Prognostic analysis of patients with combined hepatocellular-cholangiocarcinoma after radical resection: A retrospective multicenter cohort study

BACKGROUND Combined hepatocellular-cholangiocarcinoma(cHCC-CCA) is a form of rare primary liver cancer that combines intrahepatic cholangiocarcinoma(ICC) and hepatocellular carcinoma.AIM To investigate overall survival(OS) and recurrence-free survival(RFS) after radical resection in patients with cHCC-CCA, and the clinicopathological factors affecting prognosis in two center hospitals of China.METHODS We reviewed consecutive patients with cHCC-CCA who received radical resection between January 2005 and September 2021 at Peking Union Medical College and the 5th Medical Center of the PLA General Hospital retrospectively. Regular follow-up and clinicopathological characteristics were systematic collected for baseline and prognostic analysis.RESULTS Our study included 95 patients who received radical resection. The majority of these patients were male and 82.7% of these patients were infected with HBV. The mean tumor size was 4.5 cm, and approximately 40% of patients had more than one lesion. The median OS was 26.8(95%CI: 18.5-43.0) mo, and the median RFS was 7.27(95%CI: 5.83-10.3) mo. Independent predictors of OS were CA19-9 ≥ 37 U/mL(HR = 8.68, P = 0.002), Child-Pugh score > 5(HR = 5.52, P = 0.027), tumor number > 1(HR = 30.85, P = 0.002), tumor size and transarterial chemoembolization(TACE) after surgery(HR = 0.2, P = 0.005).CONCLUSION The overall postoperative survival of cHCC-CCA patients is poor, and most patients experience relapse within a short period of time after surgery. Preoperative tumor biomarker(CA19-9, alphafetoprotein) levels, tumor size, and Child-Pugh score can significantly affect OS. Adjuvant TACE after surgery prolongs RFS, suggesting that TACE is a possible option for postoperative adjuvant therapy in patients with cHCC-CCA.