An international multicentre evaluation of treatment strategies for combined hepatocellular-cholangiocarcinoma

• Published in: JHEP reports Vol. 5; no. 6; p. 100745
• Main Authors: Claasen, Marco P.A.W., Ivanics, Tommy, Beumer, Berend R., de Wilde, Roeland F., Polak, Wojciech G., Sapisochin, Gonzalo, IJzermans, Jan N.M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2023; Elsevier
• Subjects: Biliary tract cancer; Biphenotypic; CCA; Cholangiolocarcinoma; HCC; Hepatocellular carcinoma; Hepatocholangiocarcinoma; Intermediate cell; Liver cancer; Mixed hepatocellular cholangiocarcinoma; Therapeutic management; Treatment policies; Hepatocholangiocarcinoma; ILTS; HAIP; pCCA; Biliary tract cancer; MRI; LR; UCSF; TARE; FDG; LT; Hepatocellular carcinoma; RFA; Biphenotypic; Mixed hepatocellular cholangiocarcinoma; DFS; Liver cancer; 18F-FDG PET/CT; ENS-CCA; Therapeutic management; Cholangiolocarcinoma; cHCC-CCA; FL-HCC; MWA; NCDB; HEHE; PFS; Treatment policies; CCA; OS; CTx; iCCA; TACE; HCC; IQR; CT; HAIC; ICRN; Intermediate cell; NET; In-RT; Ex-RT
• ISSN: 2589-5559; 2589-5559
• DOI: 10.1016/j.jhepr.2023.100745

Management of combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is not well-defined. Therefore, we evaluated the management of cHCC-CCA using an online hospital-wide multicentre survey sent to expert centres. A survey was sent to members of the European Network for the Study of Cholangiocarcinoma (ENS-CCA) and the International Cholangiocarcinoma Research Network (ICRN), in July 2021. To capture the respondents’ contemporary decision-making process, a hypothetical case study with different tumour size and number combinations was embedded. Of 155 surveys obtained, 87 (56%) were completed in full and included for analysis. Respondents represented Europe (68%), North America (20%), Asia (11%), and South America (1%) and included surgeons (46%), oncologists (29%), and hepatologists/gastroenterologists (25%). Two-thirds of the respondents included at least one new patient with cHCC-CCA per year. Liver resection was reported as the most likely treatment for a single cHCC-CCA lesion of 2.0–6.0 cm (range: 73–93%) and for two lesions, one up to 6 cm and a second well-defined lesion of 2.0 cm (range: 60–66%). Nonetheless, marked interdisciplinary differences were noted. Surgeons mainly adhered to resection if technically feasible, whereas up to half of the hepatologists/gastroenterologists and oncologists switched to alternative treatment options with increasing tumour burden. Fifty-one (59%) clinicians considered liver transplantation as an option for patients with cHCC-CCA, with the Milan criteria defining the upper limit of inclusion. Overall, well-defined cHCC-CCA treatment policies were lacking and management was most often dependent on local expertise. Liver resection is considered the first-line treatment of cHCC-CCA, with many clinicians supporting liver transplantation within limits. Marked interdisciplinary differences were reported, depending on local expertise. These findings stress the need for a well-defined multicentre prospective trial comparing treatments, including liver transplantation, to optimise the therapeutic management of cHCC-CCA. Because the treatment of combined hepatocellular-cholangiocarcinoma (cHCC-CCA), a rare form of liver cancer, is currently not well-defined, we evaluated the contemporary treatment of this rare tumour type through an online survey sent to expert centres around the world. Based on the responses from 87 clinicians (46% surgeons, 29% oncologists, 25% hepatologists/gastroenterologists), representing four continents and 25 different countries, we found that liver resection is considered the first-line treatment of cHCC-CCA, with many clinicians supporting liver transplantation within limits. Nonetheless, marked differences in treatment decisions were reported among the different specialties (surgeon vs. oncologist vs. hepatologist/gastroenterologist), highlighting the urgent need for a standardisation of therapeutic strategies for patients with cHCC-CCA. [Display omitted] •Liver resection is considered the first-line treatment of cHCC-CCA.•Many clinicians support liver transplantation as a treatment option for cHCC-CCA.•Marked interdisciplinary differences in treatment strategies exist globally.•Well-defined cHCC-CCA treatment policies are lacking at most centers.•Standardization of therapeutic strategies for cHCC-CCA is needed.