Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma: Real-life Data on Liver Disease, Treatment and Prognosis

Background and Aims: Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) have common features and differences. This real-life study investigated their characteristics, treatment modalities, and prognoses. Meth-ods: This retrospective comparative study was performed in 1,075 patients seen at one tertiary center between January 2008 and December 2020. Overall survival (OS) was estimat -ed by the Kaplan-Meier method. Subclassification of iCCAs af-ter histological and radiological review, and molecular profil -ing was performed. Results: HCCs patients were more likely to have early-stage disease than iCCA patients. iCCA patients were more likely to be female, especially those patients with-out cirrhosis (43% vs. 17%). Cirrhosis was prominent among HCC patients (89% vs. 34%), but no difference in underlying liver disease among cirrhotic patients was found. OS of HCC patients was 18.4 (95% CI: 6.4, 48.3) months, that of iCCA patients was 7.0 (95% CI: 3.4, 20.1) months. OS of Barce-lona Clinic Liver Cancer C HCC patients was 7.8 (95% CI: 4.3, 14.2) months, that of advanced/metastatic iCCA patients was 8.5 (95% CI: 5.7, 12.3) months. In patients treated with sorafenib, OS was longer in HCC patients who received sub-sequent tyrosine kinase inhibitor therapies. No significant OS difference was found between iCCA patients with and without cirrhosis or according to histological subtype. A targetable molecular alteration was detected in 50% of the iCCA pa-tients. Conclusions: In this French series, cirrhosis was com-mon in iCCA, which showed etiological factors comparable to those of HCC, implying a distinct oncogenic pathway. Both entities had a dismal prognosis at advanced stages. However, systemic therapies sequencing in HCC and molecular profiling in iCCA offer new insights.

Automated summary

This real-life study investigated the characteristics, treatment modalities, and prognoses of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA). The study found that HCC patients were more likely to have early-stage disease, while iCCA patients were more likely to be female, especially those without cirrhosis. Cirrhosis was prominent among HCC patients, but no difference in underlying liver disease among cirrhotic patients was found. The overall survival (OS) of HCC patients was 18.4 months, while that of iCCA patients was 7.0 months. Targetable molecular alterations were detected in 50% of the iCCA patients.