Chen X, Lu Y, Shi X, et al. - The epidemiological and clinical features of combined hepatocellular-cholangiocarcinoma (CHC) are described, the prognostic indicators are investigated, and a competing risk nomogram for CHC was developed.

• The Surveillance, Epidemiology, and End Results database was assessed to retrieve the study cohort.

• In 2004 and 2018, CHC had overall incidences of 0.062 per 100,000 individuals and 0.081 per 100,000 individuals, respectively, with an annual percent change (APC) of 1.0%.

• Intermediate clinicopathological features of hepatocellular carcinoma and intrahepatic cholangiocarcinoma were detected in CHC.

• The following were confirmed as independent predictors of cancer-specific survival: race, tumor size, vascular invasion, extrahepatic invasion, distant metastasis, grade, surgery, and Metavir stage.

• The generated nomogram was well calibrated, which exhibited superior discriminative power and higher net benefits when compared with the current American Joint Committee on Cancer staging system.

• Overall, findings suggest stable morbidity of CHC between 2004 and 2018.

• The nomogram performed well in predicting the prognosis, which was meaningful to individual treatment strategies optimization.

• Based on the findings, researchers recommend considering CHC patients as potential liver transplantation recipients, especially those within the Milan Criteria.