Matsumoto Takatsugu, Kubota Keiichi, Hachiya Hiroyuki, Sakuraoka Yuhki, Shiraki Takayuki, Shimizu Takayuki, Mori Shozo, Iso Yukihiro, Kato Masato, Yamagishi Hidetsugu, Imai Yasuo, Aoki Taku
Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, 321-0293, Tochigi, Japan.
Department of Diagnostic Pathology, Dokkyo Medical University Hospital, Mibu, 321-0293, Tochigi, Japan.
World J Surg. 2019 May;43(5):1313-1322. doi: 10.1007/s00268-019-04913-3.
The concept of intraductal papillary neoplasm of the bile duct (IPNB) has been proposed to be the biliary equivalent of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. While the classification of IPMNs is based on their location of duct involvement, such classification has not been fully evaluated for IPNBs. The aim of this study is to investigate the value of IPNB classification based on its location.
A total of 306 consecutive patients who underwent surgical resection with a diagnosis of bile duct tumor were enrolled. Among these patients, 21 were diagnosed as having IPNB. The IPNBs were classified into two groups as follows: extrahepatic IPNB, which located in the distal or perihilar bile duct, and intrahepatic IPNB, which located more peripherally than the hilar bile duct. The clinicopathological features of the two groups were then compared.
Extrahepatic IPNB tended to show more invasive characteristics than intrahepatic IPNB (presence of invasive component: 40.0 vs. 9.1%, p = 0.084). Moreover, patients with extrahepatic IPNB showed significantly poorer relapse-free survival (RFS) than those with intrahepatic IPNB [5-year RFS rate (%): 81.8 vs. 16.2, p = 0.014].
Patients with intrahepatic IPNB show more favorable pathological characteristics and postoperative survival outcomes than those with extrahepatic IPNB.
胆管内乳头状肿瘤（IPNB）的概念被认为是胰腺导管内乳头状黏液性肿瘤（IPMN）的胆管对应物。虽然IPMN的分类基于其导管受累部位，但这种分类方法尚未在IPNB中得到充分评估。本研究的目的是探讨基于IPNB部位进行分类的价值。
共纳入306例连续接受手术切除且诊断为胆管肿瘤的患者。其中，21例被诊断为IPNB。IPNB分为以下两组：肝外IPNB，位于远端或肝门周围胆管；肝内IPNB，位于比肝门胆管更外周的部位。然后比较两组的临床病理特征。
肝外IPNB比肝内IPNB更倾向于表现出侵袭性特征（侵袭成分的存在：40.0%对9.1%，p = 0.084）。此外，肝外IPNB患者的无复发生存期（RFS）明显比肝内IPNB患者差[5年RFS率（%）：81.8对16.2，p = 0.014]。
与肝外IPNB患者相比，肝内IPNB患者表现出更有利的病理特征和术后生存结果。
