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Open Access 01-07-2018 | Original Article

The Predictive Value of Staging Systems and Inflammation Scores for Patients with Combined Hepatocellular Cholangiocarcinoma After Surgical Resection: a Retrospective Study

Authors: Chaobin He, MD, Yize Mao, MD, Jun Wang, MD, Yunda Song, MD, Xin Huang, MD, Xiaojun Lin, MD, Shengping Li, MD, PhD

Published in: Journal of Gastrointestinal Surgery | Issue 7/2018

Abstract

Background

Combined hepatocellular cholangiocarcinoma (cHCC-CC) is a rare form of primary liver tumor. A specific staging system for predicting survival in patients with cHCC-CC is not available. The aim of the present study was to evaluate the ability of staging systems and inflammation-based scores to predict overall survival (OS) and progression-free survival (PFS) of patients with cHCC-CC after surgical resection.

Methods

The data from 99 patients with cHCC-CC after surgical resection from June 2000 and January 2017 were retrospectively collected. Patients were allocated into HCC (hepatocellular carcinoma)—dominant (IHD) group and ICC (intrahepatic cholangiocarcinoma)—dominant (IID) group based on radiological characteristics. Similarly, patients were also divided into HCC-dominant (PHD) group and ICC-dominant (PID) group based on pathological characteristics. Univariate and multivariate analyses were performed to identify variables associated with OS and PFS. The prognostic value of staging systems and inflammation-based scores were analyzed and compared using receiver operating characteristic (ROC) curves.

Results

The 1-, 2-, and 3-year OS rates were 82.6, 66.3, and 59.6%, respectively. The 1-, 2-, and 3-year PFS rates were 52.2, 38.1, and 31.5%, respectively. Independent prognostic factors identified by multivariate analyses included HCC-TNM staging system and tumor diameter both for OS and PFS analyses. HCC-TNM staging system displayed higher area under ROC curve (AUC) values than the other staging systems or inflammation-based scores.

Conclusions

HCC-TNM staging system was able to adequately predict prognosis of patients with cHCC-CC after surgical resection, especially for patients with HCC-dominant characteristics in clinical practice.

Bosman FT HH. WHO classifcation of tumours of the digestive system. 4th ed. Lyon: International Agency for Research on Cancer; 2010.

Kassahun WT, Hauss J. Management of combined hepatocellular and cholangiocarcinoma. International journal of clinical practice. 2008;62(8):1271–8. https://doi.org/10.1111/j.1742-1241.2007.01694.x.CrossRefPubMed

Lee SD, Park SJ, Han SS, Kim SH, Kim YK, Lee SA et al. Clinicopathological features and prognosis of combined hepatocellular carcinoma and cholangiocarcinoma after surgery. Hepatobiliary & pancreatic diseases international : HBPD INT. 2014;13(6):594–601.CrossRef

Kim SH, Park YN, Lim JH, Choi GH, Choi JS, Kim KS. Characteristics of combined hepatocelluar-cholangiocarcinoma and comparison with intrahepatic cholangiocarcinoma. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2014;40(8):976–81. https://doi.org/10.1016/j.ejso.2014.04.016.CrossRef

Jarnagin WR, Weber S, Tickoo SK, Koea JB, Obiekwe S, Fong Y et al. Combined hepatocellular and cholangiocarcinoma: demographic, clinical, and prognostic factors. Cancer. 2002;94(7):2040–6.CrossRefPubMed

Chu KJ, Lu CD, Dong H, Fu XH, Zhang HW, Yao XP. Hepatitis B virus-related combined hepatocellular-cholangiocarcinoma: clinicopathological and prognostic analysis of 390 cases. European journal of gastroenterology & hepatology. 2014;26(2):192–9. https://doi.org/10.1097/MEG.0b013e3283625df9.CrossRef

Llovet JM, Bruix J. Prospective validation of the Cancer of the Liver Italian Program (CLIP) score: a new prognostic system for patients with cirrhosis and hepatocellular carcinoma. Hepatology (Baltimore, Md). 2000;32(3):679–80. https://doi.org/10.1053/jhep.2000.16475.CrossRef

Adhoute X, Penaranda G, Raoul JL, Le Treut P, Bollon E, Hardwigsen J et al. Usefulness of staging systems and prognostic scores for hepatocellular carcinoma treatments. World journal of hepatology. 2016;8(17):703–15. https://doi.org/10.4254/wjh.v8.i17.703.CrossRefPubMedPubMedCentral

He CB, Lao XM, Lin XJ. Transarterial chemoembolization combined with recombinant human adenovirus type 5 H101 prolongs overall survival of patients with intermediate to advanced hepatocellular carcinoma: a prognostic nomogram study. Chinese journal of cancer. 2017;36(1):59. https://doi.org/10.1186/s40880-017-0227-2.CrossRefPubMedPubMedCentral

10.

He CB, Lin XJ. Inflammation scores predict the survival of patients with hepatocellular carcinoma who were treated with transarterial chemoembolization and recombinant human type-5 adenovirus H101. PloS one. 2017;12(3):e0174769. https://doi.org/10.1371/journal.pone.0174769.CrossRefPubMedPubMedCentral

11.

Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860–7. https://doi.org/10.1038/nature01322.CrossRefPubMedPubMedCentral

12.

Li SH, Wang QX, Yang ZY, Jiang W, Li C, Sun P et al. Prognostic value of the neutrophil-to-lymphocyte ratio for hepatocellular carcinoma patients with portal/hepatic vein tumor thrombosis. World journal of gastroenterology. 2017;23(17):3122–32. https://doi.org/10.3748/wjg.v23.i17.3122.CrossRefPubMedPubMedCentral

13.

Kaida T, Nitta H, Kitano Y, Yamamura K, Arima K, Higashi T et al. Preoperative platelet-to-lymphocyte ratio can predict recurrence beyond the Milan criteria after hepatectomy for patients with hepatocellular carcinoma. Hepatology research : the official journal of the Japan Society of Hepatology. 2017;47(10):991–9. https://doi.org/10.1111/hepr.12835.CrossRef

14.

Abe T, Tashiro H, Kobayashi T, Hattori M, Kuroda S, Ohdan H. Glasgow Prognostic Score and Prognosis After Hepatectomy for Hepatocellular Carcinoma. World journal of surgery. 2017;41(7):1860–70. https://doi.org/10.1007/s00268-017-3909-7.CrossRefPubMed

15.

Kaltenborn A, Schrem H, Reichert B, Braun F, Emmanouilidis N, Klempnauer J et al. The Glasgow Prognostic Score and its variants predict mortality in living donor but not in deceased donor liver transplantation for hepatocellular carcinoma: A double-center validation study. Hepatology research : the official journal of the Japan Society of Hepatology. 2017;47(8):783–92. https://doi.org/10.1111/hepr.12818.CrossRef

16.

Ke M, Xu T, Li N, Ren Y, Shi A, Lv Y et al. Prognostic nutritional index predicts short-term outcomes after liver resection for hepatocellular carcinoma within the Milan criteria. Oncotarget. 2016;7(49):81611–20. https://doi.org/10.18632/oncotarget.13151.CrossRefPubMedPubMedCentral

17.

Mao Y, Xu S, Hu W, Huang J, Wang J, Zhang R et al. Imaging features predict prognosis of patients with combined hepatocellular-cholangiocarcinoma. Clinical radiology. 2017;72(2):129–35. https://doi.org/10.1016/j.crad.2016.11.003.CrossRefPubMed

18.

Jung DH, Hwang S, Hong SM, Chung YK, Song GW, Lee YJ et al. Post-resection Prognosis of Combined Hepatocellular Carcinoma-Cholangiocarcinoma According to the 2010 WHO Classification. World journal of surgery. 2017;41(5):1347–57. https://doi.org/10.1007/s00268-016-3837-y.CrossRefPubMed

19.

Ye J, Xie X, Liu B, Zhang X, Wang W, Huang X et al. Imaging Features on Contrast-Enhanced Ultrasound and Clinical Characteristics of Hepatitis B Virus-Related Combined Hepatocellular-Cholangiocarcinoma: Comparison with Hepatitis B Virus-Related Hepatocellular Carcinoma. Ultrasound in medicine & biology. 2017;43(11):2530–6. https://doi.org/10.1016/j.ultrasmedbio.2017.07.016.CrossRef

20.

Huang XW, Huang Y, Chen LD, Wang Z, Yang Z, Liu JY et al. Potential diagnostic performance of contrast-enhanced ultrasound and tumor markers in differentiating combined hepatocellular-cholangiocarcinoma from hepatocellular carcinoma and cholangiocarcinoma. Journal of medical ultrasonics (2001). 2017. https://doi.org/10.1007/s10396-017-0834-1.

21.

Aishima S, Kuroda Y, Asayama Y, Taguchi K, Nishihara Y, Taketomi A et al. Prognostic impact of cholangiocellular and sarcomatous components in combined hepatocellular and cholangiocarcinoma. Human pathology. 2006;37(3):283–91.CrossRefPubMed

22.

Loyer EM, Chin H, DuBrow RA, David CL, Eftekhari F, Charnsangavej C. Hepatocellular carcinoma and intrahepatic peripheral cholangiocarcinoma: enhancement patterns with quadruple phase helical CT—a comparative study. Radiology. 1999;212(3):866–75. https://doi.org/10.1148/radiology.212.3.r99se32866.CrossRefPubMed

23.

Choi BI, Cho JM, Han JK, Choi DS, Han MC. Spiral CT for the detection of hepatocellular carcinomas:relative value of arterial- and late-phase scanning. Abdominal imaging. 1996;21(5):440–4.CrossRefPubMed

24.

Yano Y, Yamamoto J, Kosuge T, Sakamoto Y, Yamasaki S, Shimada K et al. Combined hepatocellular and cholangiocarcinoma: a clinicopathologic study of 26 resected cases. Japanese journal of clinical oncology. 2003;33(6):283–7.CrossRefPubMed

25.

Shin CI, Lee JM, Kim SH, Choi JY, Lee JY, Han JK et al. Recurrence patterns of combined hepatocellular-cholangiocarcinoma on enhanced computed tomography. Journal of computer assisted tomography. 2007;31(1):109–15. https://doi.org/10.1097/01.rct.0000235072.34808.9b.CrossRefPubMed

26.

Lee YH, Hsu CY, Huang YH, Hsia CY, Chiou YY, Su CW et al. Vascular invasion in hepatocellular carcinoma: prevalence, determinants and prognostic impact. Journal of clinical gastroenterology. 2014;48(8):734–41. https://doi.org/10.1097/MCG.0b013e3182a8a254.CrossRefPubMed

27.

Komuta M, Spee B, Vander Borght S, De Vos R, Verslype C, Aerts R et al. Clinicopathological study on cholangiolocellular carcinoma suggesting hepatic progenitor cell origin. Hepatology (Baltimore, Md). 2008;47(5):1544–56. https://doi.org/10.1002/hep.22238.CrossRef

28.

Shen WF, Zhong W, Xu F, Kan T, Geng L, Xie F et al. Clinicopathological and prognostic analysis of 429 patients with intrahepatic cholangiocarcinoma. World journal of Gastroenterology. 2009;15(47):5976–82.CrossRefPubMedPubMedCentral

29.

Ohtsuka M, Ito H, Kimura F, Shimizu H, Togawa A, Yoshidome H et al. Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathological factors influencing survival. The British Journal of Surgery. 2002;89(12):1525–31. https://doi.org/10.1046/j.1365-2168.2002.02268.x.CrossRefPubMed

30.

Zhang YF, Zhou J, Wei W, Zou RH, Chen MS, Lau WY et al. Intermediate-stage hepatocellular carcinoma treated with hepatic resection: the NSP score as an aid to decision-making. British Journal of Cancer. 2016;115(9):1039–47. https://doi.org/10.1038/bjc.2016.301.CrossRefPubMedPubMedCentral

31.

Hayashi H, Beppu T, Ishiko T, Mizumoto T, Masuda T, Okabe K et al. [A 42-month disease free survival case of combined hepatocellular-cholangiocarcinoma with lymph node metastases treated with multimodal therapy]. Gan to kagaku ryoho Cancer & Chemotherapy. 2006;33(12):1941–3.

32.

Portolani N, Baiocchi GL, Coniglio A, Piardi T, Grazioli L, Benetti A et al. Intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma: a Western experience. Annals of Surgical Oncology. 2008;15(7):1880–90. https://doi.org/10.1245/s10434-008-9933-y.CrossRefPubMed

33.

Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-Related Inflammation. Nature. 2008;454(7203):436–44. https://doi.org/10.1038/nature07205.CrossRefPubMed

Title: The Predictive Value of Staging Systems and Inflammation Scores for Patients with Combined Hepatocellular Cholangiocarcinoma After Surgical Resection: a Retrospective Study
Authors: Chaobin He, MD
Yize Mao, MD
Jun Wang, MD
Yunda Song, MD
Xin Huang, MD
Xiaojun Lin, MD
Shengping Li, MD, PhD
Publication date: 01-07-2018
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 7/2018
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-018-3756-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The Predictive Value of Staging Systems and Inflammation Scores for Patients with Combined Hepatocellular Cholangiocarcinoma After Surgical Resection: a Retrospective Study

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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