Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Nabesima 5-1-1, Saga City, Saga, 849-8501, Japan.
Virchows Arch. 2011 Oct;459(4):449-56. doi: 10.1007/s00428-011-1131-9. Epub 2011 Jul 22.
Dedifferentiation (DD) is often encountered in gallbladder carcinoma (GBC) and poor prognosis with budding (BD) has been reported for other malignancies. However, the features of DD and BD in GBC remain unclear. The purpose of this study was to clarify the features and prognostic potential of DD and BD in GBC. A total of 80 patients with GBC (excluding intramucosal cancer) were enrolled. DD was histopathologically evaluated as tumors in which the grade of the invasive front is higher than the grade at the surface. BD was defined as an isolated single cancer cell or a cluster of fewer than five cancer cells at the invasive front. Of the 80 patients, 47 (58.8%) were positive for BD and 33 (41.2%) were positive for DD. Both BD and DD correlated significantly with disease-specific survival in univariate analysis (P < 0.0001 and P = 0.0013, respectively), but they were not identified as independent prognostic factors by multivariate analysis. In univariate analysis according to T stage, both BD and DD correlated significantly with survival in patients with T2 (n = 32) tumor (P = 0.0011 and P = 0.0018, respectively), whereas no prognostic impact in patients with T1b (n = 8), T3 (n = 34), or T4 (n = 6) tumor. Both DD and BD are frequently observed in GBC and reflect prognosis, particularly for T2 lesions. Therefore, the status of BD and DD should be taken into consideration in pathological reports on GBC.
去分化（DD）在胆囊癌（GBC）中经常遇到，并且已有报道称其他恶性肿瘤的芽生（BD）与不良预后相关。然而，GBC 中 DD 和 BD 的特征仍不清楚。本研究旨在阐明 GBC 中 DD 和 BD 的特征和预后潜力。共纳入 80 例 GBC 患者（不包括黏膜内癌）。DD 的组织病理学评估为侵袭前缘的分级高于表面的分级的肿瘤。BD 定义为侵袭前缘的单个孤立癌细胞或少于 5 个癌细胞的簇。在 80 例患者中，47 例（58.8%）BD 阳性，33 例（41.2%）DD 阳性。BD 和 DD 在单因素分析中均与疾病特异性生存显著相关（P<0.0001 和 P=0.0013），但在多因素分析中未被确定为独立的预后因素。根据 T 分期的单因素分析，BD 和 DD 均与 T2（n=32）肿瘤患者的生存显著相关（P=0.0011 和 P=0.0018），而在 T1b（n=8）、T3（n=34）或 T4（n=6）肿瘤患者中无预后影响。DD 和 BD 在 GBC 中经常观察到，反映了预后，特别是对于 T2 病变。因此，在 GBC 的病理报告中应考虑 BD 和 DD 的状态。
