Postoperative TACE Prolongs RFS in Patients With Combined Hepatocellular-Cholangiocarcinoma

The overall survival rate for patients with the rare form of primary liver cancer called combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is poor, and most patients experience recurrence shortly after undergoing surgery. However, patients who received adjuvant transarterial chemoembolization (TACE) after surgery had a prolonged recurrence-free survival (RFS), indicating this treatment, according to a new study.

The definition of cHCC-CCA was updated in 2019 by the World Health Organization, classifying it as showing both hepatocellular (HCC) and intrahepatic cholangiocarcinoma (ICC) within the same lesion. Hepatectomy in combination with lymph node dissection is currently the only possible cure for cHCC-CCA. And unlike other forms of liver cancer, the prognosis for cHCC-CCA is unclear.

A retrospective multicenter cohort study in China, published in the World Journal of Gastroenterology, evaluated overall survival (OS), RFS, and individual prognosis predictors: preoperative tumor biomarker (CA19-9, alpha-fetoprotein) levels, tumor size, Child Pugh (C-P) score, and TACE post-surgery.

This study reviewed patients who had received hepatectomy for primary liver cancer at Peking Union Medical College and The 5th Medical Center of the PLA General Hospital from January 2005 to September 2021. A total of 98 patients were included. Of the total, 95 patients had cHCC-CCA and received for radical resection.

Most patients (96.9%) had an Eastern Cooperative Oncology Group score of 0-1, and the majority (82.7%) had a hepatitis B infection.

Additionally, pathological characteristics in 98 patients found that 18 had stage I cancer (18.3%), 59 (60.2%) had stage II cancer, 19 (19.4%) had stage III cancer, and 2 could not be evaluated.

The results of this study showed the median OS was 26.8 (95% CI, 18.5-43.0) months and the median RFS was 7.27 (95% CI, 5.83-10.3) months. Preoperative tumor biomarker (CA19-9, alpha-fetoprotein) levels were greater than or equal to 37 U/mL (HR = 8.68, P = .002). The mean tumor size was 4.5 cm and approximately 40% of patients had more than 1 lesion (HR > 30.85, P = .002). Most patients had well-preserved liver function, evaluated by a C-P score greater than 5 (HR = 5.52, P = .027), and TACE after surgery prolonged RFS (HR = 0.2, P = .005).

Postoperative liver function grading “remarkably affected prognosis,” the authors noted. Patients with a C-P score of 5 had better survival than patients with a score greater than 5.

Other factors contributing to better OS:

• Median OS was greater for patients with baseline CA19-9 levels lower than 37 U/mL compared with patients with higher levels.
• Patients wuth a tumor size of less than 3 cm had a better OS than patients with lesions between 3 cm and 5 cm (67.1% vs 30.9%).

Factors that affected RFS were C-P score, tumor number, tumor size, ICC differentiation, and postoperative TACE intervention.

The researchers of this study acknowledged certain limitations, including that they used data from 2 different centers, irregularities during post-follow up, and the study’s retrospective nature, which may have contributed to selective bias.

The study was also limited given the fact that the majority of patients evaluated had Hepatitis B infection, and results for patients without Hepatitis B infection and cHCC-CCA still needs to be evaluated using a bigger population sample.

“Overall, the prognosis of these patients is poor, with most patients recurring rapidly. TACE is an effective postoperative adjuvant therapy that may prolong RFS and improve patient prognosis,” wrote the researchers.

Reference

Zhang G, Chen B-W, Yang X-B, et al. Prognostic analysis of patients with combined hepatocellular-cholangiocarcinoma after radical resection: A retrospective multicenter cohort study. World Journal of Gastroenterology. 2022;28(41):5968-5981. doi:10.3748/wjg.v28.i41.5968