Yamashita Yo-Ichi, Wang Huanlin, Kurihara Takeshi, Tsujita Eiji, Nishie Akihiro, Imai Katsunori, Hashimoto Daisuke, Chikamoto Akira, Aishima Shinichi, Baba Hideo
Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan
Department of Hepato-Biliary-Pancreatic Surgery, National Kyushu Cancer Center, Fukuoka, Japan.
Anticancer Res. 2016 Dec;36(12):6563-6569. doi: 10.21873/anticanres.11260.
The aim of this study was to evaluate the clinical significance of preoperative classification of intrahepatic cholangiocarcinoma (ICC) into perihilar and peripheral types using dynamic computed tomography (CT).
A retrospective cohort study was performed to analyze the differences in clinical characteristics between perihilar and peripheral ICC samples from patients between 1990-2014.
A total of 87 patients were divided into three ICC subtypes; perihilar (n=34), peripheral (n=44), and unclassifiable ICC (n=9). The positive rates of pathological lymphatic infiltration (ly) (p=0.02) and perineural invasion (pn) (p<0.0001) were significantly higher in perihilar ICC. There was no significant difference in the disease-free survival rate (p=0.2268); however, the overall survival rate of perihilar ICC was significantly worse (p=0.0031). The rate of systemic recurrence (>3 nodules) was significantly higher in perihilar ICC (p=0.0135).
In perihilar ICC, the local tumor invasions such as ly and pn were more frequent. Therefore, it is important in such cases to attempt to achieve a sufficient tumor margin. Systemic recurrences were more frequent in perihilar ICC, so perioperative chemotherapy should be conducted as well.
本研究旨在评估利用动态计算机断层扫描（CT）将肝内胆管癌（ICC）术前分类为肝门部和周围型的临床意义。
进行一项回顾性队列研究，以分析1990年至2014年间患者肝门部和周围型ICC样本临床特征的差异。
共87例患者被分为三种ICC亚型；肝门部（n = 34）、周围型（n = 44）和无法分类的ICC（n = 9）。肝门部ICC的病理淋巴管浸润（ly）（p = 0.02）和神经周围侵犯（pn）（p < 0.0001）阳性率显著更高。无病生存率无显著差异（p = 0.2268）；然而，肝门部ICC的总生存率显著更差（p = 0.0031）。肝门部ICC的全身复发率（> 3个结节）显著更高（p = 0.0135）。
在肝门部ICC中，ly和pn等局部肿瘤侵犯更频繁。因此，在此类病例中，尝试获得足够的肿瘤切缘很重要。肝门部ICC的全身复发更频繁，所以也应进行围手术期化疗。
