Nagashima Daisuke, Esaki Minoru, Nara Satoshi, Ban Daisuke, Takamoto Takeshi, Mizui Takahiro, Shimada Kazuaki, Hiraoka Nobuyoshi
Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan.
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Front Oncol. 2023 Aug 17;13:1216097. doi: 10.3389/fonc.2023.1216097. eCollection 2023.
Extrahepatic cholangiocarcinoma (eCCA) is a rare and aggressive disease and consisted of conventional eCCA and intraductal papillary neoplasm of the bile duct (IPNB). Intraepithelial spread (IES) of cancer cells beyond the invasive area is often observed in IPNBs; however, the prevalence of IES remains to be examined in conventional eCCAs. Here, we evaluated the clinicopathological features of eCCAs according to tumor location, with a focus on the presence of IES. The IES extension was also compared among biliary tract cancers (BTCs).
We examined the prevalence and clinicopathological significance of IES in eCCAs (n=382) and the IES extension of BTCs, including gallbladder (n=172), cystic duct (n=20), and ampullary cancers (n=102).
Among the invasive eCCAs, IPNB had a higher rate of IES (89.2%) than conventional eCCAs (57.0%). Among conventional eCCAs, distal eCCAs (75.4%) had a significantly higher prevalence of IES than perihilar eCCAs (41.3%). The presence of IES was associated with a significantly higher survival rate in patients with distal eCCAs (=0.030). Extension of the IES into the cystic duct (CyD) in distal eCCAs that cancer cells reached the junction of the CyD was a favorable prognostic factor (<0.001). The association of survival with IES, either on the extrahepatic bile duct or on the CyD, differed depending on the tumor location and type of eCCA. The extension properties of IES were also dependent on different types of tumors among BTCs; usually, the IES incidence became higher than 50% in the tissues that the tumor developed, whereas IES extension to other tissues decreased the incidence.
Thus, eCCAs have different clinicopathological characteristics depending on the tumor location and type.
肝外胆管癌（eCCA）是一种罕见且侵袭性强的疾病，包括传统型eCCA和胆管内乳头状肿瘤（IPNB）。在IPNB中常观察到癌细胞超出浸润区域的上皮内扩散（IES）；然而，传统型eCCAs中IES的发生率仍有待研究。在此，我们根据肿瘤位置评估了eCCAs的临床病理特征，重点关注IES的存在情况。还比较了胆道癌（BTCs）中IES的扩展情况。
我们研究了eCCAs（n = 382）中IES的发生率及其临床病理意义，以及BTCs（包括胆囊癌，n = 172；胆囊管癌，n = 20；壶腹癌，n = 102）的IES扩展情况。
在浸润性eCCAs中，IPNB的IES发生率（89.2%）高于传统型eCCAs（57.）。在传统型eCCAs中，远端eCCAs的IES发生率（75.4%）显著高于肝门周围eCCAs（41.3%）。IES的存在与远端eCCAs患者的生存率显著较高相关（P = 0.030）。在癌细胞到达胆囊管交界处的远端eCCAs中，IES扩展至胆囊管是一个有利的预后因素（P < 0.001）。IES与肝外胆管或胆囊管的生存关联因eCCA的肿瘤位置和类型而异。IES的扩展特性在不同类型的BTCs中也有所不同；通常，在肿瘤发生的组织中IES发生率高于50%，而IES扩展至其他组织则会降低发生率。
因此，eCCAs根据肿瘤位置和类型具有不同的临床病理特征。
