Combined Hepatocellular Cholangiocarcinomas; Analysis of a Large Database

Article (PDF Available)inClinical Medicine: Pathology 1:43-7 · March 2008with6 Reads
Source: PubMed
Abstract
Combined hepatocellular cholangiocarcinoma (combined tumor) has been described as either a variant of hepatoma or a variant of cholangiocarcinoma. Prior studies evaluated fewer than 50 patients with combined tumors, precluding multivariate analyses. Posited was the notion that analysis of a large database would yield more definite answers. This study used SEER (Surveillance, Epidemiology, and End Results Program of the National Cancer Institute) to analyze 282 combined tumors, 2,035 intrahepatic cholangiocarcinomas, and 19,336 hepatomas between the years 1973-2003. Multinomial logit regression calculated point estimates and 95% confidence intervals (c.i.) for relative risk (rr). Cox regression calculated point estimates and 95% confidence intervals (c.i.) for hazard ratios (ĥ). Men less often had cholangiocarcinomas than they had combined tumors (rr = 0.63, c.i. = 0.49-0.81). Hepatomas less often than combined tumors presented with distant spread (rr = 0.56, c.i. = 0.43-0.72). Men (rr = 1.50, c.i. = 1.17-1.93) and patients with a known Asian or Pacific birthplace (rr = 2.36, c.i. = 1.56-3.56) more often had hepatomas than they had combined tumors. Among patients not known to have an Asian/Pacific birthplace, a diagnosis of cholangiocarcinoma (ĥ = 0.72, c.i. = 0.63-0.82) or hepatoma (ĥ = 0.75, c.i. = 0.66-0.86) provided a better prognosis than did a diagnosis of combined tumor. Combined tumors differ from hepatomas and cholangiocarcinomas in terms of distribution and survival patterns in the population; they should be considered neither cholangiocarcinomas nor hepatomas.

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    • "The WHO recognizes this as a specific tumor type, whereas the AJCC stages it as a cholangiocarcinoma. It has been associated with risk factors of HCC, such as HBV, HCV and alcohol use [192] and is considered to have a worse prognosis than standard HCC [193, 194] or even intrahepatic cholangiocarcinoma [195] . In a review of the SEER database , Garancini et al. [195A] found inferior survival for combined HCC-CC following liver transplantation as compared to HCC. "
    [Show abstract] [Hide abstract] ABSTRACT: The pathologic analysis of hepatocellular carcinoma (HCC) is updated almost daily by advances at the molecular level. However, contextual assessment of these advances is dependent upon the proper diagnosis of HCC and its distinction from other malignant or benign tumors that may involve the liver. Tissue diagnosis is not necessary in every patient, but problematic tumors require pathologic examination for definitive diagnosis; in addition, tissue samples provide a valuable resource for directed studies that may provide prognostic or therapeutic (theranostic) information. In the United States, pathologic evaluation of the explanted liver in transplant recipients previously diagnosed with HCC is mandated by the OPTN/UNOS as a quality control measure to monitor the performance of transplant programs.
    Chapter · Jan 2016 · American Journal of Roentgenology
    • "Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is defined as a tumor comprised of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) within the same tumor [1]. It is quite uncommon and accounts for only approximately 1% of primary liver cancers2345. Although the pathogenesis of cHCC-CC remains uncertain, it has been recently suggested that cHCC-CC may derive from a hepatic stem cell or hepatic progenitor cell [6, 7]. "
    Article · Jan 2016
    • "This is especially true in the United States, where HCC is diagnosed on the basis of imaging appearance alone, which then in turn determines transplantation exception status and management decisions. The prognosis of combined hepatocellular cholangiocarcinoma tumors compared with cholangiocarcinoma and HCC remains controversial , with most studies showing slightly worse prognosis and a few showing intermediate survival [3, 4, 15, 16, 18,2021222324252627. A potential confounding issue in understanding survival and treatment effect in patients with combined hepatocellular cholangiocarcinoma tumors relates to the retrospective nature of most studies, in which it is unclear if the biphenotypic pathology of the malignancy was known preoperatively and whether a different definitive treatment may have provided survival or time to progression benefit. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: The purpose of this study was to evaluate the diagnostic accuracy of preoperative imaging for diagnosis of combined hepatocellular cholangiocarcinoma tumors and to evaluate the clinical and imaging features and demographics of patients presenting to our institution with such tumors. Materials and methods: From January 2001 to January 2011, 29 patients presented with pathologically proven combined hepatocellular cholangiocarcinoma tumors to our institution. A retrospective review of the imaging studies, clinical data, and demographic information in these patients was conducted. Two radiologists with 6 and 18 years of experience reviewed the imaging studies of patients with combined hepatocellular cholangiocarcinoma tumors and matched control cases of hepatocellular carcinoma (HCC) (n = 15) and cholangiocarcinoma (n = 18). The reviewers were blinded to the pathologic diagnosis. Imaging features on contrast-enhanced MRI and CT with the suggested final diagnosis were recorded. Results: The demographics of our patient population were similar to other reported U.S. populations, with cirrhosis and hepatitis present in a minority of patients. The imaging features of combined hepatocellular cholangiocarcinoma tumors overlapped with those of HCC and cholangiocarcinoma. The correct diagnosis of combined hepatocellular cholangiocarcinoma tumors was made in a minority of cases by either radiologist, with misdiagnosis more often leading to suggestion of cholangiocarcinoma than HCC. Sensitivities and specificities for diagnosis of combined hepatocellular cholangiocarcinoma tumors ranged from 33% to 34% and 81% to 100%, respectively. Conclusion: Preoperative diagnosis of combined hepatocellular cholangiocarcinoma tumors on the basis of imaging features is accurate in the minority of cases. Tumor markers and risk factors may help improve accuracy; however, in the absence of classic imaging features and supportive information for HCC or cholangiocarcinoma, biopsy should be considered for confirmation of diagnosis.
    Article · Aug 2013
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