Departments of Pathology.
Department of Pathology, NTT Medical Center Tokyo, Tokyo, Japan.
Am J Surg Pathol. 2019 Sep;43(9):1180-1190. doi: 10.1097/PAS.0000000000001332.
Intrahepatic cholangiocarcinoma (ICC) is an extremely aggressive carcinoma. Useful predictors for the patients' prognosis after surgery have not been fully established. From the University of Tokyo Hospital pathology archives, we reviewed 107 cases of ICC, 54 cases of perihilar cholangiocarcinoma, and 40 cases of extrahepatic cholangiocarcinoma (ECC); we also investigated the significance of tumor budding in ICC, in comparison with perihilar cholangiocarcinoma and ECC. The tumor-budding frequencies were different by tumor location: 40.2% (43/107) in ICC, 70.4% (38/54) in perihilar cholangiocarcinoma, and 60.0% (24/40) in ECC. Tumor budding in ICC was associated with many pathologic indicators associated with invasion, such as major vascular invasion (P=0.012) and Union for International Cancer Control stage (P=0.007). Univariate and multivariate Cox regression analyses revealed tumor budding as a powerful prognostic factor for both recurrence-free survival (RFS) and overall survival (OS) in ICC by univariate (RFS: hazard ratio [HR]: 2.666; 95% confidence interval [CI]: 1.517-4.683, OS: HR: 4.206; 95% CI: 2.447-7.230) and by multivariate analyses (RFS: HR: 3.038; 95% CI: 1.591-5.973, OS: HR: 4.547, 95% CI: 2.348-8.805). Tumor budding was also a significant prognostic factor of perihilar cholangiocarcinoma, but not of ECC. When ICC was divided into 2 subtypes, type 1 (hilar) and type 2 (peripheral), tumor budding was the strong prognostic factor in type 2 ICC, but not in type 1 ICC, suggesting that some differences in biological behavior exist between type 1 ICC and perihilar cholangiocarcinoma. Tumor budding is prognostically important in ICC, and its pathogenetic role in biliary tract carcinomas might be different by anatomic location.
肝内胆管癌（ICC）是一种极具侵袭性的癌。目前尚未充分确定有助于预测患者术后预后的有用指标。我们从东京大学医院病理档案中回顾了 107 例 ICC、54 例肝门部胆管癌和 40 例肝外胆管癌（ECC）病例，还研究了 ICC 中肿瘤芽生与肝门部胆管癌和 ECC 的关系。按肿瘤位置，肿瘤芽生频率不同：ICC 为 40.2%（43/107），肝门部胆管癌为 70.4%（38/54），ECC 为 60.0%（24/40）。ICC 中的肿瘤芽生与许多与侵袭相关的病理指标有关，如大血管侵犯（P=0.012）和国际抗癌联盟（UICC）分期（P=0.007）。单因素和多因素 Cox 回归分析显示，肿瘤芽生是 ICC 患者无复发生存（RFS）和总生存（OS）的强有力预后因素，单因素分析时（RFS：风险比[HR]：2.666；95%置信区间[CI]：1.517-4.683；OS：HR：4.206；95%CI：2.447-7.230）和多因素分析时（RFS：HR：3.038；95%CI：1.591-5.973；OS：HR：4.547，95%CI：2.348-8.805）。肿瘤芽生也是肝门部胆管癌的一个重要预后因素，但不是 ECC 的预后因素。当 ICC 分为 2 个亚型（肝门部[1 型]和外周部[2 型]）时，肿瘤芽生是 2 型 ICC 的重要预后因素，但不是 1 型 ICC 的预后因素，这表明 1 型 ICC 和肝门部胆管癌在生物学行为上存在一些差异。肿瘤芽生对 ICC 的预后很重要，其在胆道癌中的发病机制可能因解剖位置而异。
