No abstract available.
Bile Duct Neoplasms/*mortality/pathology/surgery ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/*mortality/pathology/surgery ; Humans ; Lymphatic Metastasis ; Prognosis ; Survival Rate

PURPOSE: Combined hepatocellular-cholangiocarcinoma (CHCC) is an uncommon form of cancer, and its clinicopathological features have rarely been reported in detail. This study was undertaken to evaluate the clinicopathological characteristics and prognostic factors of CHCC. MATERIALS AND METHODS: The clinicopathological features of patients diagnosed with CHCC at Severance Hospital between January 1996 and December 2007 were retrospectively studied by comparing them with the features of patients with hepatocellular carcinoma (HCC) or cholangiocarcinoma (CC) who had undergone a hepatic resection during the same period. RESULTS: Forty-three patients diagnosed with CHCC were included in this study (M : F=35 : 8, median age, 55 years). According to the parameters of the American Joint Committee on Cancer staging, there were 6 (14.0%), 9 (20.9%), 25 (58.1%), and 3 (7.0%) patients with stages I, II, III, and IV cancer, respectively. Thirty-two of the 43 patients underwent resection with curative intent. After resection, 27 patients (84.4%) had tumor recurrence during the follow-up period of 18 months (range: 6-106 months), and the median time to recurrence was 13 months. Overall median survival periods after hepatic resection of CHCC, HCC and CC were 34, 103 and 38.9 months, respectively (p<0.001). The median overall survival for all patients with CHCC was 21 months, and the 5-year survival rate was 18.1%. The presence of portal vein thrombosis and distant metastasis were independent prognostic factors of poor survival. CONCLUSION: Even after curative hepatic resection, the presence of a cholangiocellular component appeared to be a poor prognostic indicator in patients with primary liver cancer.
Adult ; Aged ; Carcinoma, Hepatocellular/mortality/*pathology ; Cholangiocarcinoma/mortality/*pathology ; Diagnosis, Differential ; Female ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/mortality/*pathology ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology ; Prognosis ; Republic of Korea/epidemiology ; Retrospective Studies

Bi-phenotypic neoplasm refers to tumors derived from a common cancer stem cell with unique capability to differentiate histologically into two distinct tumor types. Bi-phenotypic hepatocellular carcinoma-cholangiocarcinoma (HCC-CC), although a rare tumor, is important for clinicians to recognize, since treatment options targeting both elements of the tumor are crucial. Imaging findings of bi-phenotypic HCC-CC are not specific and include features of both HCC and CC. A combination of imaging and immuno-histochemical analysis is usually needed to make the diagnosis.
CA-19-9 Antigen/metabolism ; Carcinoma, Hepatocellular/mortality/pathology/radiography ; Cholangiocarcinoma/mortality/pathology/radiography ; Humans ; Liver Neoplasms/mortality/pathology/*radiography ; Magnetic Resonance Imaging ; Phenotype ; Risk Factors ; Survival Analysis ; Tomography, X-Ray Computed ; alpha-Fetoproteins/analysis

BACKGROUNDThe management of intrahepatic cholangiocarcinoma (ICC) remains a challenge due to poor prognosis. The aim of this study was to summarize the surgical management experience in recent 10 years and to identify the influencing factors related to outcome of patients with ICC in a single hepatobiliary center.

METHODSFrom January 1995 to June 2005, 136 patients with ICC undergoing surgery were reviewed retrospectively. Survival rates of patients were calculated using the Kaplan-Meier method and compared by using the log-rank test. The prognostic factors were identified by the Cox regression model.

RESULTSSeventy-nine of 136 patients underwent resection, and 65 of 79 patients were curative (R0). The surgical mortality was 2.2%. The 1-, 3- and 5-year survival rates of patients undergoing R0 resection were 72.1%, 35.6% and 20.1% respectively, which were significantly longer than those who underwent palliative resection and exploration, respectively (P < 0.01). At stage IV of the disease, 10 patients who underwent aggressive curative resection achieved a better median survival than those (n = 12) without resection (14 months vs 3 months, P < 0.001). The independent prognostic factors of the whole group were TNM stage (OR, 2.013, P = 0.008) and curative resection (OR, 2.957, P = 0.003). Higher TNM stage (OR, 1.894, P = 0.004) and lymph node metastasis (OR, 4.248, P = 0.005) linked to poor prognosis after R0 resection. For patients without lymph node metastasis, the median survival of those who underwent regional lymphadenectomy was comparable with those who did not (18 months vs 22 months, P = 0.817).

CONCLUSIONSR0 resection is mandatory for ICC patient to achieve long-term survival. Aggressive resection benefits for selected patients with local advanced disease. Higher TNM stage and lymph node metastasis were poor prognostic factors for ICC patients after R0 resection.

Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms ; mortality ; pathology ; surgery ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; mortality ; pathology ; surgery ; Female ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Prognosis ; Survival Rate

OBJECTIVETo investigate the relationship between lymph node metastasis and prognosis in patients of intrahepatic cholangiocarcinoma (ICC).

METHODSA retrospective clinical analysis was made in 132 cases of ICC, who admitted to our hospital from December 1996 to June 2003. Kaplan-meier method was used to calculate their survival rates, chi(2) test to compare the difference of sample rates. Logistic regression analysis was performed to determine the factors influencing lymph node metastasis and log-rank univariate analysis was used to assess the role of lymph node metastasis in the long-survival.

RESULTSLymph node metastasis in hepatoduodenal ligament could be detected in all 29 preoperative and 48 postoperative lymph metastatic cases, without "jumping-metastasis". Lymph metastasis was one of the major causes of postoperative mortality, and resulted in 36 of 58 followed-up death postoperatively. According to logistic analysis, pathological types of the carcinoma (chi(2) = 4.071, P = 0.044) and periductal-infiltrating tumors (chi(2) = 3.872, P = 0.037) were significant predictors of lymph node metastasis. In all 98 radical resections, 46 cases performed skeletonization of the hepatoduodenal ligament while other 52 cases not. The median survival of the two groups was 20 months and 13 months respectively (chi(2) = 9.82, P < 0.01).

CONCLUSIONSLymph nodes in the hepatoduodenal ligament may be sentinel nodes for ICC lymph node metastasis. Aggressive treatment of lymph node metastasis in the hepatoduodenal ligament is an important strategy to improve the long-survival of postoperative ICC patients.

Adult ; Aged ; Bile Duct Neoplasms ; mortality ; pathology ; surgery ; Bile Ducts, Intrahepatic ; surgery ; Cholangiocarcinoma ; mortality ; secondary ; surgery ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Survival Rate

OBJECTIVETo evaluate the clinical value of T-staging system for hilar cholangiocarcinoma which was adopted in memorial Sloan-Kettering cancer center of New York.

METHODSThe image data of these 47 patients were analyzed retrospectively from December 1997 to December 2002 whose data were according with our demand, and they were staged into three-stage according to the criteria of the T-staging system. The difference of respectability, ratio of tumor-free resection margin and actuarial survival rate were analyzed for different T-staging. And the coincident ratio of three different kinds of imaging methods was also analyzed.

RESULTSTwenty patients had T(1) tumors, twenty three had T(2) tumors and four had T(3) tumors. The resectability of the three stage was 60%, 39% and 0% respectively, and the difference was significant (P = 0.013). The likelihood of achieving tumor-free margin decreased progressively with increasing T stage (P = 0.018). The cumulative 1-year survival rates of T(1), T(2) and T(3) patients were 60%, 39% and 0% respectively, and the cumulative 3-year survival rate was 35%, 9% and 0% respectively, the survival of different stage patients differed markedly (P = 0.0103). The coincident ratio of combined using MRCP and color Doppler-ultrasonography was higher than that of combined using MRCP and B-ultrasonography or combined using CT/SCT and color Doppler-ultrasonography (P = 0.007).

CONCLUSIONSThe T-staging system has a better value for preoperative assessment, and can be used to judge resectability and survival of hilar cholangiocarcinoma. It will be helpful to use MRCP and color Doppler-Ultrasonography combined to verdict the coverage of the tumor and the T-staging preoperatively.

Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms ; mortality ; pathology ; surgery ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; mortality ; pathology ; surgery ; Female ; Follow-Up Studies ; Hepatectomy ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; methods ; Retrospective Studies ; Survival Rate

BACKGROUND/AIMS: Combined hepatocellular and cholangiocarcinoma (HCC-CC) is a rare form of primary liver carcinoma which contains characteristics of both hepatocellular carcinoma and cholangiocarcinoma. The aim of this study was to evaluate the prognostic factors of combined HCC-CC after curative resection. METHODS: Between January 1987 and December 2005, pathologically confirmed combined HCC-CC patients who underwent curative resection at Seoul National University Hospital were evaluated. We reviewed the medical records and evaluated the time-to-recurrence (TTR), overall survival (OS) and prognostic factors of combined HCC-CC. RESULTS: A total of 31 patients were evaluated (M:F=27:4; median age, 61 years). According to the American Joint Committee on Cancer system, patients with stage I, II, III(A), III(B) and III(C) at the time of resection were 4, 16, 7, 2 and 2, respectively. Twenty six patients (83.9%) had tumor recurrence during the follow-up period and their median TTR was 5.7 months. Twenty one patients received additional treatment while 5 patients did not. As a result, median OS was 21.6 months and 3 year survival rate was 15.4%. In multivariate analysis, stage III than stage I or II at resection was an independent prognostic factor associated with shortened TTR (p<0.01). Older age (p=0.03), stage III(C) rather than stage I, II, III(A) at time of resection (p=0.02), and Child-Pugh B rather than A (p<0.01) were independent prognostic factors associated with shortened OS. CONCLUSIONS: Even after curative resections, patients with combined HCC-CC show poor prognosis with early recurrence and poor survival. However, surgical treatment should be warranted for relatively young patients in early stage with well preserved liver function.
Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms/*mortality/pathology/surgery ; *Bile Ducts, Intrahepatic ; Carcinoma, Hepatocellular/*mortality/pathology/surgery ; Cholangiocarcinoma/*mortality/pathology/surgery ; Female ; Hepatectomy ; Humans ; Liver Neoplasms/*mortality/pathology/surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis ; Neoplasm Staging ; Predictive Value of Tests ; Prognosis ; Severity of Illness Index ; Survival Analysis ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the role of vascular resection and reconstruction in the treatment of hilar cholangiocarcinoma.

METHODS117 patients with potentially resectable hilar cholangiocarcinoma underwent exploration. Twenty-one patients had exploration or drainage only due to distant metastases, and the other 96 patients received surgical resection. Thirty-one of those had vascular resection and reconstruction, including portal vein resection alone in 21 patients, combined hepatic artery and portal vein resection in 2 and hepatic artery resection alone in 8. Therefore, the patients were divided into four groups: non-surgical resection (21), portal vain resection (21), hepatic artery resection (10) and non-vascular resection (65) and their clinical data were reviewed retrospectively.

RESULTSThe hepatic artery resection group had significantly higher perioperative morbidity and mortality rate (80.0% and 20.0%) than non-vascular resection group (16.9% and 1.5%), respectively, (P < 0.05), while no significant difference was found between the portal vein resection alone group and the non-vascular resection group (P > 0.05). Of all resected vessel specimens, vascular wall invasion beyond the adventitia was pathologically confirmed in 82.6% of the portal veins and 50.0% of the hepatic arteries. The 1-, 3- and 5-year survival rates were 59.0%, 34.0%, and 16.0% in the non-vascular resection group, versus 44.0%, 23.0% and 11.0% in the portal vein resection alone group (P < 0.05) and 18.0%, 0 and 0 in the hepatic artery resection group (P < 0.01), respectively, with a significant difference among the three groups. The 1-, 3- and 5-year survival rates in the non-surgical resection group were 13.0%, 0 and 0, respectively, which were similar to those in the hepatic artery resection group. Though a significant difference in survival rates existed between the portal vein resection alone group and non-resected group (P < 0.001), no significant difference was found between the hepatic artery resection group and non-resected group (P > 0.05).

CONCLUSIONBoth portal vein and hepatic artery resection can improve resection rate for hilar cholangiocarcinoma, and portal vein resection may improve the prognosis in selected patients. However, hepatic artery resection can not improve survival and may even lead to an increase of perioperative morbidity and mortality.

Adult ; Aged ; Bile Duct Neoplasms ; mortality ; surgery ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; mortality ; surgery ; Female ; Follow-Up Studies ; Hepatic Artery ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Portal Vein ; pathology ; surgery ; Reconstructive Surgical Procedures ; mortality ; Retrospective Studies ; Survival Rate ; Vascular Surgical Procedures ; mortality