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HEPATOLOGY Comparison of clinical characteristics of combined hepatocellular-cholangiocarcinoma and other primary liver cancers Chern-Horng Lee,* Sen-Yung Hsieh,?,§ Chee-Jen Chang?,§ and Yu-Jr Lin? *Division of General Medicine, ?Department of Hepato-Gastroenterology and ?Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, and §Chang Gung Medical College University School of Medicine, Taoyuan, Taiwan Key words combined hepatocellular-cholangiocarcinoma, hepatitis B, hepatitis C. Accepted for publication 26 July 2012. Correspondence Dr Chern-Horng Lee, Division of General Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, No 5, Fu-Shing Street, Kweishan, Taoyuan, Taiwan. E-mail: lee4570@adm.cgmh.org.tw Financial disclosures: None. Conflicts of interest: The authors do not have any conflicts of interest. Abstract Background and Aim: Combined hepatocellular-cholangiocarcinoma (CHC) is a rare liver malignancy. In this study, we compared patient characteristics and outcomes for primary CHC, intrahepatic cholangiocarcinoma (ICC), and hepatocellular carcinoma (HCC). Methods: Medical records of patients with tissue-proven CHC (65 cases) treated at the Chang Gung Memorial Hospital between 1991 and 2005 were retrospectively reviewed. These records were compared to records of patients diagnosed with tissue-proven HCC (1985 cases) and ICC (127 cases) during the same period. Results: Hepatitis B and C are major causes of CHC. CHC patients exhibited greater similarity to HCC than to ICC patients with respect to cirrhotic changes, age, and positive serology for hepatitis B surface antigen and anti-hepatitis C antibody. Survival was related to tumor characteristics and intervention therapies, but not to etiologies. Conclusions: The clinical characteristics of CHC are similar to those of HCC, but overall survival is more similar to that of ICC; survival may be related to tumor biology rather than the cause. Multimodal treatment with an in