结直肠癌肝转移与肝内胆管癌的临床病理分析：它们只是截然不同的事物吗？

Clinicopathological analysis of colorectal cancer liver metastasis and intrahepatic cholangiocarcinoma: are they just apples and oranges?

作者信息

Chiu C-T, Chiang J-M, Yeh T-S, Tseng J-H, Chen T-C, Jan Y-Y, Chen M-F

机构信息

Department of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.

出版信息

Dig Liver Dis. 2008 Sep;40(9):749-54. doi: 10.1016/j.dld.2008.01.018. Epub 2008 Mar 10.

DOI:10.1016/j.dld.2008.01.018

PMID:18329969

Abstract

BACKGROUNDS/AIMS: Intrahepatic cholangiocarcinoma and colorectal cancer liver metastasis are the most primary and secondary adenocarcinoma of the liver, respectively. A large-scale long-term comparative study of these two cohort patient is lacking.

METHODS

A total of 166 colorectal cancer liver metastasis patients and 206 intrahepatic cholangiocarcinoma patients who had undergone curative liver resection were retrospectively analysed. Among 206 intrahepatic cholangiocarcinoma, there were 47 intraductal growth type-intrahepatic cholangiocarcinoma and 159 non-intraductal growth type-intrahepatic cholangiocarcinoma. The demographics, clinicopathological data, immunohistochemical study and survival were analysed.

RESULTS

The intrahepatic cholangiocarcinoma patients were more female-predominated, associated with hepatolithiasis, symptomatic, jaundiced, and with larger tumour size compared with those of colorectal cancer liver metastasis. Prognostic factors of intrahepatic cholangiocarcinoma were pathologic staging, histologic pattern and section margin; whereas prognostic factors of colorectal cancer liver metastasis were rectal origin, differentiation, section margin and bilobar distribution. CK7 and CK20 differentiated majority of intrahepatic cholangiocarcinoma from colorectal cancer liver metastasis, while CDX2 and MUC5AC helped to differentiate inconclusive cases. The 1-, 3-, 5- and 10-year survival rates of colorectal cancer liver metastasis were 77%, 31%, 20% and 14%, compared to 53%, 21%, 13% and 7% of intrahepatic cholangiocarcinoma (p=.0001). Furthermore, the survival of colorectal cancer liver metastasis was comparable to staged II intrahepatic cholangiocarcinoma (p=.8866) and intraductal growth type-intrahepatic cholangiocarcinoma (p=.1915).

CONCLUSIONS

Demographics, precipitating factor, clinical manifestations, and prognostic factors of colorectal cancer liver metastasis and intrahepatic cholangiocarcinoma differed remarkably. High incidence of CDX2 and MUC2 expression in colorectal cancer liver metastasis and intraductal growth type-intrahepatic cholangiocarcinoma might explain their similar cytoarchitecture and survival.

摘要

背景/目的：肝内胆管癌和结直肠癌肝转移分别是肝脏最常见的原发性和继发性腺癌。目前缺乏对这两组患者进行大规模长期比较研究。

方法

回顾性分析了166例接受根治性肝切除术的结直肠癌肝转移患者和206例肝内胆管癌患者。在206例肝内胆管癌患者中，有47例导管内生长型肝内胆管癌和159例非导管内生长型肝内胆管癌。对人口统计学、临床病理数据、免疫组织化学研究和生存率进行了分析。

结果

与结直肠癌肝转移患者相比，肝内胆管癌患者女性居多，与肝内胆管结石相关，有症状，黄疸，肿瘤体积更大。肝内胆管癌的预后因素为病理分期、组织学类型和切缘；而结直肠癌肝转移的预后因素为直肠起源、分化程度、切缘和双叶分布。CK7和CK20可将大多数肝内胆管癌与结直肠癌肝转移区分开来，而CDX2和MUC5AC有助于区分不明确的病例。结直肠癌肝转移患者的1年、3年、5年和10年生存率分别为77%、31%、20%和14%，而肝内胆管癌患者的相应生存率为53%、21%、13%和7%（p = 0.0001）。此外，结直肠癌肝转移患者的生存率与II期肝内胆管癌（p = 0.8866）和导管内生长型肝内胆管癌（p = 0.1915）相当。