Department of Pathology, Jichi Medical University, Tochigi-ken, Japan.
Department of Surgery, Jichi Medical University, Tochigi-ken, Japan.
Pathol Int. 2020 Nov;70(11):857-864. doi: 10.1111/pin.13014. Epub 2020 Sep 10.
Extrahepatic bile duct (EHBD) cancer is a devastating cancer, and more common in Asian countries than in Western countries. Histological grading continues to be a highly relevant factor in prognosis and management of many kinds of cancer, however no uniform histological grading system exists for EHBD cancer. Histological heterogeneity within tumors is a problem in the evaluation of EHBD cancer. We developed an EHBD histological grading scheme to evaluate tumor differentiation pattern, and statistically analyzed its relationship with prognosis. In the present study, 257 surgically resected EHBD cancers were reviewed and their histological glandular differentiation (HGD) pattern was scored, and then we summed up the most and second most predominant scores. These scores were statistically analyzed for their relationship with patient prognosis. Patients showed a trend of shortening recurrence-free survival (RFS) and overall survival (OS) in association with higher HGD scores. In multivariate analyses, HGD score was determined to be an influential factor in RFS (P = 0.00041) and OS (P < 0.0001). In addition, combining HGD score and lymph node status correctly stratified patient prognosis in RFS. In conclusion, this new HGD scoring system is highly practical and has powerful prognostic value for EHBD cancer.
肝外胆管（EHBD）癌是一种毁灭性的癌症，在亚洲国家比在西方国家更为常见。组织学分级在许多癌症的预后和治疗中仍然是一个非常重要的因素，然而，EHBD 癌没有统一的组织学分级系统。肿瘤内的组织学异质性是评估 EHBD 癌的一个问题。我们开发了一种 EHBD 组织学分级方案来评估肿瘤分化模式，并对其与预后的关系进行了统计学分析。在本研究中，回顾了 257 例手术切除的 EHBD 癌，并对其组织学腺体分化（HGD）模式进行了评分，然后总结了最常见和第二常见的评分。对这些评分进行了统计学分析，以研究其与患者预后的关系。患者的无复发生存率（RFS）和总生存率（OS）与 HGD 评分的升高呈缩短趋势。多因素分析显示，HGD 评分是 RFS（P=0.00041）和 OS（P<0.0001）的一个影响因素。此外，HGD 评分与淋巴结状态相结合，可以正确分层患者的 RFS 预后。总之，这种新的 HGD 评分系统对 EHBD 癌具有高度的实用性和强大的预后价值。
