Prognostic Evaluation and Survival Prediction for Combined Hepatocellular-Cholangiocarcinoma Following Hepatectomy

PurposeThis study aimed to assess prognostic factors associated with combined hepatocellularcholangiocarcinoma (cHCC-CCA) and to predict 5-year survival based on these factors. Materials and MethodsPatients who underwent definitive hepatectomy from 2006 to 2022 at a single institution was retrospectively analyzed.Inclusion criteria involved a pathologically confirmed diagnosis of cHCC-CCA. ResultsA total of 80 patients with diagnosed cHCC-CCA were included in the analysis.The median progression-free survival (PFS) was 15.6 months, while distant metastasis-free survival (DMFS), hepatic progression-free survival (HPFS), and overall survival (OS) were 50.8, 21.5, and 85.1 months, respectively.In 52 cases of recurrence, intrahepatic recurrence was the most common initial recurrence (34/52), with distant metastasis in 17 cases.Factors associated with poor DMFS included tumor necrosis, lymphovascular invasion (LVI), perineural invasion and histologic compact type.Postoperative CA19-9, tumor necrosis, LVI, and close/positive margin were associated with poor overall survival.LVI emerged as a key factor affecting both DMFS and OS, with a 5-year OS of 93.3% for patients without LVI compared to 35.8% with LVI.Based on these factors, a nomogram predicting 3-year and 5-year DMFS and OS was developed, demonstrating high concordance with actual survival in the cohort (Harrell C-index 0.809 for OS, 0.801 for DMFS, respectively). ConclusionThe prognosis of cHCC-CCA is notably poor when combined with lymphovascular invasion.Given the significant impact of adverse features, accurate outcome prediction is crucial.