Oba Mitsunobu, Nakanishi Yoshitsugu, Amano Toraji, Okamura Keisuke, Tsuchikawa Takahiro, Nakamura Toru, Noji Takehiro, Asano Toshimichi, Tanaka Kimitaka, Hirano Satoshi
Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan.
Ann Surg Oncol. 2021 Apr;28(4):2001-2009. doi: 10.1245/s10434-020-09135-9. Epub 2020 Oct 10.
The pathological tumor classification of distal cholangiocarcinoma in the American Joint Committee on Cancer (AJCC) Cancer Staging Manual 8th edition is based on invasive depth, whereas that of perihilar cholangiocarcinoma (PHCC) continues to be layer-based. We aimed to clarify whether invasive depth measurement based on invasive tumor thickness (ITT) could help determine postoperative prognosis in patients with PHCC.
We enrolled 184 patients with PHCC who underwent hepatectomy plus extrahepatic bile duct resection or hepatopancreatoduodenectomy with curative intent. ITT was measured using simple definitions according to the sectioning direction or gross tumor pattern.
The median ITT was 5.8 mm (range 0.7-15.5). Using the recursive partitioning technique, ITT was classified into grades A (ITT < 2 mm, n = 9), B (2 mm ≤ ITT < 5 mm, n = 68), C (5 mm ≤ ITT < 11 mm, n = 81), and D (11 mm < ITT, n = 26). The median survival times (MSTs) in patients with grade B, C, or D were 90.8, 44.6, and 21.1 months, respectively (patients with grade A did not reach the MST). There were significant differences in postoperative prognosis between ITT grades (A vs. B, p = 0.027; B vs. C, p < 0.001; C vs. D, p = 0.004). Through multivariate analysis, regional node metastasis, invasive carcinoma at the resected margin, and ITT grade were determined as independent prognostic factors.
ITT could be measured using simple methods and may be used to stratify postoperative prognosis in patients with PHCC.
美国癌症联合委员会（AJCC）《癌症分期手册》第8版中肝外胆管癌的病理肿瘤分类基于浸润深度，而肝门部胆管癌（PHCC）的分类仍基于层次。我们旨在阐明基于浸润性肿瘤厚度（ITT）的浸润深度测量是否有助于确定PHCC患者的术后预后。
我们纳入了184例行肝切除术加肝外胆管切除术或胰十二指肠切除术且有治愈意图的PHCC患者。根据切片方向或大体肿瘤形态，采用简单定义测量ITT。
ITT的中位数为5.8毫米（范围0.7 - 15.5毫米）。采用递归分割技术，ITT分为A组（ITT＜2毫米，n = 9）、B组（2毫米≤ITT＜5毫米，n = 68）、C组（5毫米≤ITT＜11毫米，n = 81）和D组（11毫米＜ITT，n = 26）。B组、C组或D组患者的中位生存时间（MST）分别为90.8个月、44.6个月和21.1个月（A组患者未达到MST）。ITT分级之间的术后预后存在显著差异（A组与B组，p = 0.027；B组与C组，p＜0.001；C组与D组，p = 0.004）。通过多因素分析，区域淋巴结转移、切缘浸润癌和ITT分级被确定为独立的预后因素。
ITT可以用简单方法测量，并可用于对PHCC患者的术后预后进行分层。
