Tumor component proportion determines the prognosis of patients with combined hepatocellular-cholangiocarcinoma.
Source: PubMed, NCBI / U.S. National Library of Medicine
The pathological diagnostic purpose of the tumor component proportion of combined hepatocellular-cholangiocarcinoma (CHC) remains a perplexing issue, hindering clinicians from characterizing its biological behavior and formulating intervention strategies. A multicenter database of patients with CHC who underwent therapeutic hepatectomy was analyzed. Based on a > 70% hepatocellular carcinoma (HCC) or cholangiocarcinoma (CCA) component, the patients were stratified into three groups: CHC, CHC, and CHC. Survival outcomes were assessed using Kaplan-Meier analysis. Tumor markers and recurrence patterns were compared via Chi-square test, and prognostic factors were identified through Cox regression analysis. Postoperative adjuvant transarterial chemoembolization (PA-TACE) benefits were further evaluated. Among 19 641 patients with primary liver cancer, 306 with CHC were classified: 93 (30.4%) in the CHCgroup, 101 (33.0%) in the CHCgroup, and 112 (36.6%) in the CHCgroup. The best and the worst prognoses were observed in the CHCgroup and CHCgroup, respectively (median RFS time: CHCgroup 1.02 years, CHCgroup 0.36 years, CHCgroup 0.30 years; median OS time: CHCgroup 3.16 years, CHCgroup 1.93 years, CHCgroup 1.86 years). The highest ratios of elevated alpha-fetoprotein and carbohydrate antigen 19-9 were recorded in the CHCgroup and the CHCgroup, respectively. CHCand CHCpatients showed the most frequent intrahepatic and extrahepatic recurrences, respectively. PA-TACE improved early RFS (
Abstract
The pathological diagnostic purpose of the tumor component proportion of combined hepatocellular-cholangiocarcinoma (CHC) remains a perplexing issue, hindering clinicians from characterizing its biological behavior and formulating intervention strategies. A multicenter database of patients with CHC who underwent therapeutic hepatectomy was analyzed. Based on a > 70% hepatocellular carcinoma (HCC) or cholangiocarcinoma (CCA) component, the patients were stratified into three groups: CHC, CHC, and CHC. Survival outcomes were assessed using Kaplan-Meier analysis. Tumor markers and recurrence patterns were compared via Chi-square test, and prognostic factors were identified through Cox regression analysis. Postoperative adjuvant transarterial chemoembolization (PA-TACE) benefits were further evaluated. Among 19 641 patients with primary liver cancer, 306 with CHC were classified: 93 (30.4%) in the CHCgroup, 101 (33.0%) in the CHCgroup, and 112 (36.6%) in the CHCgroup. The best and the worst prognoses were observed in the CHCgroup and CHCgroup, respectively (median RFS time: CHCgroup 1.02 years, CHCgroup 0.36 years, CHCgroup 0.30 years; median OS time: CHCgroup 3.16 years, CHCgroup 1.93 years, CHCgroup 1.86 years). The highest ratios of elevated alpha-fetoprotein and carbohydrate antigen 19-9 were recorded in the CHCgroup and the CHCgroup, respectively. CHCand CHCpatients showed the most frequent intrahepatic and extrahepatic recurrences, respectively. PA-TACE improved early RFS (< 2 years) only in CHCpatients. Multivariate analysis confirmed that tumor component proportion was an independent prognostic factor for all survival endpoints. Predominant HCC or CCA components (> 70% tumor composition) critically shape CHC biology and prognosis. Tumor component proportion emerges as a novel parameter for therapeutic decision-making. We proposed a comprehensive flow chart integrating pathological sampling, histological component evaluation, clinical data mapping, and postoperative intervention strategies for CHC.