Researchers discovered that combined hepatocellular-cholangiocarcinoma (CHC) was associated with similar overall survival rates with intrahepatic cholangiocarcinoma (ICC) in the initial 36 months, but that these outcomes compared to ICC improved significantly in the subsequent follow-up, as published in Cancer Medicine.

CHC is poorly understood due to its rarity and dual nature. “The ambiguous biological features of CHC may hinder the formulation of treatment protocols and seriously affect the prognosis of patients,” the authors wrote. 

Molecular analysis suggests that both CHC and ICC share common carcinogenic pathways. Because investigations into CHC are limited, the researchers decided to conduct a study to “clearly define the clinicopathologic characteristics and to evaluate the survival outcomes as well as different therapeutic regimens” of CHC.

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They identified patients with CHC and ICC (n=1066) through the Surveillance, Epidemiology, and End Result cancer database from 2004 until 2006. Of the 1066 patients, 286 had CHC and 780 had ICC. 

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“The data on demographics, American Joint Committee on Cancer (AJCC) stages, histopathological characteristics, treatments, and survival outcomes were collected from the database,” Yang and Shi wrote.

The results demonstrated that the majority of CHC tumors were poorly differentiated (37.8%), with the most common AJCC stage being stage I (31.4%). The researchers also discovered that surgery was associated with better outcomes, both in the early and advanced stages of the disease.

“Multivariable analysis of all CHC patients revealed that only tumor size, M1 stage, AJCC stage IIIC, AJCC stage IV, surgery, and chemotherapy were significantly associated with overall survival,” they wrote.

The researchers also discovered that the overall survival rates decreased significantly in the ICC group when compared to the CHC group after the initial 36 months following treatment. “Further investigation is warranted to establish a standard regimen for CHC,” they concluded.


Yang Z, Shi G. Survival outcomes of combined hepatocellular-cholangiocarcinoma compared with intrahepatic cholangiocarcinoma: a SEER population-based cohort study. Cancer Med. Published online December 4, 2021. doi:10.1002/cam4.4474