混合型肝细胞-胆管癌临床病理特征及根治术后预后的倾向性评分匹配分析OA

Objective To analyze the clinicopathological characteristics and the prognosis after surgical resection of combined hepatocellular-cholangiocarcinoma(cHCC-CCA)patients.Methods Clinical data of 160 patients with primary liver cancer who underwent radical resection at Senior Department of Liver Diseases,Chinese PLA General Hospital from January 2018 to December 2022 were retrospectively collected.Patients were divided into three groups according to tumor pathology:the cHCC-CCA group(n=40),the intrahepatic cholangiocarcinoma(ICC)group(n=40),and the hepatocellular carcinoma(HCC)group(n=80).The clinicopathological features of the three groups were compared.Propensity score matching(PSM)was applied to perform 1∶1 matching between the cHCC-CCA group and the ICC group,and between the cHCC-CCA group and the HCC group,respectively.Baseline characteristics before and after PSM,as well as survival differences among groups after PSM,were compared.Results Before PSM,there were significant differences among the three groups in hepatitis virus infection rate,positive rates of alpha protein(AFP,≥100 ng/mL)and carbohydrate antigen 199(CA199,≥37 U/mL),incidence of cirrhosis,lymph node metastasis,tumor differentiation,and performance of lymph node dissection(all P<0.05).The hepatitis virus infection rate and AFP positive rate in the cHCC-CCA group were similar to those in the HCC group,and significantly higher than those in the ICC group.The rates of lymph node metastasis and lymph node dissection in the cHCC-CCA group were intermediate between those in the ICC and HCC groups(all P<0.05).Compared with the HCC group,the cHCC-CCA and ICC groups had higher rates of postoperative adjuvant chemotherapy,but lower rates of interventional therapy,targeted therapy,and immunotherapy(all P<0.05).There were no significant differences in overall survival(OS)or recurrence-free survival(RFS)between the cHCC-CCA and ICC groups(both P>0.05),and both were significantly shorter than those in the HCC group(P<0.05).After PSM,there was no significant difference in OS or RFS between the cHCC-CCA and ICC groups(P>0.05).Compared with the HCC group,the cHCC-CCA group had a shorter median OS[28.0(11.4,49.6)months vs 50.0(32.5,67.0)months,P=0.016],with no significant difference in RFS(P>0.05).Conclusion The clinicopathological features of cHCC-CCA patients share characteristics of both HCC and ICC.Surgical resection is an effective treatment for cHCC-CCA.