Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2020; 12(11): 1020-1030
Published online Nov 27, 2020. doi: 10.4254/wjh.v12.i11.1020
Factors associated with 5-year survival of combined hepatocellular and cholangiocarcinoma
Tomoki Sempokuya, Eric A Wien, Robert J Pattison, Jihyun Ma, Linda L Wong
Tomoki Sempokuya, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
Eric A Wien, Robert J Pattison, Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States
Jihyun Ma, Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States
Linda L Wong, Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96817, United States
Author contributions: Sempokuya T contributed to study design, data collection, statistical analysis; Sempokuya T, Wien E and Pattison R contributed to the literature review, manuscript drafting, and editing; Ma J contributed to study design and statistical analysis; Wong L contributed to study supervision, manuscript drafting and editing; and all of the authors approved the final version of the manuscript.
Institutional review board statement: Since we utilized publicly available de-identified database, review by our institutional review board was not required.
Informed consent statement: Informed consent was not required to conduct this study.
Conflict-of-interest statement: LW is a speaker bureau for Eisai. Other authors do not have any conflict of interest.
Data sharing statement: All the data used in this analysis is available from SEER database.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tomoki Sempokuya, MD, Doctor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198, United States. tsempoku@hawaii.edu
Received: April 15, 2020
Peer-review started: April 15, 2020
First decision: June 4, 2020
Revised: July 25, 2020
Accepted: October 12, 2020
Article in press: October 12, 2020
Published online: November 27, 2020
Processing time: 222 Days and 23.7 Hours
ARTICLE HIGHLIGHTS
Research background

Combined hepatocellular and cholangiocarcinoma (HCC/CC) is a rare primary hepatic malignancy which carries a poor prognosis due to its aggressive nature. Few centers have enough cases to draw definitive conclusions and there is limited understanding of prognosis.

Research motivation

As there has not been a randomized clinical trial done on this topic to elucidate the best treatment modality on HCC/CC, there is a need to better characterize the prognosis of this disease.

Research objectives

In this retrospective study, we attempted to identify associated factors for 5-year survival.

Research methods

We conducted a retrospective study of The Surveillance, Epidemiology, and End Results database to identify HCC/CC cases from 2004 to 2015. We collected demographics, American Joint Committee on Cancer (AJCC) stage, treatment, tumor size, and survival data. Mann-Whitney U test was used to compare continuous variables without normal distribution, and t-test was used to compare continuous variables with a normal distribution. The Kaplan-Meier survival curve analyzed Five-year survival. These data were converted to categorical variables. Univariate and multivariate logistic regression model was used to analyze factors associated with 5-year survival. Multivariate Cox proportional hazard regression was done on 5-year survival.

Research results

We identified 497 patients with the following characteristics: Mean age 62.4 years, 149 (30.0%) were female, racial distributions were 276 (55.5%) white, 53 (10.7%) black, 84 (16.9%) Asian and Pacific Islander (API), 77 (15.5%) Hispanic, and 7 (1.4%) others or unknown. Stage I/II disease occurred in 41.5% and tumor size < 50 mm was seen in 35.6% of patients. The overall median survival was 6 mo. After multivariate logistic regression, tumor size < 50 mm [odds ratio (OR): 2.415, P = 0.05], resection (OR: 12.849, P < 0.01), and transplant (OR: 27.129, P < 0.01) showed significance for 5-year survival. Age > 60, sex, race, AJCC stages, metastasis, and LRT were not significant. However, API vs white showed significant OR of 2.793 (CI: 1.120-6.967). Cox proportional hazard regression showed AJCC stages, tumor size < 50 mm, LRT, resection, and transplant showed significant hazard ratio.

Research conclusions

HCC/CC patients with tumor size < 50 mm, resection, and transplant were associated with an increase in 5-year survival. API showed advantageous OR and hazard ratios over white, black.

Research perspectives

Prognosis and possible treatment modality for HCC/CC is different from hepatocellular carcinoma or cholangiocarcinoma alone. As we depend heavily on imaging diagnosis of hepatocellular carcinoma, this study may suggest the importance of role of biopsy to confirm correct diagnosis.