Shirai Kazuhisa, Ebata Tomoki, Oda Koji, Nishio Hideki, Nagasaka Tetsuro, Nimura Yuji, Nagino Masato
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
World J Surg. 2008 Nov;32(11):2395-402. doi: 10.1007/s00268-008-9726-2.
Perineural invasion is commonly observed in biliary tract cancer and is an independent prognostic factor. Since intrahepatic cholangiocarcinoma (ICC) develops from biliary epithelia in the liver, ICC may share the same characteristics in terms of the prognostic implications of perineural invasion. The aim of this study was to evaluate the clinical significance of perineural invasion in ICC.
A total of 59 patients with ICC who underwent hepatectomy were retrospectively reviewed. The numbers of nerves with and without tumor involvement were counted. The perineural invasion index (PNI) was calculated as the number of involved nerves divided by the total number of nerves examined. Predictors for perineural invasion and prognostic factors were analyzed.
Perineural invasion was observed in 47 of 59 (80%) patients, and the median PNI was 0.082. The macroscopic tumor appearance and tumor location were significantly associated with perineural invasion (p = 0.013 and 0.032, respectively). Univariate and multivariate analyses (excluding seven in-hospital deaths) revealed that histologic grade, the presence of perineural invasion, nodal metastasis, and intrahepatic metastasis were independent prognostic factors. The survival rate of the patients with (n = 42) or without (n = 10) perineural invasion was 17 and 80% at 3 years; and 17 and 70% at 5 years, respectively (p = 0.001).
Perineural invasion is frequently found in patients with ICC and is an independent prognostic factor. ICC is an aggressive tumor similar to other biliary tract cancers. Because perineural invasion is a histologic marker of aggressiveness, it potentially has a role as a determinant of patient selection for adjuvant therapy.
神经周围浸润在胆管癌中很常见，是一个独立的预后因素。由于肝内胆管癌（ICC）起源于肝脏的胆管上皮，ICC在神经周围浸润的预后意义方面可能具有相同的特征。本研究的目的是评估神经周围浸润在ICC中的临床意义。
回顾性分析了59例行肝切除术的ICC患者。统计有肿瘤累及和无肿瘤累及的神经数量。计算神经周围浸润指数（PNI），即受累神经数量除以检查的神经总数。分析神经周围浸润的预测因素和预后因素。
59例患者中有47例（80%）观察到神经周围浸润，PNI中位数为0.082。大体肿瘤外观和肿瘤位置与神经周围浸润显著相关（分别为p = 0.013和0.032）。单因素和多因素分析（排除7例院内死亡）显示，组织学分级、神经周围浸润的存在、淋巴结转移和肝内转移是独立的预后因素。有（n = 42）或无（n = 10）神经周围浸润的患者3年生存率分别为17%和80%；5年生存率分别为17%和70%（p = 0.001）。
ICC患者中经常发现神经周围浸润，且是一个独立的预后因素。ICC是一种与其他胆管癌相似的侵袭性肿瘤。由于神经周围浸润是侵袭性的组织学标志物，它可能在辅助治疗的患者选择决定因素中发挥作用。
