Postresection Outcomes of Combined Hepatocellular Carcinoma-Cholangiocarcinoma, Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma

Introduction Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is rare. This study investigated the clinicopathological features of cHCC-CC and compared the postresection survival outcomes of cHCC-CC, hepatocellular carcinoma (HCC), and intrahepatic cholangiocarcinoma (IHC). Methods Between January 2000 and September 2012, 53 patients with cHCC-CC underwent tumor resection, accounting for 1.1 % of surgeries for primary liver malignancies. Control groups included patients with HCC (n=1452) and IHC (n=149) who underwent R0 resection of stage I/II tumors <= 5 cm. Results Mean tumor diameter of cHCC-CC group was 5.5 +/- 2.9 cm, and single tumor was identified in 50. Pathological classification included combined (n=41), mixed (n=11), and double (n=1) tumors. The 1-, 3-, 5-, and 10-year tumor recurrence rates were 60.8, 71.8, 80.7, and 80.7 %, respectively. The 1-, 3-, 5-, and 10-year overall survival rates were 73.3, 35.6, 30.5, and 11.1 %, respectively. Tumor recurrence and patient survival did not differ significantly according to AJCC tumor staging and histological type (all p >= 0.2). Tumor recurrence rates did not differ significantly between the cHCC-CC, HCC, and IHC groups (p=0.43), whereas differences in survival rates were significant (p=0.000), with a median survival after tumor recurrence of 8, 51, and 6 months, respectively (p=0.000). Conclusions Patients with cHCC-CC showed similar recurrence rates to those of control patients with HCC and IHC, whereas their survival outcomes were worse than those of control HCC patients because of poor responses to recurrence treatment. Further evaluation of differences in tumor characteristics and tumor biology is necessary to accurately predict the prognosis of patients with cHCC-CC.