The Growing Interest in the Combined Hepatocellular-intrahepatic Cholangiocarcinoma (cHCC-CCA).

Combined hepatocellularcholangiocarcinoma (cHCCCCA) is a rare primary liver cancer displaying both hepatocytic and cholangiocytic differentiation. This combined tumor has about 1% incidence among primary hepatic cancers, a more aggressive behaviour and a poorer prognosis as compared to hepatocellular carcinoma (HCC). While keeping the proportion of 1% among primary liver cancers, the cHCCCCA incidence is increasing. A systematic review and metaanalysis of 53 epidemiological studies performed both in Western and Asian countries between 2008 and 2019 demonstrated that cHHC-CCA incidence had increased in this period with an annual percentage change (APC) of + 4% as compared to HCC (APC + 2.6%) [1]. The increase occurred mainly in Western countries, whereas trends decreased in the Asian region, although still remaining high. The etiology of the combined tumor is the same as that of its components. Geographic variations in CCA incidence are related to the variations in risk factors. Classical risk factors for HCC and CCA seem also to predispose to the development of cHCC-CCA. In the context of a better control of viral B and C infections, the increased risk of primary liver cancers should probably be related to the worldwide increase in the prevalence of metabolic EDITORIAL DOI: http://dx.doi.org/10.15403/jgld-5033