Hasebe Takahiro, Konishi Masaru, Iwasaki Motoki, Nakagohri Toshio, Takahashi Shin-ichiroh, Gotohda Naoto, Kinoshita Taira, Ochiai Atsushi
Surgical Pathology Section, Clinical Laboratory Division, National Cancer Center Hospital East, Kashiwa, Chiba, 277-0882, Japan.
Hum Pathol. 2008 Jan;39(1):37-48. doi: 10.1016/j.humpath.2007.05.002. Epub 2007 Sep 27.
Although the pathological tumor-node-metastasis (pTNM) classification is the histologic prognostic classification currently used clinically worldwide to predict the outcome of patients with extrahepatic bile duct carcinoma (EBDC), some patients with EBDC in the early pTNM stage experience tumor recurrence and some of them die of their disease. We have confirmed that the histologic characteristics of tumor cells and tumor stromal cells in the vessels and lymph nodes of patients with EBDC are more strongly associated with tumor recurrence or death than in the primary tumor. The purpose of this study was to establish a primary tumor/vessel tumor/nodal tumor (PVN) classification for EBDC that would accurately predict the outcome of 72 patients. Multivariate analyses using the Cox proportional hazard regression model were used to compare the ability of the PVN classification to predict tumor recurrence and death with that of the pTNM, the American Joint Committee on Cancer, and the Japanese pTNM classification systems; and the results showed that only the PVN classification significantly increased the hazard rates for tumor recurrence and death independent of nodal status (P < .05). We conclude that the PVN classification is probably the most accurate prognostic classification system available for EBDC.
尽管病理肿瘤-淋巴结-转移（pTNM）分类是目前全球临床上用于预测肝外胆管癌（EBDC）患者预后的组织学预后分类，但一些处于pTNM早期阶段的EBDC患者会出现肿瘤复发，其中一些患者会死于该疾病。我们已经证实，与原发性肿瘤相比，EBDC患者血管和淋巴结中肿瘤细胞及肿瘤基质细胞的组织学特征与肿瘤复发或死亡的关联更为紧密。本研究的目的是为EBDC建立一种原发性肿瘤/血管肿瘤/淋巴结肿瘤（PVN）分类，以准确预测72例患者的预后。使用Cox比例风险回归模型进行多变量分析，比较PVN分类与pTNM、美国癌症联合委员会以及日本pTNM分类系统预测肿瘤复发和死亡的能力；结果显示，只有PVN分类能显著提高独立于淋巴结状态的肿瘤复发和死亡风险率（P < .05）。我们得出结论，PVN分类可能是目前可用于EBDC的最准确的预后分类系统。
