Clinical Analysis Of Double Primary Hepatic Cancer Consisting Of Synchronous Hepatocellular And Intrahepatic Cholangiocarcinoma

Background and Objective:Synchronous hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(ICC)coexisting in the same liver,which is called Double Primary Hepatic Cancer(DPHC),have rarely been reported before.Making accurate diagnosis before operation is generally difficult,mainly depends on the pathological examination to the surgical specimens.The first choice of treatment is surgical resection,mostly non anatomic wedge resection as a treatment for HCC.The information for prognosis of DPHC is deficient.It is important to analyze the clinical and pathological characteristics of DPHC to improve the surgical treatment strategy.The article provides information of 12 cases to report and discuss on the clinical and pathological characteristics,diagnosis,treatment and prognosis of DPHC.Methods:The information of 12 patients with DPHC treated in Shandong Provincial Hospital from 2009 to 2018 were collected and retrospectively analyzed.To compare with each other,60 cases of pure HCC and 60 cases of pure ICC were randomly selected by the ratio of 5:1 with DPHC in the same period.The statistical data were analyzed retrospectively by SPSS 17.0 and Excel.The continuous variables were compared with t-test or rank sum test,and the discrete variables were compared with chi square test.The survival process was described by Kaplan-Meier survival curve.The risk factors of DFS and OS were analyzed by Log-rank test and Cox proportional risk regression model.Results:12 cases were all male with average age of 61.1(±6.1).The incidence of DPHC is about 0.26%in primary liver cancer.HBV related DPHC(83.3%)was higher than that in pure ICC(38.3%).Lymph node metastasis(16.7%)was higher than that in HCC group(1.7%).Preoperative diagnosis was mainly related to HCC(83.3%).Simultaneous increase of AFP and CA19-9(25.0%)was higher than those in pure HCC(5.0%)and pure ICC(8.3%).The median DFS was 6.0(±2.6)months,and the median OS was 15.00(±1.7)months.Factors related to DFS included ICC tumor size,CA19-9 level and postoperative prophylactic TACE treatment.The factors related to OS included HCC tumor size,ICC tumor size and postoperative TACE(including prophylactic and recurrent treatment).The pathological diagnosis showed an obviously effect of preoperative adjuvant TACE on HCC,which is limited on ICC.Conclusion:The incidence of DPHC is about 0.26%in primary liver cancer.Viral hepatitis B is a risk factor for DPHC.Accurate diagnosis is difficult to obtain,mostly multiple HCC.For multiple liver tumors,when AFP and CA19-9 increased simultaneously,it may suggested the diagnosis of DPHC.The first choice of treatment is radical resection.The principle is complete resection of the tumor and regional lymphoectomy,with sufficient remainder liver volume.Preoperative TACE is suggested for DPHC with large HCC to strive for the operation,while radical resection is still recommended as the first choice for DPHC with large ICC.Prognosis:multivariate analysis showed that the factors related to DFS included ICC tumor size,CA19-9 level and postoperative prophylactic TACE treatment.The factors related to OS included HCC tumor size,ICC tumor size and postoperative TACE(including prophylactic and recurrent treatment).