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Outcome of Combined Hepatocellular and Cholangiocarcinoma of the Liver

DOI: 10.1155/2010/917356

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Background. The objective of this study was to examine the epidemiology, natural history, and prognostic factors of combined hepatocellular and cholangiocarcinoma (cHCC-CC) using population-based registry. Methods. The Surveillance, Epidemiology, and End Results Program database (1973–2004) was used to identify cases of cHCC-CC. Multivariable logistic regression was used to evaluate factors associated with cancer-directed surgery (CDS). The influence of CDS on cancer specific survival was evaluated using Kaplan-Meier curves and Cox proportional hazards modeling. Results. A total of 380 cases of cHCC-CC were identified, which account for approximately 0.87% of primary liver tumors. Of all patients, 69.8% of patients had regional or distant stage; 65.6% of patients had poorly or undifferentiated histology. Only 44.9% of patients with localized disease, received CDS. By logistic regression analysis, being widowed, advanced stage, and earlier diagnosis year were associated with lower rate of utilization of CDS. In multivariate analysis, tumor stage, receipt of CDS, and recent year of diagnosis were found to be significant predictors for cancer-specific survival. Conclusions. Patients with localized cHCC-CC who are selected for CDS were strongly associated with improved survival. However, many patients with localized tumors did not receive potentially curative cancer-directed surgery. Further study is warranted to address the barriers to the delivery of appropriate care to these patients. 1. Introduction Combined hepatocellular and cholangiocarcinoma (cHCC-CC) is an uncommon subtype of primary liver cancer [1, 2]. The disease was first described in 1949 by Allen and Lisa and has been defined as the intimate intermingling of both a HCC component and CC component Two histopathological classification schemes have been proposed Allen and Lisa [1] described three groups, type A with HCC and CC present at different sites within the same liver, and type B with HCC and CC present at adjacent sites and mingle with continued growth, and type C with HCC and CC are combined in the same tumor. Goodman et al. [2] categorized cHCC-CC into three types: collision type, transitional type, and fibrolamellar type. Kim et al. [3] and Zhang et al. [4] proposed that cHCC-CC is a distinct type of primary liver carcinoma, which is morphologically and phenotypically intermediate between HCC and CC and may be derived from hepatic progenitor cells with the bipotential to differentiate into both hepatocytic and cholangiocytic lineages. Because of the rarity of cHCC-CC, previously

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