Clinical characteristics and outcome of patients with combined hepatocellular-cholangiocarcinoma-a European multicenter cohort

BACKGROUND

There is no clear consensus on the optimal systemic treatment regimen in combined hepatocellular-cholangiocarcinoma (cHCC-CCA) patients. We describe clinical characteristics and outcome of cHCC-CCA patients, with a special focus on patients receiving palliative systemic therapy, including immune checkpoint inhibitors (ICIs).

METHODS

In this European retrospective, multicenter study, patients with histologically proven cHCC-CCA treated at four institutions between April 2003 and June 2022 were included. In patients receiving palliative systemic therapy, outcome was compared between cytotoxic chemotherapy (CHT)- and non-cytotoxic CHT (nCHT)-treated patients.

RESULTS

Of 101 patients, the majority were male (n = 70, 69%) with a mean age of 64.6 ± 10.6 years. Only type of first-line treatment was independently associated with overall survival (OS). Palliative systemic therapy was administered to 44 (44%) patients. Of those, 25 (57%) patients received CHT and 19 (43%) had nCHT (n = 16 of them sorafenib) in systemic first line. Although there was no significant difference in overall response rate (ORR; CHT versus nCHT: 8% versus 5%), disease control rate (24% versus 21%), and median progression-free survival {3.0 months [95% confidence interval (CI) 1.4-4.6 months] versus 3.2 months (95% CI 2.8-3.6 months), P = 0.725}, there was a trend towards longer median OS in the CHT group [15.5 months (95% CI 8.0-23.0 months) versus 5.3 months (95% CI 0-12.5 months), P = 0.052]. However, in multivariable analysis, type of first-line regimen (CHT versus sorafenib) was not associated with OS. ORR in patients receiving ICIs (n = 7) was 29%.

CONCLUSIONS

In patients with cHCC-CCA, OS, progression-free survival, ORR, and disease control rate were not significantly different between individuals receiving CHT and patients receiving nCHT. Immunotherapy may be effective in a subset of patients. Prospective studies are needed to identify optimal systemic treatment regimens in cHCC-CCA.

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Abdominelle Schmerzen sind oft Konsultationsanlass in Arztpraxen und Notaufnahmen. Die häufigsten Differenzialdiagnosen lassen sich mit gut verfügbarer, kosteneffektiver und risikoarmer Diagnostik (Laboruntersuchungen, Sonographie, Gastroskopie) bestätigen. Zum Ausschluss seltener Ursachen, wie kleiner solider oder hämatologischer Malignome, Stoffwechselstörungen oder Polyneuropathien unterschiedlichster Genese, kann eine erweiterte Diagnostik erforderlich sein. Im Folgenden stellen wir den Fall eines Patienten mit massivsten epigastrischen Beschwerden infolge einer Neuroborreliose vor und rekapitulieren die diagnostischen Schritte zur Abklärung des abdominellen Schmerzes.