Hasebe Takahiro, Konishi Masaru, Iwasaki Motoki, Endoh Yasushi, Nakagohri Toshio, Takahashi Shinichiroh, Kinoshita Taira, Ochiai Atsushi
Pathology Division, National Cancer Center Research Institute East, Kashiwa, Chiba, Japan.
Hum Pathol. 2005 Jun;36(6):655-64. doi: 10.1016/j.humpath.2005.04.004.
Extrahepatic bile duct carcinomas (EHBDCs) consist of primary tumors, tumors in vessels, and tumors in lymph nodes. The purpose of this study was to prospectively investigate whether the histological characteristics of tumor cells and tumor stromal cells in vessels and lymph nodes were significantly associated with the outcomes of 60 EHBDC patients as compared with the histological characteristics of tumor cells and tumor stromal cells in primary tumors. Multivariate analyses, using the Cox proportional hazard regression model, showed that in EHBDCs without nodal metastasis, blood vessel tumor emboli with an angiomatous stroma significantly increased the hazard ratios (HRs) of tumor recurrence and death ( P < .05). In EHBDCs with nodal metastasis, the presence of tumor necrosis in the nodal tumors significantly increased the HRs of tumor recurrence and initial distant organ metastasis ( P < .05). In EHBDCs located in the distal to middle portion of the extrahepatic bile duct, blood vessel tumor emboli with an angiomatous stroma significantly increased the HRs of tumor recurrence, initial distant organ metastasis, and death ( P < .05). Severe nuclear atypia of the tumor cells in lymph vessels significantly increased the HRs of tumor recurrence and initial distant organ metastasis ( P < .05). In EHBDCs located in the hilar portion of the extrahepatic bile duct, the presence of nodal tumors with more than 4 mitotic figures significantly increased the HRs of tumor recurrence and initial distant organ metastasis ( P < .05). Several histological characteristics of tumor cells and tumor stromal cells in vessels and lymph nodes have significant effects on tumor progression of EHBDCs.
肝外胆管癌（EHBDC）由原发性肿瘤、血管内肿瘤和淋巴结肿瘤组成。本研究的目的是前瞻性调查与原发性肿瘤中肿瘤细胞和肿瘤基质细胞的组织学特征相比，血管和淋巴结中肿瘤细胞和肿瘤基质细胞的组织学特征是否与60例EHBDC患者的预后显著相关。使用Cox比例风险回归模型进行的多变量分析显示，在无淋巴结转移的EHBDC中，伴有血管瘤样基质的血管肿瘤栓子显著增加了肿瘤复发和死亡的风险比（HRs）（P <.05）。在有淋巴结转移的EHBDC中，淋巴结肿瘤中存在肿瘤坏死显著增加了肿瘤复发和初始远处器官转移的HRs（P <.05）。在位于肝外胆管远端至中部的EHBDC中，伴有血管瘤样基质的血管肿瘤栓子显著增加了肿瘤复发、初始远处器官转移和死亡的HRs（P <.05）。淋巴管中肿瘤细胞的严重核异型性显著增加了肿瘤复发和初始远处器官转移的HRs（P <.05）。在位于肝外胆管肝门部的EHBDC中，有超过4个有丝分裂象的淋巴结肿瘤的存在显著增加了肿瘤复发和初始远处器官转移的HRs（P <.05）。血管和淋巴结中肿瘤细胞和肿瘤基质细胞的几种组织学特征对EHBDC的肿瘤进展有显著影响。
