WHO 2010 분류에 따른 간세포암-담관암 혼합암종의 절제후 예후 분석

Abstract

Background: Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) has wide histologic diversity. This study investigated the effects of cHCC-CC histology, according to the 2010 World Health Organization (WHO) classification, on patient prognosis. Methods: The medical records of patients who underwent surgical resection for cHCC-CC at Asan Medical Center between July 2012 and June 2019 were retrospectively evaluated. Results: During the study period, 168 patients, 122 (72.6%) men and 46 (27.4%) women, of mean age 56.6±10.7 years, underwent surgical resection for cHCC-CC, including 159 (94.6%) who underwent R0 resection. Mean tumor diameter was 4.4±2.8 cm, and 161 patients (95.8%) had solitary tumors. Histologically, 86 (51.2%) patients had classical type, and 82 (48.8%) had tumors with stem cell (SC) features, including 33 (19.6%) with intermediate-cell and 23 (13.7%) each with typical SC and cholangiolocellular features; three (1.8%) tumors were unclassifiable. Except for patient age, clinicopathological features did not differ according to the 2010 WHO classification. At 1, 3, and 5 years, tumor recurrence rates were 31.9%, 49.6%, and 58.1%, respectively, and patient survival rates were 91.0%, 70.2%, and 60.3%, respectively. Univariate analysis showed that tumor size >5 cm, microscopic and macroscopic vascular invasion, lymph node metastasis, 8th AJCC tumor stage, and 2010 WHO classification were significantly prognostic. Multivariate analysis showed that 8th AJCC tumor stage and 2010 WHO histologic classification were independently prognostic for tumor recurrence and patient survival. There were no significant prognostic differences among the three SC subtypes. Conclusions: Post-resection outcomes are better in patients with SC-type than with classical-type cHCC-CC.