 (ICC, all p < 0.001). Stage-specific survival for mixed histology tumors was most similar to that of HCC for all stages. cHCC-CCA were transplanted at a relatively high rate, and transplant outcomes for mixed tumors were substantially worse than for HCC lesions.

Discussion

cHCC-CCA demonstrate stage-specific survival similar to HCC, but post-surgical survival more consistent with ICC. Patients with a pre-operative diagnosis of cHCC-CCA should undergo resection when appropriate.

Abbreviations

ICC
intrahepatic cholangiocarcinoma
HCC
hepatocellular carcinoma
cHCC-CCA
combined hepatocellular and intrahepatic cholangiocarcinoma
NCDB
National Cancer Data Base
PUF
participant user file
AJCC
American Joint Committee on Cancer
CoC
Commission on Cancer
ACS
American College of Surgeons
SEER
surveillance epidemiology and end results
US
United States

Cited by (0)

This work has not previously or concurrently been submitted for publication. The work was presented as a poster during the Scientific Forum at the American College of Surgeons Clinical Congress in Chicago, IL October 2015.