Recurrence patterns of combined hepatocellular-cholangiocarcinoma on enhanced computed tomography

OBJECTIVE: To determine whether the computed tomographic (CT) findings of primary and recurrent combined hepatocellular-cholangiocarcinoma (HCC-CC) can predict the main tumor component on histopathologic examination, and to describe the recurrence patterns of HCC-CC after surgery. METHODS: Preoperative and postoperative CT findings of 12 HCC-CC patients who underwent curative surgery were retrospectively reviewed. The main features of the primary and recurrent tumors on CT and the pathological findings were classified as hepatocellular carcinoma (HCC)-dominant and cholangiocarcinoma (CC)-dominant groups. The concordance between the preoperative CT features and the initial pathological findings was evaluated using kappa statistics. The survival periods of the HCC-dominant and the CC-dominant group were compared using the Mann-Whitney U test. RESULTS: In 11 (91.7%) of 12 patients, the main CT features of HCC-CC were in strong agreement with main pathological findings (kappa = 0.824). The most common site of recurrence was the remnant liver. In 3 cases, only nodal metastasis was noted. The mean survival period was significantly longer in the HCC-dominant group than in the CC-dominant group of recurrent tumor (P = 0.016). CONCLUSIONS: Contrast-enhanced CT scanning can predict the dominant component of primary and recurrent HCC-CC. This capability can optimize treatment strategy for the patient with recurrent HCC-CC.