The diagnostic conundrum and liver transplantation outcome for combined hepatocellular-cholangiocarcinoma

Document Type

Journal Article

Publication Date

5-1-2010

Journal

American Journal of Transplantation

Volume

10

Issue

5

DOI

10.1111/j.1600-6143.2010.03062.x

Keywords

Cholangiocarcinoma; Hepatocellular carcinoma; Liver cancer; Liver transplantation; Surgery/liver transplantation; Survival rate

Abstract

Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare primary liver malignancy with mixed hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) histological features. It is almost impossible to obtain an accurate, preoperative noninvasive diagnosis of cHCC-CC with tumor markers or cross-sectional abdominal imaging due to the mixed histological features. Despite these difficulties, accurate cHCC-CC diagnosis remains an important goal with prognostic significance. In our study, we retrospectively reviewed the tumor markers: AFP and CA 19-9, and cross-sectional liver imaging, in light of liver explant findings, to identify and characterize cHCC-CC features followed by liver transplantation (LT) outcome analysis. The results from this 12 patient cohort failed to identify characteristic features for cHCC-CC. None of the imaging features helped to identify the cHCC-CC tumor and they mimicked either HCC or CC, depending on the degree of glandular differentiation expressed histologically. In our cHCC-CC LT recipients, the 1-, 3- and 5-year cumulative survival probabilities were 79%, 66% and 16%, respectively with a 5-year survival comparable to or better than LT for intrahepatic CC but poorer than LT for HCC following the Milan criteria. Conceivably explained by its cholangiocarcinoma component the LT outcome for this rare and hard to diagnose tumor appears poor. © 2010 The American Society of Transplantation and the American Society of Transplant Surgeons.

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