Nonresectable combined hepatocellular carcinoma and cholangiocarcinoma: analysis of the response and prognostic factors after transcatheter arterial chemoembolization

Abstract

Purpose: To evaluate the clinical effectiveness of transcatheter arterial chemoembolization (TACE) performed in patients with nonresectable combined hepatocellular carcinoma (HCC) and cholangiocarcinoma and analyze the prognostic factors of patient survival after TACE.

Materials and methods: Each patient provided informed consent for TACE. The institutional review board approved the current study and waived the requirement for patient consent for this retrospective review. From 1997 to 2009, 50 patients underwent TACE for nonresectable combined HCC-cholangiocarcinoma. Tumor response was evaluated on the basis of findings on computed tomographic (CT) scans obtained a mean of 30.7 days after TACE. The survival rate and the prognostic factors of patient survival were evaluated.

Results: After TACE, 35 (70%) of the 50 patients were classified as responders--having either a partial response or stable disease with successful (>50%) tumor necrosis--and 15 (30%) were classified as nonresponders. Tumor response was significantly related to tumor vascularity: One (10%) of the 10 patients with hypovascular tumors and 34 (85%) of the 40 patients with hypervascular tumors were responders (P < .001). The median patient survival period was 12.3 months. Results of multivariable Cox regression analyses confirmed that tumor size (hazard ratio [HR], 2.49; P = .028), tumor vascularity (HR, 4.19; P = .001), Child-Pugh class (HR, 4.3; P = .001), and portal vein invasion (HR, 6.45; P < .001) were the independent factors associated with patient survival duration after TACE.

Conclusion: TACE is safe and may be effective for prolonging the survival of patients with nonresectable combined HCC-cholangiocarcinoma, as compared with the historically reported survivals of these patients. Tumor vascularity is highly associated with tumor response. The patient survival period after TACE for combined HCC-cholangiocarcinoma is significantly dependent on tumor size, tumor vascularity, Child-Pugh class, and presence or absence of portal vein invasion.