Background/Objectives: Combined hepatocellular cholangiocarcinoma (cHCC-ICC) is a rare malignancy that involves a combination of features of hepatocellular carcinoma and intrahepatic cholangiocarcinoma (ICC) and exhibits a more aggressive clinical course; however, its risk factors and outcomes remain largely undefined. Methods: This study is a single-center retrospective study of 82 patients diagnosed with ICC or cHCC-ICC who underwent surgical resection from June 2011 to January 2023. Our analysis included 70 patients with resected ICC and 12 with resected cHCC-ICC. Results: The overall survival (OS) for the entire cohort was 21.6 months, with a recurrence-free survival (RFS) of 11.8 months. The cHCC-ICC group had significantly higher levels of AST and ALT (AST median 206 U/L vs. 46 U/L; ALT median 165.5 U/L vs. 48 U/L;p= 0.012 andp= 0.013, respectively), whereas the ICC group had higher alkaline phosphatase (median 66 U/L vs. 104 U/L;p= 0.03). CA 19-9 values (76 U/mL vs. 22 U/mL;p= 0.02) were higher in the ICC group, while AFP values were higher in the cHCC-ICC group (7.3 ng/mL vs. 3.2 ng/mL;p= 0.0004). The cHCC-ICC group had a significantly higher rate of recurrence (83% vs. 47%,p= 0.028) with a significantly decreased RFS (4.7 months vs. 12.4 months; log-rankp= 0.007). In multivariate analysis, patients with resected ICC had a significantly reduced risk of recurrence by 73% compared to their counterparts (HR 0.27 [0.10–0.73],p= 0.01). Conclusions: cHCC-ICC is a rare entity that needs to be further studied to improve patient outcomes. Further studies are warranted and may suggest the need for more aggressive initial treatment strategies in patients diagnosed with cHCC-ICC.
背景/目的：混合型肝细胞胆管癌（cHCC-ICC）是一种罕见的恶性肿瘤，兼具肝细胞癌和肝内胆管癌（ICC）的特征，临床病程更具侵袭性，但其危险因素和预后在很大程度上仍未明确。方法：本研究为单中心回顾性研究，纳入2011年6月至2023年1月期间接受手术切除的82例ICC或cHCC-ICC确诊患者。分析对象包括70例接受切除的ICC患者和12例接受切除的cHCC-ICC患者。结果：全队列总生存期（OS）为21.6个月，无复发生存期（RFS）为11.8个月。cHCC-ICC组的AST和ALT水平显著更高（AST中位数206 U/L vs. 46 U/L；ALT中位数165.5 U/L vs. 48 U/L；p值分别为0.012和0.013），而ICC组的碱性磷酸酶水平更高（中位数66 U/L vs. 104 U/L；p=0.03）。ICC组的CA 19-9值更高（76 U/mL vs. 22 U/mL；p=0.02），而cHCC-ICC组的AFP值更高（7.3 ng/mL vs. 3.2 ng/mL；p=0.0004）。cHCC-ICC组的复发率显著更高（83% vs. 47%，p=0.028），且RFS显著缩短（4.7个月 vs. 12.4个月；对数秩检验p=0.007）。多变量分析显示，与cHCC-ICC患者相比，接受切除的ICC患者的复发风险显著降低73%（风险比0.27 [0.10–0.73]，p=0.01）。结论：cHCC-ICC是一种罕见的疾病，需要进一步研究以改善患者预后。有必要开展更多研究，这可能提示对诊断为cHCC-ICC的患者需要采取更积极的初始治疗策略。
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