Yoshii Hisamichi, Izumi Hideki, Fujino Rika, Kurata Makiko, Inomoto Chie, Sugiyama Tomoko, Nakagohri Toshio, Nomura Eiji, Mukai Masaya, Tajiri Takuma
Department of Gastroenterological Surgery, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan.
Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan.
Diagnostics (Basel). 2023 Nov 9;13(22):3406. doi: 10.3390/diagnostics13223406.
The American Joint Committee on Cancer (AJCC) 8th edition T-staging system for distal cholangiocarcinoma (DCC) proposes classification according to the depth of invasion (DOI); nevertheless, DOI measurement is complex and irreproducible. This study focused on the fibromuscular layer and evaluated whether the presence or absence of penetrating fibromuscular invasion of DCC contributes to recurrence and prognosis. In total, 55 patients pathologically diagnosed with DCC who underwent surgical resection from 2002 to 2022 were clinicopathologically examined. Subserosal layer and/or pancreatic (SS/Panc) invasion, defined as penetration of the fibromuscular layer and invasion of the subserosal layer or pancreas by the cancer, was assessed with other clinicopathological prognostic factors to investigate recurrence and prognostic factors. According to the AJCC 8th edition, there were 11 T1, 28 T2, and 16 T3 cases, with 44 (80%) cases of SS/Panc invasion. The DOI was not significantly different for both recurrence and prognostic factors. In the multivariate analysis, only SS/Panc was identified as an independent factor for prognosis (hazard ratio: 16.1; 95% confidence interval: 2.1-118.8, = 0.006). In conclusion, while the determination of DOI in DCC does not accurately reflect recurrence and prognosis, the presence of SS/Panc invasion may contribute to the T-staging system.
美国癌症联合委员会（AJCC）第8版远端胆管癌（DCC）的T分期系统建议根据浸润深度（DOI）进行分类；然而，DOI测量复杂且不可重复。本研究聚焦于纤维肌层，评估DCC纤维肌层穿透性浸润的有无是否与复发及预后相关。对2002年至2022年期间接受手术切除的55例经病理诊断为DCC的患者进行了临床病理检查。将癌穿透纤维肌层并侵犯浆膜下层或胰腺定义为浆膜下层和/或胰腺（SS/Panc）浸润，将其与其他临床病理预后因素一起评估，以研究复发和预后因素。根据AJCC第8版，有11例T1、28例T2和16例T3病例，其中44例（80%）有SS/Panc浸润。DOI在复发和预后因素方面无显著差异。在多因素分析中，仅SS/Panc被确定为预后的独立因素（风险比：16.1；95%置信区间：2.1-118.8，P = 0.006）。总之，虽然DCC中DOI的确定不能准确反映复发和预后，但SS/Panc浸润的存在可能对T分期系统有影响。
