Double primary hepatic cancer (hepatocellular carcinoma and intrahepatic cholangiocarcinoma) in a single patient: A clinicopathologic study of 35 resected cases

Background and Aim Combined hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) coexisting in the liver have rarely been reported before. The aim of this study is to report on the clinicopathological features and prognosis of patients with double hepatic cancer. Methods The clinicopathologic, perioperative, and long-term survival data of 35 patients who underwent synchronously resection of double hepatic cancer from January 2002 to December 2008 were studied retrospectively. The data were compared with those patients who had pure HCC or ICC during the study period. Results The incidence of double hepatic cancer was 0.25%. The male to female ratio was 4:1. The prevalence of hepatitis B infection was very high (35/35). Simultaneously elevated serum -fetoprotein and cancer antigen 19-9 levels (10/35) were observed in 10/35 patients. Metastatic lymph nodes with ICC cells were diagnosed in 4 of 35 patients. Only one patient was diagnosed preoperatively with double hepatic cancer of HCC and ICC. The median overall survival (OS) was 18 months, and the 1-year, 3-year, and 5-year OS rates were 60.0%, 28.9%, and 23.1%, respectively. Multivariate analysis indicated that the tumor size of ICC, presence of lymph node metastasis, and histological differentiation of the ICC component were independent risk factors of OS. Conclusion Double hepatic cancer of HCC and ICC is very rare with distinctive clinicopathologic features. The prognosis of double hepatic cancer was as poor as pure ICC. The ICC component played a more important role than the HCC component in influencing the prognosis of double hepatic cancer.