Dong-Hwan Jung1, Shin Hwang2, Ki-Hun Kim1, Seung-Mo Hong3, Young-Joo Lee1, Chul-Soo Ahn1, Deok-Bog Moon1, Tae-Yong Ha1, Gi-Won Song1, Gil-Chun Park1, Eun Sil Yu3, Sung-Gyu Lee1. 1. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea. 2. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea. shwang@amc.seoul.kr. 3. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Abstract
BACKGROUND: Simultaneous double primary hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) (dpHCC-ICC) is very rare. This study investigated the clinicopathological features and post-resection prognosis of dpHCC-ICC. METHODS: We identified 10 patients with dpHCC-ICC through an institutional database search. Three control groups with HCC, ICC and combined HCC-cholangiocarcinoma (cHCC-CC) were selected (each n = 120) using propensity score matching. RESULTS: The incidence of dpHCC-ICC was 0.23%. The mean age was 57.4 ± 11.7 years, and 8 were male. Hepatitis B virus infection was associated with 8 patients. All dpHCC-ICC were diagnosed incidentally from surgical specimens. Only two patients demonstrated simultaneous elevation of alpha-fetoprotein/des-γ-carboxy prothrombin and carbohydrate antigen 19-9. All patients underwent macroscopic curative resection. The HCC component was classified as stage I in 7 and stage II in 3, and ICC component was classified as stage I in 5, stage II in 2 and stage IV in 3. Tumor recurrence and patient survival rates were 30.0 and 90.0% at 1 year and 52.0 and 77.1% at 3 years, respectively. Tumor recurrence rates were not different between the dpHCC-ICC and the three control groups (p = 0.505). The overall and post-recurrence patient survival rates were similar between the dpHCC-ICC and cHCC-CC groups (p > 0.2); however, these were inferior to those in the HCC group but comparable with those in the ICC group. CONCLUSIONS: The post-resection prognosis of dpHCC-ICC was more dependent on the tumor stage of the ICC component than that of the HCC component. Therefore, they can be clinically regarded as ICC with concurrent HCC.
BACKGROUND: Simultaneous double primary hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) (dpHCC-ICC) is very rare. This study investigated the clinicopathological features and post-resection prognosis of dpHCC-ICC. METHODS: We identified 10 patients with dpHCC-ICC through an institutional database search. Three control groups with HCC, ICC and combined HCC-cholangiocarcinoma (cHCC-CC) were selected (each n = 120) using propensity score matching. RESULTS: The incidence of dpHCC-ICC was 0.23%. The mean age was 57.4 ± 11.7 years, and 8 were male. Hepatitis B virus infection was associated with 8 patients. All dpHCC-ICC were diagnosed incidentally from surgical specimens. Only two patients demonstrated simultaneous elevation of alpha-fetoprotein/des-γ-carboxy prothrombin and carbohydrate antigen 19-9. All patients underwent macroscopic curative resection. The HCC component was classified as stage I in 7 and stage II in 3, and ICC component was classified as stage I in 5, stage II in 2 and stage IV in 3. Tumor recurrence and patient survival rates were 30.0 and 90.0% at 1 year and 52.0 and 77.1% at 3 years, respectively. Tumor recurrence rates were not different between the dpHCC-ICC and the three control groups (p = 0.505). The overall and post-recurrence patient survival rates were similar between the dpHCC-ICC and cHCC-CC groups (p > 0.2); however, these were inferior to those in the HCC group but comparable with those in the ICC group. CONCLUSIONS: The post-resection prognosis of dpHCC-ICC was more dependent on the tumor stage of the ICC component than that of the HCC component. Therefore, they can be clinically regarded as ICC with concurrent HCC.
Authors: Kathryn Fowler; Nael E Saad; Elizabeth Brunt; M B Majella Doyle; Manik Amin; Neeta Vachharajani; Benjamin Tan; William C Chapman Journal: Ann Surg Oncol Date: 2015-08-21 Impact factor: 5.344