Analysis of the clinical and pathological characteristics of 27 cases of combined hepatocellular carcinoma and cholangiocarcinoma

To analyze the origin, clinical and pathological characteristics, diagnosis, treatment and prognosis of combined hepatocellular carcinoma and cholangiocarcinoma (HCC-CC). Methods: Data from 27 patients who underwent hepatectomy and were pathologically confirmed as having cHCC-CC in Cancer Center of Sun Yet-sen University from February 1988 to August 2003 were collected. We retrospectively analyzed the clinical pathological characteristics, diagnosis, treatments and prognosis in addition to indices including sex, age, hepatitis B virus infection, AFP, diameter of tumor, disseminated nodules, thrombosis, invasion of adja- cent organs, lymph node metastasis and metastasis to other organs. The 1-, 3-, and 5-year overall survival rates were analyzed by Kaplan-Meier method. Results: None of the 27 cases of cHCC-CC was accurately di- agnosed. The average age of the patients was 49 years (27-76 years). The percent of female patients was 70.4%. HBV infection was present in 63.6% of all cases. AFP expression was found in 48.1% of the patients ( 25 ng/mL). The cases with a tumor diameter less than 5 cm accounted for 11.1% of the total cases. The cas- es with a tumor diameter between 5.1 cm and 10 cm accounted for 66.7% of the total cases. The cases with a tumor diameter larger than 10 cm accounted for 16.2% of the total cases. Disseminated nodules were found in 30.8% of the patients. Macroscopic tumor thrombosis was found in 15.4% of the patients. Adjacent organ in- vasion was observed in 22.2% of the patients. Lymph node metastases were found in 19.2% of the patients. Metastases to other organs were found in 7.7% of the patients. The 1-, 3-, and 5-year overall survival rates of the 16 cases that were followed up were 31.3%, 18.8% and 6.3%, respectively. Conclusion: cHCC-CC is diffi- cult to diagnose preoperatively. In most patients, the tumor is found at an advanced stage during the initial di- agnosis. The diagnosis depends on pathological examination. Surgical resection is the main treatment. The prognosis of cHCC-CC is worse than that of HCC.