Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan.
Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan.
J Gastrointest Surg. 2023 Jun;27(6):1113-1121. doi: 10.1007/s11605-023-05614-y. Epub 2023 Feb 7.
The histological features and radiological shape of extrahepatic cholangiocarcinoma (eCCA) have not been widely studied in relation to prognosis. Multi-detector computed tomography (MDCT) is thought to be useful in diagnosis of progress and tumor distribution; it can also show morphological differences (round, triangular, and square forms) at the tumoral obstruction sites. Histological types of eCCA may be revealed, with potential association with tumor growth and survival.
We examined the distribution of tumor radiological shape subtypes on MDCT. The surgical outcomes of consecutive patients with eCCA who underwent macroscopic curative resection were reviewed.
CT subtypes in 109 patients were 62 triangular, 35 square, and 12 round. There were clear prognostic differences in long-term survival rates (P < 0.001); 5-year survival rates were 100% in round, 64% in triangular, and 19% in square types. There was no recurrence in any cases of round-type tumor at the site of obstruction. Depth of tumor invasion and rates of nodal involvement were significantly higher in triangular and square-type tumors than in round-type tumors. In papillary adenocarcinoma, radiological obstructions were round type in seven patients (78%) and triangular type in two patients (22%). In tubular adenocarcinoma, all round-type tumors were well differentiated, the ratio of square-type tumors increasing as the degree of differentiation decreased from "well" to "moderate," and "poor" respectively (23%, 39%, 57%; P = 0.033).
Tumor radiological shape predicts tumor progression, histological type, and survival in eCCA. This information may be helpful in preoperative radiological staging on MDCT.
肝外胆管癌（eCCA）的组织学特征和影像学形态尚未广泛研究其与预后的关系。多排螺旋 CT（MDCT）被认为对诊断进展和肿瘤分布有用；它还可以显示肿瘤阻塞部位的形态差异（圆形、三角形和方形）。eCCA 的组织学类型可能会被揭示，这可能与肿瘤生长和生存有关。
我们检查了 MDCT 上肿瘤影像学形状亚型的分布。回顾性分析了连续接受根治性手术的 eCCA 患者的手术结果。
109 例患者的 CT 亚型分别为 62 例三角形、35 例方形和 12 例圆形。长期生存率存在明显的预后差异（P < 0.001）；5 年生存率分别为圆形 100%、三角形 64%和方形 19%。在任何阻塞部位的圆形肿瘤均无复发。与圆形肿瘤相比，三角形和方形肿瘤的肿瘤浸润深度和淋巴结受累率明显更高。在乳头状腺癌中，7 例（78%）影像学阻塞为圆形，2 例（22%）为三角形。在管状腺癌中，所有圆形肿瘤均为高分化，随着分化程度从“高分化”到“中分化”和“低分化”，方形肿瘤的比例分别增加（23%、39%、57%；P = 0.033）。
肿瘤影像学形态可预测 eCCA 的肿瘤进展、组织学类型和生存。这些信息可能有助于 MDCT 术前影像学分期。
