Combined Hepatocellular Carcinoma and Cholangiocarcinoma: Diagnosis and Prognosis After Resection or Transplantation
Combined Hepatocellular Carcinoma and Cholangiocarcinoma: Diagnosis and Prognosis After Resection or Transplantation
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DOI：
10.1016/j.transproceed.2015.11.029
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发表时间：
2016-05-01
影响因子：
0.9
通讯作者：
Cheng, Y. -F.
中科院分区：
文献类型：
--
作者：
Wu, C. -H.;Yong, C-C.;Cheng, Y. -F.
背景资料。原发性肝脏恶性肿瘤是世界范围内癌症死亡的主要原因，其中肝细胞癌和胆管细胞癌占大多数。相比之下，联合肝细胞癌仅占这些肝癌的不到5%，且其影像特征不明确，给诊断和治疗带来了困难。对32例早期肝细胞癌合并肝细胞癌患者行肝切除术(n=24)或肝移植(n=8)进行回顾性研究。对术前影像和病理报告进行回顾，并进行相关分析。分析两组患者的生存率和复发率。12例CC成分大于50%的患者表现为典型的CC强化，而17例CC成分低于50%的患者表现为典型的肝细胞癌强化。那些影像表现不明确的人，肿瘤成分几乎相等。大多数表现为不均匀强化或周边强化。考虑到主要的肿瘤成分，66%的图像与组织病理学相一致。总的3年复发率为59%，平均复发时间约7个月。肝切除后合并肿瘤的3年生存率为76%，移植后的3年生存率为75%，不考虑主要肿瘤成分。然而，CC成分超过50%的患者进行移植时，3年生存率降至50%。联合肿瘤在肝切除或移植后的总体存活率似乎令人满意，但与单纯的肝细胞癌相比，复发的风险很高。另一方面，移植后主要的CC成分肿瘤与较差的生存结果相关；因此，肝移植没有作用，也不是一个好的治疗选择。
Background. Primary liver malignancy is the leading cause of cancer death worldwide, with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) representing the majority. Combined HCC-CC, in contrast, accounts for less than 5% of these liver cancers and has not been clearly characterized by imaging, making diagnosis and management difficult.Materials and Methods. This retrospective study investigated 32 patients with early-stage combined HCC-CC tumor who underwent hepatectomy (n = 24) or liver transplantation (n = 8). Preoperative imaging and pathologic reports were retrospectively reviewed and correlated. Survival and recurrence rates were then analyzed.Results. Twelve patients with more than 50% CC component showed typical CC enhancement, whereas 17 patients with less than 50% CC component exhibited typical HCC enhancement. Those with equivocal imaging findings resulted near equal tumor component. The majority demonstrated either heterogeneous or peripheral enhancement. Considering the major tumor component, 66% of the images were consistent with histopathology. The over-all 3-year recurrent rate was 59%, with a mean time to recurrence of about 7 months. The 3-year survival rate of combined tumor after hepatectomy was 76% and after transplant was 75%, regardless of major tumor component. However, patients with more than 50% CC component showed a decrease in 3 -year survival rate to 50% when transplantation was performed.Conclusion. The overall survival rate for combined tumor after either hepatectomy or transplantation seems to be satisfactory but carries a high risk of recurrent when compared to pure HCC. On the other hand, a major CC component tumor after transplantation is associated with poor survival outcome; thus, liver transplantation has no role and is not a good management option.