Cancer Res Treat.  2025 Jan;57(1):229-239. 10.4143/crt.2024.176.

Prognostic Evaluation and Survival Prediction for Combined Hepatocellular-Cholangiocarcinoma Following Hepatectomy

• Chun SJ
• Jung YJ
• Choi Y
• Yi NJ
• Lee KW
• Suh KS
• Lee KB
• Kang HC
• Chie EK
• Kim KS

• KMID: 2564596
• DOI: http://doi.org/10.4143/crt.2024.176

Abstract

Purpose
This study aimed to assess prognostic factors associated with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and to predict 5-year survival based on these factors.
Materials and Methods
Patients who underwent definitive hepatectomy from 2006 to 2022 at a single institution was retrospectively analyzed. Inclusion criteria involved a pathologically confirmed diagnosis of cHCC-CCA.
Results
A total of 80 patients with diagnosed cHCC-CCA were included in the analysis. The median progression-free survival was 15.6 months, while distant metastasis-free survival (DMFS), hepatic progression-free survival, and overall survival (OS) were 50.8, 21.5, and 85.1 months, respectively. In 52 cases of recurrence, intrahepatic recurrence was the most common initial recurrence (34/52), with distant metastasis in 17 cases. Factors associated with poor DMFS included tumor necrosis, lymphovascular invasion (LVI), perineural invasion, and histologic compact type. Postoperative carbohydrate antigen 19-9, tumor necrosis, LVI, and close/positive margin were associated with poor OS. LVI emerged as a key factor affecting both DMFS and OS, with a 5-year OS of 93.3% for patients without LVI compared to 35.8% with LVI. Based on these factors, a nomogram predicting 3-year and 5-year DMFS and OS was developed, demonstrating high concordance with actual survival in the cohort (Harrell C-index 0.809 for OS, 0.801 for DMFS, respectively).
Conclusion
The prognosis of cHCC-CCA is notably poor when combined with LVI. Given the significant impact of adverse features, accurate outcome prediction is crucial. Moreover, consideration of adjuvant therapy may be warranted for patients exhibiting poor survival and increased risk of local recurrence or distant metastasis.

Keyword

Combined hepatocellular-cholangiocarcinoma; Hepatectomy; Nomograms

Figure

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  Fig. 1. Progression-free survival (A), distant metastasis-free survival (B), hepatic progression-free survival (C), and overall survival (D) in patients with combined hepatocellular-cholangiocarcinoma.

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  Fig. 2. Distant metastasis-free survival of patients according to tumor necrosis (A), lymphovascular invasion (LVI) (B), histologic type (C), and postop carbohydrate antigen 19-9 (CA19-9) level (D). Overall survival of patients according to tumor necrosis (E), lymphovascular invasion (F), histologic type (G), and postop CA19-9 level (H). N/A, not available.

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  Fig. 3. Nomogram for prediction of distant metastasis-free survival (A) and overall survival (B) for combined hepatocellular-cholangiocarcinoma, calibration curve for nomogram of 5-year distant metastasis-free survival (C) and 5-year overall survival (D). CA19-9, carbohydrate antigen 19-9; LVI, lymphovascular invasion; N/A, not available; PI, perineural invasion.

Reference

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