Combined hepatocellular and cholangiocarcinoma - Demographic, clinical, and prognostic factors
Combined hepatocellular and cholangiocarcinoma - Demographic, clinical, and prognostic factors
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DOI：
10.1002/cncr.10392
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发表时间：
2002-04-01
期刊：
影响因子：
6.2
通讯作者：
Klimstra, D
中科院分区：
文献类型：
--
作者：
Jarnagin, WR;Weber, S;Klimstra, D
背景具有肝细胞和胆管细胞特征的肿瘤在组织病理学上是众所周知的，但对其临床行为知之甚少。本研究的目的是确定发生这些罕见肿瘤的患者的人口统计学特征，并与单纯肝细胞癌（HCC）或外周胆管癌（CC）患者的治疗结果进行比较。从前瞻性数据库中确定了27例合并肿瘤患者。分析病理标本以确诊。分析了人口统计学、临床数据和生存率。将切除术后的结果与CC患者和一组匹配的HCC患者进行比较。合并肿瘤的性别分布（52%男性和48%女性）介于HCC（67%男性和33%女性）和CC（30%男性和70%女性）之间（P = 0.03）。在合并肿瘤和CC患者中，阳性B或C型肝炎血清学和肝硬化的发生率相似（分别为15%和0% vs. 13%和4%）;同样，亚裔患者分别占这些肿瘤患者的7%和9%。相比之下，肝硬化（41%）和肝炎血清学阳性（56%）在HCC患者中更为常见，其中19%的患者为亚洲血统。27例合并肿瘤患者中有21例（78%）接受了切除术。所有6例合并肿瘤的患者均在18个月内死于疾病。切除后，联合肿瘤患者的5年生存率最低（24%），但与CC（33%）或HCC（37%）患者无显著差异。肝脏是所有三组中最常见的复发部位。合并肿瘤患者的人口统计学和临床特征与CC患者最为相似。最重要的是，未发现联合肿瘤与慢性肝病相关;因此，这些肿瘤的可切除率高于通常报道的HCC。切除术与一些患者的长期生存有关，但复发性肝病很常见。与单纯HCC相比，胆管细胞分化的存在似乎使预后恶化，尽管这种差异没有达到统计学意义。
BACKGROUND. Tumors with combined hepatocellular and cholangiocellular features are well known histopathologically but their clinical behavior is poorly understood. The objectives of the current study were to define the demographic profile of the patients in whom these uncommon tumors occur and to evaluate treatment outcome in comparison with that in patients with either hepatocellular carcinoma (HCC) or peripheral cholangiocarcinoma (CC) alone.METHODS. Twenty-seven patients with combined tumors were identified from a prospective database. Pathologic specimens were analyzed to confirm the diagnosis. Demographics, clinical data, and survival were analyzed. Outcome after resection was compared with that of patients with CC and with a matched group of patients with HCC.RESULTS. The gender distribution of the combined tumors (52% men and 48% women) was intermediate between HCC (67% men and 33% women) and CC (30% men and 70% women) (P = 0.03). The incidence of positive hepatitis B or C serology and cirrhosis was similar in patients with combined tumors and those with CC (15% and 0% vs. 13% and 4%, respectively); similarly, patients of Asian heritage constituted 7% and 9%, respectively, of the patients with these tumors. By contrast, cirrhosis (41%) and positive hepatitis serology (56%) were far more common in patients with HCC, and 19% of these patients were of Asian heritage. Twenty-one of 27 patients with combined tumors (78%) underwent resection. All 6 patients with combined tumors that were not amenable to resection died of disease within 18 months. After resection, the 5-year survival was lowest in patients with combined tumors (24%) but was not significantly different from that in patients with CC (33%) or HCC (37%). The liver was the most common site of recurrence in all three groups.CONCLUSIONS. The demographic and clinical features of patients with combined tumors were most similar to those of patients with CC. Most important, combined tumors were not found to be associated with chronic liver disease; consequently, the resectability rate was higher for these tumors than typically is reported for HCC. Resection was associated with long-term survival in some patients, but recurrent hepatic disease was common. The presence of cholangiocellular differentiation appeared to worsen the prognosis when compared with pure HCC, although this difference did not reach statistical significance.