Surgical Treatments and Prognoses of Patients with Combined Hepatocellular Carcinoma and Cholangiocarcinoma

Combined hepatocellular carcinoma and cholangiocarcinoma is a very rare form of primary liver cancer containing components of both tumor types. We evaluated the effectiveness of surgical treatment and factors related to survival and recurrence. Of the 2427 patients who underwent hepatectomy or liver transplantation because of a primary hepatic malignancy from January 1989 to July 2006 at the Asan Medical Center, Seoul, Korea, 29 had hepatocellular carcinoma and cholangiocarcinoma as a single mixed or transitional tumor. Their medical records were retrospectively reviewed. Disease-free survival rates at 6 months, 1 year, and 3 years were 51.1%, 38.3%, and 25.6%, respectively. Univariate analysis showed that CA 19-9 above 37 U/ml was predictive of low overall survival (P = .03) and that TNM stage was significantly associated with disease-free survival (P = .04). Patients with combined hepatocellular carcinoma and cholangiocarcinoma had poor postoperative survival rates. High CA 19-9 level was associated with poorer survival, suggesting that the cholangiocarcinoma portion may be a major determining factor for patient prognosis. Aggressive surgical treatment, including lymph node dissection, may improve survival in patients suspected of or diagnosed with these tumors.